Please write a discussion response to this. Liver cancer is a major cause of can

Please write a discussion response to this.
Liver cancer is a major cause of cancer burden with increased incidence rates in countries worldwide in recent years (McGlynn et al., 2021). Hepatocellular carcinoma (HCC), a primary histologic type of cancer is the main contributor of liver cancer diagnoses and mortalities (McGlynn et al., 2021). Hepatocellular carcinoma is the most common form of primary liver cancer and accounts for 90% of all hepatic cancers (Nagaraju et al., 2021;Toh et al., 2019). Due to the highly aggressive nature and poor survival of liver cancer, it is the second most lethal cancer worldwide (Toh et al., 2019). The World Health Organization estimates by the year 2030 more than 1 million people will die each year from liver cancer (Fernández-Barrena et al., 2020).
Epigenetics provides the fundamental mechanisms for the maintenance of cell identity, development, stem cell renewal, genome integrity, and proliferation (Fernández-Barrena et al., 2020). Epigenetic alterations result in changes in how genes are expressed, which correlate with triggers for HCC (Nagaraju et al., 2021). The deregulation of gene expression and aberrant molecular signaling contributes to the survival advantages of cancer cells which are hallmarks of HCC (Nagaraju et al., 2021;Toh et al., 2019). The earliest genetic alteration in hepatocarcinogenesis that accounts for 95% of tumors is the aberrant expression of telomerase reverse transcriptase (TERT) (Fernández-Barrena et al., 2020). This abnormal expression of TERT is caused by promoter mutations, gene amplification, translocation, and also viral insertion in Hepatitis B virus (HBV) (Fernández-Barrena et al., 2020). The second most frequent mutation in hepatocarcinogenesis is CTNNB1 which inactivates tumor protein TP53, which correlates with the progression of cancer (Fernández-Barrena et al., 2020).
The liver is a specialized organ that is continuously adapting to highly variable environmental conditions (Toh et al., 2019). The liver adapts to circadian cues, metabolic processes, dietary xenobiotics, microbiota, and viral infections which results in the constant repair and regeneration of this specialized organ (Nagaraju et al., 2021;Toh et al., 2019). Risk factors for HCC include Hepatitis B virus (HBV) and C virus (HCV); alcohol consumption; metabolic syndrome, diabetes, and obesity; nonalcoholic fatty liver disease (NAFLD); tobacco; aflatoxin B1; and dietary factors (Frager & Schwartz, 2020;McGlynn et al., 2021;Yang et al., 2019). Environmental stresses caused by these factors lead to epigenetic modifications and alterations in the progression of hepatocarcinogenesis (Nagaraju et al., 2021).
The incidence rates of HCC in most populations are diagnosed around the age of 75 years old (McGlynn et al., 2021). The rate of incidence of HCC is two to four-fold higher in men when compared to women (McGlynn et al., 2021). The incidence of HCC has declined in most developed countries but increased in many low to middle-resource countries (Frager & Schwartz, 2020;McGlynn et al., 2021;Yang et al., 2019). In 2016 results, the highest incidence of HCC was among American Indians/Alaskan Natives, followed by Hispanics, Asian/Pacific Islanders, non-Hispanic African-Americans, and non-Hispanic Caucasian individuals (McGlynn et al., 2021).
According to the American Association for the study of Liver Disease (AASLD), liver ultrasonography is the standard surveillance for HCC (Yang et al., 2019). The optimal interval for surveillance is 6 months (Yang et al., 2019). Radiological scans such as computed tomography (CT) or magnetic resonance imaging (MRI) can also be used for diagnosis and staging (Yang et al., 2019). Treatment for HCC is based on staging. The natural history of HCC is categorized into 5 stages using the Barcelona Clinic Liver Cancer (BCLC) classification, which is currently the most commonly used standardized staging system that provides an estimated survival period and recommended treatment for patients at each stage (Reig et al., 2022;Yang et al., 2019). Tumor resection, liver transplantation, transarterial embolization (TRAE), transarterial radioembolization (TARE), and systemic pharmacological drugs are forms of treatment based on the stage of disease progression (Yang et al., 2019). The first-line medication of choice includes Atezolizumab-Bevacizumab and Durvalumab-Tremelimumab, with Sorafenib or Lenvatinib, or Durvalumab to follow if the initial drug options were not feasible (Reig et al., 2022). Second-line medication choices include Regorafenib, Cabozantinib, and Ramucirumab (Reig et al., 2022). Third-line medication of choice is Cabozantinib (Reig et al., 2022).
Counseling involves education about prevention, surveillance, staging, and treatment options. The most prominent risk factors for HCC are HBV and HCV (McGlynn et al., 2021). Primary prevention includes HBV vaccine coverage, managing chronic viral hepatitis with antiviral treatment, reducing environmental risk factors, and modifying lifestyle choices to reduce risk factors (Yang et al., 2019). While prevention by vaccination of HCV is not possible, limiting transmission routes via screening blood products is recommended, using single-use needles, and sterilization of surgical equipment are primary strategies to decrease the routes of transmission of HBV and HCV (Yang et al., 2019). Education in regard to smoking and alcohol consumption should also be provided due to their link with risk factors for cirrhosis (Yang et al., 2019). Factors associated with NAFLD/NASH include hypertension, hyperlipidemia, cirrhosis, obesity, and diabetes (Yang et al., 2019). Diet, exercise, and lifestyle modification information should also be provided to help reduce risk factors.
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