Surveillance for HCC

Patients with chronic HBV have an increased lifetime risk for the development of HCC. In a study of middle-aged males in Taiwan, HBsAg positivity was associated with a greater than 200-fold excess risk of death from HCC, with approximately half the deaths in that group being due to liver cancer or liver failure (Beasley et al, 1981). Given that liver cancers have a median doubling time of 4 months, that they are commonly encapsidated and metas-tasize late, and that the liver is a large organ with marked functional reserve, HCCs may have a lengthly asymptomatic phase. Tumors that are discovered in this preclin-ical phase, especially if they are less than 5 cm in diameter, may be successfully treated with resection, ablative therapy, or liver transplant. Thus, it is rational to screen those at significant risk for HCC periodically using an imaging study and the tumor marker, alpha-fetoprotein (AFP). As the goal is to discover small HCCs at a stage when they can be cured, the frequency of screening should be dictated by the biology of the tumor and not the perceived risk of HCC in the individual patient. Once the decision is made to screen, the protocol used should be standard. I screen using AFP and liver ultrasound every 6 months, generally starting at the age of 35 years. Patients at highest risk of HCC, including those with cirrhosis, a family history of HCC or birth in sub-Saharan Africa should be screened from the age of diagnosis.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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