Checks for HCC

[Peteshine]

Hey guys,

This was just a quick query to see what everyone knew... Right in the break down of HBV we are always told there is a small proportion of people who develop HCC later on in life... The labs that we do every couple months give us our ALT, VL and a whole bunch of other things. Do these same testing show if there is an HCC presence in the liver or even fatty lesions? I might have spelt lesions wrong but i was explained in previous threads they are like little fatty lumps and often aren't anything to worry about... What is the percentage of HCC for males, age and all the other factors etc..

Sorry to be the doom and gloom but it was just something i myself wanted to find out... In spite of the good results from the ALT and VL, if the testers don't show the real deadly stuff how does one know?

[Peteshine]

wow guys you are actually making an ultra scan sound exciting.....

I will mention this all on monday and see what my hep doc has to say...

No doubt she willbe inquiring about me attending these Hep meetings every month. I was a bit tired and couldn't be bothered going to the last one...

[zellyf]

NP - You and every pg woman who has ever had an ultrasound.  Actually, with 2 of my pregnancies I had to go to a specialist to get a level 2 ultrasound and THEY had a gel warmer.  So nice.  

Both kids were fine.

[NashPred]

I was adopted within a month or two of birth and feel lucky to have been adopted by wonderful parents. I really only think of my biological parents when medical questions come up and I would never consider them my parents. My adoptive parents are the only parents I have ever known and they are the ones that made me into the person I am today….God Bless them both for loving me unconditionally.

Cajim’s explanation of the u/s is correct and it really is that easy. The Ultra Sound is not a big deal. It is completely painless and if you ask me, it tickles a little bit…..but then I am a little ticklish. It’s nothing at all like a biopsy. It is completely un-invasive. The only down side to it is that the jelly/lubricant feels COLD. I wish they could warm that stuff up a little bit first.

[cajim]

BTW how is the ultra sound procedure done? As long as its nothing like the liver biopsy which i pray i won't ever have to do again...

--You lie on a table, the tech applies some lubricants on your liver area, he/she moves some ultrasound probe on that area, he/she then wipes the lubricants off, and you are done!  So safe that the tech does not even have to wear anything special like the x-ray tech.  Lasts about 15 mins.

[Peteshine]

Hey Nash,

It is very strange but yet i'm not too surprised by the adoption thing... There are many of us who are lucky enough to have a brand new family ie a place called home and be in the know for a disease we currently have. For that i am definately grateful and counting my blessings..

So when were you actually adopted then?

I think for me the most important thing is to know more about my medical history and any siblings i might have. Altho i would find it extremely hard to imagine there is another good looking me out there!

I have my 3 month check-up on monday so will mention the ultra sound...

BTW how is the ultra sound procedure done? As long as its nothing like the liver biopsy which i pray i won't ever have to do again...

[NashPred]

Wow Peteshine, I just keep finding out more and more things we have in common. First we like the same TV shows and movies and now I find out that we were both adopted.

The adoption thing makes me wonder if I have had HBV since birth. I have never felt the desire to seek out my birth parents, but the older I get and the more medical problems that start coming up, it makes me curious about my biologic mothers and fathers medical history. This history could come in handy at some point…..so I know how you feel.

BTW….I don’t think you have anything to worry about in regards to HCC, but you do want to have regular ultra sounds done to monitor for it.

[Peteshine]

So would you say without cirrhosis there can't be HCC? I'm asking this as in my liver biopsy i was told i had early fibrosis and certainly no cirrhosis, not even early cirrhosis... However this was done in 2006 and despite my VL going down and my ALT going there, could there still be the possibility of fibrosis?

Btw guys i got my new lab results and ALT is now 20 and VL is 47 IU/ml.

Zelly, i was gonna say, in regards to the lesions found... How does it take 6 months for a check-up? Shouldn't you get it done quicker?

[zellyf]

HCC be present 1). at my age

--Yes, it is far less likely.
2). without me experiencing any symptoms

--Yes, it is largely asymptomatic until later stages.

3). with no indication on my standard blood tests?

--Yes. AFP can miss up to 40% of HCCs.  That is why you also need the imaging.

Even with all of these factors your risk of HCC in the absence of cirrhosis is low.  

[cajim]

Can HCC be present 1). at my age

--Unlikely.

2). without me experiencing any symptoms

--Early stages of HCC do not have to have symptoms.

3). with no indication on my standard blood tests?

--That is good.

The value of US is also to establish a history so that the doc can have serial info.

[Peteshine]

Unfortunately i don't have any family history as i was adopted at 6 years old... Before adoption i was at an orphanage. It does worry me about not knowing my med history and as i have a meeting with my hep doc next monday i will definately mention an ultrascan. Can HCC be present 1). at my age 2). without me experiencing any symptoms 3). with no indication on my standard blood tests? I mean i read from some of the responses that if say like AFP is raised then it would be an indication to do further checks.... Zelly your response was no such data can even show any abnormalities... Does that me that a standard test would only show the VL and ALT levels etc....

[zellyf]

You know, its non-invasive and doesn't hurt so if your doc says so...why not?  Besides, won't it take forever to schedule one anyway?  You might be 30 by the time they get you in.  ;-) Do you have family history?

[Peteshine]

So considering my age is there any rush at the current time to get monitored for HCC?

[zellyf]

AFP is the only blood marker but 30 to 40% of HCC will not release AFP so AFP alone is not a good screen.  The standard for screening via imaging is once or twice a year after age 30 depending on your risk factors.

[cajim]

US/CT/MRI semi-annually is what is recommended to monitor HCC by my hepatologist.

[Peteshine]

I'm gathering everyone has had an ultrasound to check for HCC regardless of age then? Do you guys normally have it done when you go for the quarterly blood tests to find out ALT and VL? Apart from AFP which if raised can indicate a problem is there anything else the standard results can pin point any other irregularities?

[grmr]

Hi Pete..

yes you should have ulstrasound to check for HCC.. anyway you run the risk just if you labs are wrong (ALT, VL).. I read one of the HCC marker is alphafetoprotein (AFP).
It usually goes up in paetients  with HCC...

[Peteshine]

so there is still 4.6% chance of getting HCC despite being on the medication we are all lucky to have? I mean 4.6% is a very low percentage but it is a percentage nevertheless. I'm 28 now right (had my brithday last weekend actually guys and it was a good one) but when do you think i should also start to be screened for HCC?

[zellyf]

I like that.  I knew my numbers were old.  

[cajim]

Here is a figure from Notes on “Viral Load in Chronic Hepatitis B Emerges as Strong Predictor of Hepatocellular Carcinoma Risk,” Bruce Sylvester.

Based on data from 43,993 person-years of follow-up over 11 years, 176 subjects were eventually diagnosed with HCC (4.6%).

[zellyf]

You need to have ultrasound screenings to check for HCC.  The blood work isn't enough.

This is from 2001:

HCC is the dominant cause of death for male carriers in middle adulthood with a lifetime risk of 27% for HCC compared to 4% for females. Predicted life expectancy is 72 years for male carriers, compared to 79 years for non-carriers. Female carriers have a life expectancy of 81 years and non-carriers 83 years. This model probably applies to all southern Chinese populations and emigrants with similar life history, and other populations that acquired infection early in life.

So, the study is limited in its scope but gives some idea.  I'm sure this did not include patients who had access to viral suppression therapy like we have now.