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hcc at mid-30s
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hcc at mid-30s

Hi everyone, I am new to this forum and glad to find many useful discussion here.
I am in my mid-30s and recently just had a liver resection due to hcc. Good thing is it's caugh in early stage...

Brief history:
-got hepB probably at birth
-ALT elevated for a few years in my 20s (in the 50~100 range; not treated that time due to no effective drug available and want to have baby first)
-ALT got back to normal in the past few years, together with lower virus DNA (decreased from 10^7 to <2000 copy); also eAg became netagive while eAb became positive)
-normal ultrasound findings (monitor every 6 month) in the past few years

However, a few months ago, a tumor was found caugh by AFP and comfirmed by MRI. Have been on Baraclude since then (never got treated before).

My questions are:
1. why hcc was found suddently although test results seem to suggest everything was getting better in the past few years(normal ALT, low virus load, e-seroconversion) ?
2. is  Baraclude the best option for me?
3. any other things I should consider/try to prevent re-occurance?

Any comment/suggestion would be highly appreciated!
43 Comments Post a Comment
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Avatar_m_tn
I agree with you that it is strange that the tumor was suddenly found, normally it should have been preceded by fibrosis and cirrhosis. Fibrosis you can see on ultrasound and cirrhosis by fibroscan or biopsy.
Did you do fibroscan or biopsy? How often you checked AFP?

As for the re-occurrence, heptech food supplements  are proved to reduce and even reverse cirrhosis, maybe you should consider them as an option.

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Avatar_m_tn
Please tell more about yourself, what is your diet, your BMI? Do you do any sport, exercises?
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Avatar_f_tn
Hi Rome70, thanks for the reply!
I did a biopsy 3 yrs ago, no crirhosis. Even the pathology report done on the liver removed found no cirrhosis.
In general, I consider myself eating healthy diet (lots of fruits and vegi, only eat red meats ocationally).  Normal BMI (a bit on the lean side).  Not much exercie though.

Can you please provide a bit more info on "heptech food supplements"?

Thank you .
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Avatar_m_tn
Thanks for the info. Did you take any vitamins or food supplements?

Check this http://www.heptech.com/

They have pro and consumer lineup. Pro is branded heptech and consumer

http://www.advanceliferesearch.com/

It is absolutely the same thing but heptech is more concentrated.
if you are in the US they sell Heptech only through the doctors, while advancedlife is sold to everybody.

Search the other posts about heptech products you will find more info. Stef2011 reversed cirrhosis within 6 month on Heptech.

How fast the tumor developed? When did you do AFP test before the last time?

Did you ever test your HbsAg quantity?
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Avatar_m_tn
Sorry to hear that you had HCC but glad that it was caught early.  I only have very general knowledge of HCC, so here are my opinion:
1. HCC can develop without fibrosis/cirrhosis. "While most HCCs occur in cirrhotic livers, tumours can also occur in livers with minimal histological changes. This phenomenon is more common in Southern Africa (where about 40% have minimal liver damage) than in Asia,America and Europe (where more than 90% are associated with cirrhosis). "
Many causes have been suggested:
a) integration of part of the hbv genome into the liver cell genome;
b) HBV X protein promotes development of HCC
2. I believe antiviral treatment is appropriate. This is, I believe, to ensure virus replication is reduced, therefore no progression of fibrosis/cirrhosis. Viral load has been identified as the biggest risk factor for HCC. Also, I think,  a low viral load will reduce inflammation, hence less hepatic cell division to replace damaged liver cells.
3. I believe regular and frequent screening is important.

Just my opinion.
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Avatar_f_tn
Thanks for the info about heptech, will look into it.

In the past I checked AFP every 6 months or so, and the last AFP was just checked at the right timing - when it's just slighly elevated!

Never have HbsAg quantity done; as I understand from other postings in this board, this test is not avaliable in the US, right?
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Avatar_f_tn
Hi StephenCastlecrag, thank you so much for your comment!

Yes it's true that, although it's less common, HCC can develop without fibrosis/cirrhosis - myself is an example.  

Frequent monitoring is really important, and I hope you all could learn from my experience.... I am now trying whatever might help hoping to prevent the reoccurance.
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Avatar_m_tn
Thanks for sharing the info. Will do AFP test every 3 month from now.

As for the HbsAg test -- yes, this is what I heard, unfortunately it is not available in the US. But people send samples abroad for testing.
Some people think that it is a conspiracy of pharmaceutical companies to sell the NUCs because HbsAg quant test is used to monitor interferon treatment...

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Avatar_f_tn
Yes I will have AFP every 3 month from now...

"As for the HbsAg test -- yes, this is what I heard, unfortunately it is not available in the US. But people send samples abroad for testing."

Do you happen to know how/where to send samples abroad for testing?

Thanks
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Avatar_m_tn
sorry to hear about your hcc. what was your afp level? mine is always high and i have had to have mri but was clear. i will take another soon. i hope you will not have to go through that again.
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Avatar_f_tn
Thanks Flameboy.

The highest afp before surgery was in the 200 range.

How high is your afp? and how often do you check it? Hope you will be fine since mri was clear.  But still worthy to keep a close eye on it since I heard that aft could be elevated a few months before a mass can be detected by imaging...

Best wishes to you.
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Avatar_m_tn
I can not remember exactly where, please search the posts here. It was a lab in Holand and another one in India.
I can recomend a French lab http://www.lab-cerba.com I was tested there but not by post they do good hbsag quantitive test.  it is a big lab and they seem to accept samples by post, because they have international dept, they also have english speaking staff, and even answer e-mails.
I remember that Fedex can send frozen blood samples from the US, at least it was mentioned here.
If you succede in using this please do let us know, I think many would be interested.

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Avatar_m_tn

try to live as healthy as possible, keep hbvdna und by entecair or by tenofovir, check that vitamin d is always at high normal range (close to 90ng/ml)

you may also check all studies about gcmaf, i tried it for hbv and it didn t work but it did work for my immune suppression state, also keeping nagalase normal or low may be helpful.
you can find research about gcmaf on pubmed or gcmaf.eu and a japanese hospital working with a university there, check old posts in this board
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Avatar_m_tn
mine was never as high as 200 it was in the 30,s before but is now at 5.8 i checked 3 months ago.i will keep a close eye on it. take care of yourself. good luck
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Avatar_m_tn

as to hbsag quantity:
less than 1000iu/ml very low hcc risk equal to those who cleared hbv
more than 1000iu/ml higher risk

so i d definitely check this and try to keep it less than 1000iu/ml by combo etv+intf or tdf+intf.intf should have also an effect on immune system against hcc but i am not expert on intf during hcc or after resection so you have to check with very expert liver specialsts.sinc eintf is also a drug for many cancer is should be helpful

also fibroscan is very important, not biopsy, fibroscan monitoring with values less than 7-8kpa are at decreased risk of hcc while those with values higher at increased risk

liver must be cleared on fat, fatty liver is another hcc risk promoter
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Avatar_f_tn
Thank you so much for the info on where to find a lab that does HBs Ag quantification!  Yes will provide update if find something that works.
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Avatar_f_tn
"mine was never as high as 200 it was in the 30,s before but is now at 5.8 i checked 3 months ago.i will keep a close eye on it. take care of yourself. good luck ."

If it goes back to normal, rather than keep increasing, should be fine. Always good to be cautious though. Good luck to you too.

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Avatar_f_tn
Thanks stef for your input.  A few questions below:

"as to hbsag quantity:
less than 1000iu/ml very low hcc risk equal to those who cleared hbv
more than 1000iu/ml higher risk
so i d definitely check this and try to keep it less than 1000iu/ml by combo etv+intf or tdf+intf.intf should have also an effect on immune system against hcc but i am not expert on intf during hcc or after resection so you have to check with very expert liver specialsts.sinc eintf is also a drug for many cancer is should be helpful"

Yes will try to find ways to have hbsAg quantity tested. When you said "etv+intf combo", do you refer to sequential combo (etv first, then intf add-on at later time)?

"also fibroscan is very important, not biopsy, fibroscan monitoring with values less than 7-8kpa are at decreased risk of hcc while those with values higher at increased risk"

Again, never have fibroscan done due to not available in the US.

What do you mean "liver must be cleared on fat"? I don't have fatty liver though...thanks
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Avatar_m_tn
What do you mean "liver must be cleared on fat"? I don't have fatty liver though...thanks

good you dont have fatty liver but add simvastatin to your treatment, it has 505 reducton on hcc risk, the highest hcc risk reduction

Yes will try to find ways to have hbsAg quantity tested. When you said "etv+intf combo", do you refer to sequential combo (etv first, then intf add-on at later time)?

you can try both sequential or combo directly, the point is getting rid of hbsag or lower it.i posted a study time ago where reduction of hbsag was even followed by hcc size reduction
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Avatar_f_tn
Usually how often hbsag quantity is checked when on medication? thx
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Avatar_m_tn
I may be wrong but I recall 12 weeks intervals from somewhere.
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Avatar_f_tn
ok, thanks!
how frequent for fibroscan then?
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Avatar_m_tn
For inactive hbv Normally fibroscan  every 6 month.
But for you often afp testing is probably more important. You will not catch  a little tumor on fibroscan. It is good for screening for fibrosis and cirrhosis but if you are able to develop hcc so fast without cirrhosis, fibroscan is of little use.

This is my unprofessional view.
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Avatar_f_tn
Hi Rome70, I agree with your point of view.

Regarding sAg quantity, I am still trying to find out way to draw blood and send samples oversea for testing.... Compared to many of you, I have little knowledge on many of the new/updated approaches (including importance of sAg quantity monitoring; BTW, my doctor doesn't think it's helpful probably that's the opinion for most US doctors).  I am still digging through the archieve to find out if sAg quantity is still important to monitor for people have hcc history.  If any of you happen to have relevant info, would appreciate your sharing!

Many thanks!
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Avatar_m_tn

i think you should aim at:
keep hbsag as low as possible
hbvdna und
no sugars
low lipids
simvastatin
diet made of fresh vegetables, low meat, fish and everything not processed, no chemicals of any kind added to food, look for certificate organic food

food is full of chemicals even from the farmers, pesticides, hormones antibiotics and so on.it can be very very easy to develop hcc from these checmicals in food than from hbv
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Avatar_m_tn

also have a look on livonlabs liposomes, use of vit c in liposomes and glutathione can help a great deal to keep oxidative stress normal and oxidative stress is a promoter of dna damage, so better have it normal

also baking soda can be of use, cancers need acid ph to develop, you can take a spoon of baking soda to keep your ph at about 7 or little higher than 7 but less than 8, you can check your ph by urine ph
also barley in some water can be used to keep acidity low but baking soda is more potent
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Avatar_f_tn
Hi Stef, thanks a lots for your input/suggestion!  A couple questions here:

no sugars: you mean no added sugar, or even avoid sweet foods (fruits etc)?
low lipids: should limit healthy lipids (such as omega-3 from walnut) as well?

"food is full of chemicals even from the farmers, pesticides, hormones antibiotics and so on.it can be very very easy to develop hcc from these checmicals in food than from hbv ."

These days I keep wondering how much does hbv, diet, stress etc play role in my development of hcc.... your point of view is a bit surprised to me - if asked to rank in the order of significance, I would had put: hbv~stress > diet (for me, I paid quite a lot of attention trying to eat healthy although not as strict as you just suggested; but didn't manage well on stress in the past few years) ....

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Avatar_f_tn
"also have a look on livonlabs liposomes, use of vit c in liposomes and glutathione can help a great deal to keep oxidative stress normal and oxidative stress is a promoter of dna damage, so better have it normal

also baking soda can be of use, cancers need acid ph to develop, you can take a spoon of baking soda to keep your ph at about 7 or little higher than 7 but less than 8, you can check your ph by urine ph
also barley in some water can be used to keep acidity low but baking soda is more potent ."

Interesting info.  I heard about alkaline diet, but never heard of taking baking soda directly (take it in power form?)...
"barley in some water": just soak raw barley in (hot?) water and drink the water?

Thanks
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Avatar_f_tn
I'm sorry to hear abt ur Hcc, but its a good thing u discovered it early and had it removed. May I know what size was the tumor when it was first discovered? I ask because I know some liver cysts or nodules are benign and I wonder how soon can this be confirmed.

I recently had an u/s and then an MRI to followup on a 6mm suspected liver hemangioma on u/s. but MRI was not conclusive as it said it is too tiny to diagnose anything conclusive. Till now I do not know what that means. They just told me to followup again in 6mths. My AFP was 0.8. I am worried what this nodule may be.
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Avatar_m_tn

if you follow my old posts you ll see all my diet and efforts, i am also in same situation as you since my hcc risk is very very high.started with cirrhosis in 2009 with precore bcp mutations.
by use of antivirals and especially diet and heptech protocol i regressed cirrhosis as early as 2 years (never reported cases so fast, antivirals require 5years or more to regress cirrhosis)

so diet is essential followed by antivirals or antivirals+intf according to situation

the alkaline diet is good for keeping good health for general population and especially for us, i use baking powder from pharmacy in pure form and dissolve in some water but barley in ht water is good too

i dont eat any sugar anymore, use very little diary products (full of hormones and antibiotics), almost no salt.in a short time you get used to taste without them, sensitivity increases so you feel the salt or sweet of the foods direclty
avoid refined foods and try to eat as many vegetables as you can, for cancer the diet indicates 5 portions of fruit and vegetables daily, this is too much but if you canget close to this it is good

coofee cucurmin and various spieces have anticancer effect just check this community or google.
in case hcc is from chemical in your bodyfrom pollution or chemical in food glutathione in liposomes by livonlabs helps clear the body from this stuff

this is an eample, use google chrome for translation, i m sure even this diet changes cannot save everybody from cancer when it is there but i am sure these changes can prevent most of cancer cases, at least this is also what research says

http://www.tantasalute.it/articolo/guarisce-da-un-cancro-incurabile-modificando-la-dieta-l-incredibile-testimonianza/40399/
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Avatar_m_tn

a very good example is the diet i used to clear my fatty liver and results showed up in as little as few months, that diet is the same for all metabolic related diseases, cancer prevention included.it has very little proteins so legumes must be included to balance the almost zero meat/diary products

http://www.medhelp.org/posts/Hepatitis-B/update-on-my-fatty-liver/show/1500346

http://www.medhelp.org/posts/Hepatitis-B/fatty-changes-in-liver-disappeared-due-to-diet-control/show/1596797
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Avatar_m_tn

also double check ingredients of foods and drugs for aspartame or artificial sweetners.aspartame is proven to make cancer, in italy we have a lab paid by italian citizens by taxes (so you cant corrupt them) who checks toxicity and cancerogenity of all substances and aspartame was proven to promote cancer in very tiny doses
EU should have reviwed authorization in september but.....aspartame and similar are in kind of foods

by the way it was also proven to abolish 100% of the gcmaf effect on macrophages, so i probably damages imune system too
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Avatar_f_tn
it's about 1cm when discovered. size didn't change much at time of surgery (done within a month), despite afp keep increasing. Be aware that hcc could occur without elevated afp, thus it's better to combine both afp & US or MRI for monitoring.  
If you still concern, won't hurt to re-check in 3m instead of 6m. Good luck.
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Avatar_f_tn
stef, thanks a lot for sharing your diet change experience.

I don't add salt or sugar when I cook for many years now, no problem with getting rid of salt, just that still like those sweet foods such as bread and chocolate (mostly dark chocolate with >50% cocoa content).

I try to eat more whole grains and beans but can't digest them efficiently (will have lots of gases each time after eating them).

I love fruits and vegi, so no problem at all of eating 5 serving daily :-)

I recently start Reishi supplement, which is said to help on enhancing your immune system.  Have you looked into it or tried it?
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Avatar_f_tn
interested in the details of your diet, wonder if you have put it into file.doc yet?

https://docs.google.com/leaf?id=0B_yFgxI8KNcRZWEzYTc3N2QtNWE2ZC00NGE4LThiMDgtMGQxZDNlYzU4NzE1&hl=en_US&pli=1

thanks
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Avatar_m_tn

we talked about supplements made by fungus but i dont think they can help clear hbv, some member should try them and report results

i am about to start pegintf injections plus nuncs so maybe best not to mix too many things now

sorry i cant put on doc i am so busy it is even too much to post here, if you have time please copy to a doc file maybe easier to read

try to avoid sugars they feed tumors directly, cocao is very good for the poliphenols content but without sugars
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Avatar_m_tn
Statins May Lower Death Risk in Liver Cancer                                                                By Cole  Petrochko, Staff Writer, MedPage TodayPublished: January 27, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
Action Points                                                

    This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
    Statin use seemed to reduce the risk of death in patients with hepatocellular cancer.
    Point out that the positive effect of statin use on overall survival remained significant even after adjusting for age, sex, race, staging, hepatitis C and B history, liver cirrhosis, treatment, alcohol use, and diabetes.


SAN FRANCISCO  --  Statin use seemed to reduce the risk of death in patients with hepatocellular cancer, researchers reported here.
In a cohort of patients with hepatocellular carcinoma (HCC), those who used statins in addition to local and systemic therapy or surgical resection had a 30% reduction in mortality versus those who did not use statins (hazard ratio 0.7, 95% CI 0.5 to 0.9), according to Young Kwang Chae, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues.
The positive effect on overall survival (OS) remained significant even after adjusting for age, sex, race, staging, hepatitis C and B history, liver cirrhosis, treatment, alcohol use, and diabetes (aHR 0.7, 95% CI 0.5 to 0.9, P=0.03), Chae said at a poster session during the Gastrointestinal Cancers Symposium.
The authors noted that "preclinical evidence supports antitumoral activity of statins," adding that several observational studies showed a protective effect of statin use with incidence of hepatocellular cancer.
"Hepatocellular cancer is a very vascular disease," Chae told MedPage Today.
The investigators followed 644 patients with pathologically confirmed HCC patients over 10 years. The sample included 68 statin users and 571 non-users who were mostly white (69.1% and 65%, respectively) and male (77.9% and 72.9% respectively). The median OS of all patients was 19.2 months, and 10.7% reported statin use.
More than half (70.7%) were diagnosed at TNM stage III and IV, while 52.6% had no evidence of hepatitis B or C virus infection. Local and systemic therapy was done in 81.7% of the patients while 18.3% underwent surgical resection.
Median OS was higher among statin users than non-users at 25.4 months versus 18.5 months (P=0.04).
Among patients without cirrhosis, statin use was associated with a 40% mortality reduction (HR 0.6, 95% CI 0.4 to 0.9, P=0.04).
History of hepatitis did not affect outcomes, nor did age, sex, race, staging, treatment type, alcohol use, or diabetes status.
Chae noted that HCC patients taking statins were older (mean age 63.1) and many had diabetes (51.5%). These participants had "more cardiovascular disease and were more likely to be sick and have poor prognosis, but, in fact, they actually lived longer," Chae pointed out.
Chae said that potential areas for follow-up would be tests to determine subgroups  --  such as cirrhosis versus non-cirrhosis patients  --  where statin use is most effective. "There should be a group that statins are most effective in, and I would like to randomize them to use," he said.
The authors also noted the study could be validated with a large, prospective study.
The study was limited by retrospective data and lack of randomization among patients, although Chae noted that the latter was offset in the multivariate analysis.
The authors had no conflicts of interest.

Primary source: Gastrointestinal Cancers Symposium
Source reference:
Chae YK, et al "The association between statin use and hepatocellular cancer outcome" GiCS 2013; Abstract 165.
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Avatar_f_tn
Thank you for sharing the info.   Is statin a off-label medicine? taken as supplement?
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Avatar_m_tn
Statins are a class of drugs used to lower cholesterol levels.
"As of 2010, a number of statins are on the market: atorvastatin (Lipitor and Torvast), fluvastatin (Lescol), lovastatin (Mevacor, Altocor, Altoprev), pitavastatin (Livalo, Pitava), pravastatin (Pravachol, Selektine, Lipostat), rosuvastatin (Crestor) and simvastatin (Zocor, Lipex).[6] Several combination preparations of a statin and another agent, such as ezetimibe/simvastatin, are also available." from Wikipedia.

So it is a prescribed medication, not a supplement. Please consult your doctor.
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Avatar_f_tn
Hi stef, in your previous post on fatty liver you mentioned your diet: "black rice 80gr with vegetables in it (potatoes and many others) and a lot of blueberries and berries (about 180gr a day)"

Do you cook black rice together with vegetables? you only eat 80gr (cooked?) per day? Do you use organice black rice and berries?

Thanks
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Avatar_m_tn

i use frozen bio vegetables (not available fresh) and some fresh vegetables (carrots, all broccoli type and so on), i boil them with the rice sometimes and sometimes separated.bio rice is much more tasty and takes longer to boil

to make black rise tasty it is best you check online recipes, vegetables and fish can make it tasty, i also used to add curcumin and some pure virgin oliv oil (home made)

i think bio is important for the rice because it contains also outer rice shell and you eat pesticides and chemicals with the normal type

sorry bio  is european word for organic
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Avatar_m_tn
potatoes, not good for cancer, eat less of this and more broccoli, cabbage

i used to eat 80gr or more per meal (thatll make 150gr rice per day), blubberies half lunch and half dinner to make total 180gr

definitely all organic, if not organic the pesticides are there and you eat it

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Avatar_f_tn
Thanks stef for the diet info.

So you don't eat any kind of meat (including fish) or egg at all?

Yes potato is not a good choice, why not consider sweet potato (concern about too much sugar?)?

I eat quite a lot of vegi, but can't do without fat. Although I don't add much oil when I cook, I eat nuts when I eat vegi. Otherwise if just pure vegi, I can easily feel nauseous. I guess you don't have that proble? or how do you deal with that?
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