hcc at mid-30s

[rosy888]

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!

[Rome70]

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.

[Rome70]

Please tell more about yourself, what is your diet, your BMI? Do you do any sport, exercises?

[rosy888]

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 .

[Rome70]

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?

[StephenCastlecrag]

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.

[rosy888]

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?

[rosy888]

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.

[Rome70]

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...

[rosy888]

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

[Flameboy]

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.

[rosy888]

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.

[Rome70]

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.

[stef2011]

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

[Flameboy]

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

[stef2011]

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

[rosy888]

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.

[rosy888]

"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.

[rosy888]

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

[stef2011]

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

[rosy888]

Usually how often hbsag quantity is checked when on medication? thx

[Rome70]

I may be wrong but I recall 12 weeks intervals from somewhere.

[rosy888]

ok, thanks!
how frequent for fibroscan then?

[Rome70]

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.

[rosy888]

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!