What is liver fibrosis?

Liver fibrosis occurs when repetitive or long-lasting injury or inflammation causes excessive amounts of scar tissue to build up in the organ. Most types of chronic liver disease can eventually cause fibrosis.

Unlike healthy liver cells, scar tissue cells cannot self-repair or otherwise function. As a result of this, fibrosis can reduce overall liver function and impair the organ's ability to regenerate.

Scar tissue from fibrosis can also block or limit the flow of blood within the liver. This can starve and eventually kill healthy liver cells, creating more scar tissue in the process.

Treatment tends to involve clearing infections, making lifestyle changes, and taking certain medications. This can often reverse the damage of mild to moderate liver fibrosis.

If inflammation continues, possibly because a person has not received treatment, liver fibrosis can develop into more serious liver conditions.

In this article, we will discuss the causes of liver fibrosis, how doctors measure the extent of damage, how symptoms change over time, and the treatments available.

Stages

If a doctor believes that someone has liver fibrosis, they will carefully collect a small tissue sample, or biopsy, from the liver using a large needle.

A pathologist, which is a doctor who specializes in finding the root cause of disease, will then examine the sample under a microscope. They do this to assess the extent and type of damage.

Determining the degree of fibrosis is difficult because pathologists only have a small sample to work with. Other doctors can also assess the same sample in different ways.

Healthcare providers can use several scales to define the stages of fibrosis. These include the Metavir, Ishak, and Batts–Ludwig scales.

These and similar scoring systems take into account the effect that the fibrosis has had on the portal vein, which delivers blood from the intestines to the liver.

Many scales also measure the extent of fibrosis and the location or number of septa, which are fibrous bands of tissue in the biopsy sample.

The Metavir scoring system rates the progression of fibrosis on a scale from A0 to A3:

·         A0: no activity

·         A1: mild activity

·         A2: moderate activity

·         A3: severe activity

The Metavir system also scores the level of fibrosis from F0 to F3:

·         F0: an absence of fibrosis

·         F1: portal fibrosis with no septa

·         F2: portal fibrosis with infrequent septa

·         F3: numerous septa but no cirrhosis

·         F4: cirrhosis

Cirrhosis is scar tissue building up in the liver. This can occur due to unchecked fibrosis. Learn more about cirrhosis here.

The most advanced type of fibrosis someone can have before developing cirrhosis, according to the Metavir system, is stage A3F3.

The Ishak fibrosis scoring system is more complex, and it typically runs from 0 to 6:

·         0: an absence of fibrosis

·         1: an expansion of some portal areas, possibly with short, fibrous septa

·         2: an expansion of most portal areas, possibly with short, fibrous septa

·         3: an expansion of portal areas with sporadic portal-to-portal bridging

·         4: an expansion of portal areas with significant portal-to-portal and portal-to-central bridging

·         5: significant portal-to-portal and portal-to-central bridging with sporadic nodules

·         6: likely or definite cirrhosis

Using the Ishak scale, the most advanced stage of fibrosis a person can have before developing cirrhosis is stage 5.

The Batts–Ludwig scale, common in the United States, is slightly simpler. This scale runs from 0 to 4:

·         0: a lack of fibrosis

·         1: portal fibrosis

·         2: rare portal-to-portal septa

·         3: fibrous septa

·         4: definite or likely cirrhosis

Using the Batts–Ludwig scale, the most advanced stage of fibrosis a person can have before developing cirrhosis is stage 3.

People with fibrosis are usually unaware that they have it. This is because it rarely causes any obvious symptoms.

However, within the liver, fibrosis can:

·         reduce overall function, including the purifying of blood, storing of energy, and clearing of infections

·         limit the organ's ability to regenerate

·         restrict blood flow within the organ

People usually start to experience symptomswhen fibrosis progresses to cirrhosis. These initial symptoms can vary, but some of the most common indicators of early cirrhosis include:

·         a poor appetite

·         feeling weak

·         unexplained exhaustion

·         unexplained weight loss

·         nausea and vomiting

·         discomfort or mild pain in the upper right abdomen

Some common signs of more advanced cirrhosis include:

·         a tendency to bruise or bleed easily

·         edema, or fluid retention in the lower legs, ankles, or feet

·         jaundice, which is a yellowing of the skin and eyes

·         ascites, or abdominal bloating from a buildup of fluid

·         very itchy skin

·         increased sensitivity to medications and their side effects

·         problems with certain cognitive functions, such as memory, concentration, or sleeping

·         a darkening of the urine

Source: Medical News Today

What to know about liver metastases

Liver metastases refers to when a cancer that originally formed in another part of the body spreads to the liver. Some healthcare professionals may call liver metastases "secondary liver cancer."

The cancer cells that develop in liver metastases are not cells from the liver. They are cells from the part of the body where the cancer originated.

Because the cancer has spread to the liver from another part of the body, a doctor may refer to liver metastases as stage 4 or advanced cancer.

Primary liver cancer is less common than liver metastases. Typically, people with primary liver cancer have risk factors such as cirrhosis or hepatitis.

Symptoms

The early stages of liver metastases may not present any noticeable symptoms. As the tumorin the liver advances, however, the liver may swell.

The swelling can cause an obstruction to blood and bile flow. When this occurs, a person may experience symptoms such as:

weight loss

dark urine

loss of appetite

abdominal bloating

jaundice, or a yellowing of the skin and eyes

nausea and vomiting

enlarged liver

pain in the right shoulder

pain in the upper right side of the abdomen

confusion

fever

fatigue

sweating

A person with cancer in another area of the body who notices new symptoms should let their healthcare provider know as soon as possible.

If a person has symptoms of liver cancer, a healthcare provider might suspect liver metastases.

After performing an initial examination and asking some questions, they will need to run tests to confirm that liver cancer is present.

Some of the tests they may run include:

a CT scan of the abdomen

liver functions tests, which check how well the liver is functioning

ultrasound of the liver

laparoscopy, which involves a flexible tube that allows the doctor to take a biopsy of the liver

angiogram, wherein a doctor uses dye to make high-contrast images of the liver

an MRI scan

Treatment for common types

Treating liver metastases typically aims to alleviate symptoms and increase life expectancy. In most cases, there is no way to cure liver metastases.

There are two treatment approaches for liver metastases: local and systematic. A person's age and overall health status will determine what approach a doctor may suggest.

Treatment will also depend on where the primary cancer is, the size and number of tumors on the liver, and any past treatments the person has tried.

Some local treatment options include:

radiofrequency ablation, which uses high-frequency electrical currents to create enough heat to kill cancer cells

radiation therapy, which can be from injected radiation or machines that use a beam of radiation to target a tumor

Systematic treatments may target cancer throughout the body via the bloodstream. Some possible options for liver metastases include:

biological response modifier therapy, which helps boost the body's immune system

chemotherapy, which uses drugs to target rapidly growing cells throughout the body

hormone therapy, which targets cancers that rely on hormones to grow, such as breast cancer

targeted therapy, which directly targets cancer cells

Prognosis and life expectancy

Life expectancy and prognosis for people with liver metastases are typically poor, as the cancer tends not to be curable.

However, treatments may help shrink the tumor, improve life expectancy, and relieve symptoms.

Overall 5 year survival rates depend on the cancer's origin. Other factors include sex, age, and the overall health of the individual.

For example, according to one study, the 5 year survival rates for people with liver metastases originating from the colon are as follows:

fewer than 8 months without treatment

11% chance of survival with treatment

A doctor is the best person to give a prediction on survival. In all cases, survival rates are only estimates. A person may live far longer or shorter than expected.

Source: Medical News Today

Which cancers receive the least funding, and why?

A recent study that looked at nonprofit research funding for different types of cancer found that some of the most common (and most deadly) cancers receive far less money than others, which can directly affect research, drug development, and patient education.

The research, which appears in the Journal of the National Comprehensive Cancer Network, uncovered trends in cancer funding that highlight areas needing more attention.

The funding of certain types of cancer was poor, considering how often they occur and how many people die from them. These types included colon, endometrial, liver and bile duct, cervical, ovarian, pancreatic, and lung cancer.

On the other hand, some cancers — including breast and pediatric cancer, leukemia, and lymphoma — received significantly more funding relative to those factors.

The lead researchers, all from Northwestern University in Evanston, IL, were: Suneel Kamath, the chief fellow in the department of hematology and oncology at the university's Feinberg School of Medicine at the time of this study; Sheetal Kircher, assistant professor of hematology and oncology at Feinberg; and Al Benson, professor of hematology and oncology at Feinberg.

"Well-funded patient advocacy organizations should be applauded for their successes," says Kircher. "We hope to bring awareness to the organizations with less relative funding so we can collaborate to improve funding and outcomes for all patients with cancer."

IRS tax records reveal funding disparities

To uncover how much funding each type of cancer received, the researchers looked at the IRS tax records for nonprofits that raise money for any type of cancer. They only included organizations that reported at least $5 million in annual revenue in 2015.

Overall, there were 119 nonprofit organizations, and together, they raised $5.98 billion in annual revenue. A large chunk of this amount was not for one specific cancer — instead, the money went to general cancer funds, such as the American Cancer Society.

For the remaining nonprofit organizations, the researchers looked at how much revenue each generated and compared this with the number of new cases of the particular type of cancer. They also looked at the number of deaths each type caused and considered how many years of lost life could result from those deaths.

By doing this, they were able to determine the rate of funding compared with the prevalence and mortality rate of the disease.

An alarming trend for certain cancers

The results showed that poor funding negatively affected the cancers that people tend to associate with stigmatized behavior.

These cancers include: lung cancer, which smoking cigarettes can trigger; liver cancer, which can result from drinking alcohol; and melanoma, which is often due to a person using tanning beds or spending time in the sun without wearing sunscreen.

"The goal of this study is not to divert funds away from cancers that are well-supported, but rather expand funding for other cancers that aren't getting enough support currently," explains Kamath.

Source: Medical News Today.

Computer use in midlife may prevent cognitive decline

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esearchers found that using a computer, playing games, and participating in social activities may reduce the risk of mild cognitive impairment.

New research suggests that playing games, using a computer, and having a rich social life can keep mild cognitive impairment at bay.

Our brains go through changes as we get older, and some people may experience issues with memory, thinking, or judgment.

Mild cognitive impairment (MCI) is the stage between age-related cognitive decline and dementia — however, MCI does not significantly affect daily life and activities.

People with MCI tend to forget things, lose their train of thought or the thread of conversations, and feel overwhelmed by making decisions. According to the Centers for Disease Control and Prevention (CDC), more than 16 million people in the United States are living with cognitive impairment.

MCI may increase the risk of dementia, but not everyone with MCI goes on to develop the condition. To date, the Food and Drug Administration (FDA) have not approved any treatments specifically for MCI.

Lifestyle choices such as physical exercise and intellectual stimulation have positive effects on the brain. In recent years, researchers have been conducting more studies to find treatments that may prevent cognitive decline.

Stimulating activities promote brain health

A new study found that using a computer, playing games, crafting, and participating in social activities may reduce the risk of MCI. The results appear in Neurology, the medical journal of the American Academy of Neurology (AAN).

"Our study took a close look at how often people participated in mentally stimulating activities in both middle age and later life, with a goal of examining when such activities may be most beneficial to the brain," says study author and AAN member Dr. Yonas E. Geda, of the Mayo Clinic in Scottsdale, AZ.

The researchers recruited 2,000 people in their late 70s without MCI and asked them to fill out a questionnaire about how often they engaged in different types of mentally stimulating activity both in their 50s and 60s and in later life.

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Participants underwent thinking and memory tests every 15 months, and the researchers monitored them for an average of 5 years. During this period, 532 people developed MCI.

Of these participants, only 15 used a computer in middle age. In comparison, 77 of the 1,468 participants without MCI used a computer during the same life stage.

Overall, each different type of mentally stimulating activity showed positive effects on brain health:

·         Computer use in middle age and later life lowered the risk of MCI by 37%.

·         Engaging in social activities, doing crosswords, or playing cards in middle age and later life reduced the risk of MCI by 20%.

·         Craft activities lowered the risk of MCI by 42%, but only in later life.

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The more mental activities, the better

The researchers found that the number of mentally stimulating activities also played a role in the risk of developing MCI. Among the people who participated in the study, those who engaged in two or more activities saw greater benefits, as follows:

Those who participated in two or three activities were 28% and 45% respectively less likely to develop MCI compared with those who did not do any activities.

Taking part in four or five activities reduced the risk of developing MCI by 56% and 43% respectively.

The study benefited from a large number of participants, but the researchers caution that the results are based only on each individual's recollections about their participation in mentally stimulating activities in middle age. More research is necessary to confirm the findings.

"Our study was observational, so it is important to point out that while we found links between a lower risk of developing [MCI] and various mentally stimulating activities, it is possible that instead of the activities lowering a person's risk, a person with [MCI] may not be able to participate in these activities as often," Geda concludes.

Source: MedicalNewsToday

Study introduces 'the Big Bang Theory of migraine'

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irls who approach puberty at a more rapid rate than their peers may be at higher risk of migraine, according to new research.

New research may have found what triggers migraine in some women.

Migraine affects children as well as adults, and statistics show that boys and girls experience the condition at a similar rate — until menstruation starts, that is.

After the first menstrual period, girls experience migraine at a higher percentage than boys.

The new study looked a little deeper into the puberty–migraine connection.

It was led by Dr. Vincent Martin, a professor in the Division of General Internal Medicine and the director of the Headache and Facial Pain Center at the University of Cincinnati (UC) Gardner Neuroscience Institute in Ohio.

The researchers revealed that although migraine tends to affect more girls than boys, there may be another factor to consider: early puberty.

"We know that the [percentage] of girls and boys who have migraine is pretty much the same until menstruation begins," says Dr. Martin.

"When the menstrual period starts in girls, the prevalence goes way up, but what our data suggest is that it occurs even before that."

Puberty and its relation to migraine in girls

This research, which the team presented at the American Headache Society 61st Annual Scientific Meeting in Pennsylvania, PA, pored over data from 761 adolescent girls from three metropolitan areas in the United States.

The ages of the participants ranged from 8 to 20, and scientists collected the data over a 10-year span that started in 2004.

The scientists examined the participants, who were ages 8–10 at the start of the study, every 6–12 months to determine if puberty was approaching.

They considered signs of puberty to include breast development (thelarche), the growth of pubic hair (pubarche), and the start of menstruation (menarche).

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Also, the participants (at around 16 years old) filled out questionnaires to determine their migraine status during the study. Around 11% of the participants had received a diagnosis of migraine, and 7% had probable migraine. The bulk of the participants had no migraine at all (82%).

When the researchers examined the data further, they discovered an additional factor for those who had migraine: These participants tended to have experienced earlier thelarche or menarche than those without the condition.

Although there was no quantifiable difference in those who had early pubarche, girls with migraine experienced thelarche around 4 months earlier and menarche around 5 months earlier, on average.

Also, there was a considerable uptick in the chances of developing migraine for each year earlier that a girl experienced either thelarche or menarche.

"This suggests a strong relationship between early puberty and the development of migraine in adolescent girls," says Susan Pinney, Ph.D., a professor in the UC Department of Environmental Health and a lead investigator on the study.

Migraine and children

Migraine is not exclusive to adults. In fact, the Migraine Research Foundation note that migraine occurs in around 10% of school-aged children, with more than half experiencing their first episode by the age of 12. As noted above, migraine incidence increases once a girl goes through puberty.

Migraine is a neurological condition, more than just a "bad headache." Those who have these headaches might experience other symptoms beyond head pain, such as nausea, vomiting, dizziness, and mood changes, as well as sensitivity to light, sound, touch, and odors.

Experts do not know exactly what causes migraine, but it is likely that a genetic factor is involved, as well as environmental factors.

If both parents have migraine, for instance, their children have a 75% chance of inheriting it — and even if only one parent has it, the children still have a 50% chance.

Early puberty a possible risk factor

The new study emphasizes that girls who experience puberty earlier than their peers are at an increased risk of developing migraine.

"To suggest the origins of migraine may occur actually before menstrual periods begin is pretty novel," says Dr. Martin.

He goes on: "At each of these stages, different hormones are starting to appear in girls. During pubarche, testosterone and androgens are present, and during thelarche, there is the very first exposure to estrogen. Menarche is when a more mature hormonal pattern emerges.

"Our study implies that the very first exposure to estrogen could be the starting point for migraine in some adolescent girls. It may be the Big Bang Theory of migraine."

Source: MedicalNewsToday