Mouth Cancer From Smoking Cigarettes

Mouth Cancer From Smoking Cigarettes
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Smoking is the single biggest cause of cancer in the world
Experts agree that smoking is the single biggest cause of cancer in the world. 1-3 Smoking causes over a quarter of cancer deaths in developed countries and nearly one in five cancer cases. 4, 5

Around half of current smokers will be killed by their habit if they continue to smoke. And 25-40% of smokers will die in middle age 6, 7

Smoking causes even more deaths from other respiratory diseases and heart conditions than from cancer. 2 If current trends continue, scientists estimate that tobacco will kill about one billion people in the twenty-first century. 2

Smoking greatly increases the risk of lung cancer
A 2011 study found that more than four in five lung cancers are caused by smoking. 5 In 2002, lung cancer killed around 33,600 people - about one person every 15 minutes. 9

Tobacco smoke was first shown to cause lung cancer in 1950. 10 This study found that people who smoked 15-24 cigarettes a day had 26 times the lung cancer risk of non-smokers. And people who smoked less than 15 cigarettes a day still had 8 times the lung cancer risk of non-smokers.

After these first results came out, UK scientists began a large study of smoking in British doctors, which Cancer Research UK has helped to fund. 11 This  British Doctors’ Study has provided much of our current knowledge about the dangers of smoking.

The people with the highest lung cancer risks are those who:
smoke the most cigarettes per day
smoke over long periods of time, and
start smoking young
We cannot exactly calculate a person’s lung cancer risk based on how many cigarettes they smoke or the number years they have been a smoker. But studies have shown that lung cancer risk is greatest among those who smoke the most cigarettes over the longest period of time. 2

The length of time spent smoking seems to be the more important of these two factors. The British Doctors’ Study found that people who had smoked for 45 years had 100 times the lung cancer risk of people who had smoked for 15 years, regardless of whether they smoked heavily or moderately. 12. And smoking one packet a day for 40 years is about 8 times more dangerous than smoking two packets a day for 20 years. 9

Even light or irregular smoking can increase the risk of cancer. One study found that even people who smoked 1-4 cigarettes a day had much greater risks of dying from lung cancer or heart disease, 11 while another found that even people who smoke just 2 cigarettes a day are more likely to develop cancers of the mouth and oesophagus (food pipe). 14 And the EPIC study found that occasional smokers who have never smoked daily, still have higher risks of most cancers, and double the risk of bladder cancer. 15

Starting smoking at an early age increases the risk of cancer even more. One study found that young smokers are especially vulnerable to DNA damage caused by chemicals in cigarette smoke. And when they quit, they have higher levels of DNA damage than people who started smoking later in life. 16

Smoking is a major cause of several types of cancer
Smoking also increases your risk of cancers of the bladder, cervix, kidney, larynx (voice box), pharynx (upper throat), nose, mouth, oesophagus (foodpipe), pancreas, stomach, liver and some types of leukaemia. 2, 3, 17 And smokers are 7 times more likely to die of these cancer than non-smokers. 18

There is some evidence that smoking could also cause other cancers including bowel cancer and Hodgkin’s lymphoma. 19, 20

Smoking is the most important preventable cause of bladder cancer and causes more than one in three cases in the UK. 5 It increases the risk of this disease by 3-5 times. 21
Smoking doubles the risk of kidney cancer, and causes a quarter of cases in the UK. 22, 5
Smoking is the number one cause of mouth and oesophageal cancers, and together with alcohol, causes about three in four cases of these cancers in the UK. 5 By the age of 75, a non-smoker has a 1 in 125 chance of developing these cancers, but a smoker’s odds are 1 in 16. 24
Smoking is the most important preventable cause of pancreatic cancer, one of the most dangerous types of cancer in the UK. It causes over a quarter of pancreatic cancer cases. 5, 25
Smoking is an important preventable cause of stomach cancer and causes over one in five cases in the UK. 5
There is some evidence to suggest that smoking may increase the risk of breast cancer, bowel cancer and lymphomas but more research will be needed to say for sure. 27-30

Stopping smoking can reduce your risk
A large number of studies have shown that stopping smoking can greatly reduce the risk of smoking-related cancers. 2 And the earlier you stop, the better. The last results from the Doctors’ Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it. 11

However, it’s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life. 31

The effects of stopping vary depending on the cancer. For example, ten years after stopping, a person’s risk of lung cancer falls to about half that of a smoker. 32 And the increased oral and laryngeal cancer risks practically disappear within ten years of stopping. 2 But the risks of bladder cancer are still higher than normal 20 years after stopping. 21

Cutting down the number of cigarettes you smoke slightly reduces your risk of lung cancer, 33 but you’ll only experience the full health benefits if you stop altogether. One study found that even smokers who halved the number of cigarettes they smoked had similar risks of dying from heart disease and only slightly lower risks of dying from cancer. 34

Tobacco smoke contains many dangerous chemicals
Scientists have identified about 4,000 different chemicals in tobacco smoke. According to the International Agency for Research into Cancer, more than 70 of these chemicals could cause cancer 94. Many of the other thousands of chemicals are toxic and harmful to your health, including carbon monoxide, hydrogen cyanide and ammonia. 2, 35

One study compared the amounts of cancer-causing chemicals in tobacco smoke with their ability to cause cancer. It concluded that the chemicals in smoke most likely to increase our risk of cancer include 1,3-butadiene, arsenic, benzene and cadmium. 36

Cigarettes contain at least 599 different additives including chocolate, vanilla, sugar, liquorice, herbs and spices. These are not toxic but they make cigarettes taste nicer and ensure that smokers want to continue smoking. 37

Tobacco smoke contains significant amounts of dangerous chemicals
Carbon monoxide is the fourth most common chemical in tobacco smoke and can make up 3-5% of its volume. 35 Many of the other toxins are present in lower amounts, but some can still cause major damage at low concentrations. 38

Even single poisons can lead to substantial cancer risks. For example, benzene is a known cause of leukaemia. One study estimated that the benzene in cigarettes is responsible for between 10-50% of the leukaemia deaths caused by smoking. 39

Some studies have suggested that radioactive polonium-210 could account for much of the lung cancer risk caused by smoking. Polonium-210 becomes concentrated in hotspots in smokers' airways, subjecting them to very high doses of high-energy alpha-radiation. 40, 41 One study estimated that smoking 1.5 packs a day leads to as much radiation exposure as having 300 chest X-rays a year. 42

Chemicals in tobacco smoke can build up to harmful amounts
Many tobacco poisons disable the cleaning systems that our bodies use to remove toxins. Cadmium overwhelms cleaner enzymes that mop up toxins and convert them into more harmless forms 43. And many gases such as hydrogen cyanide and ammonia kill cilia, tiny hairs in our airways that help to clear away toxins 44.

So over time, tobacco poisons can build up to high levels in our blood, substantially increasing our risks of cancer and other diseases. By comparing the levels of toxins in smokers and non-smokers, some studies have found that smokers can have:

twice as much cadmium in their blood 45
four times as much polonium-210 in their lungs 46
ten times as much benzene in their breath . 47
ten times as much arsenic in their blood.
For most of us, much of our exposure to cancer-causing chemicals like benzene, formaldehyde, cadmium and nitrosamines comes from breathing in tobacco smoke. 35, 48, 49 For example, one study found that smoking households have four times as much benzene in the air as non-smoking households 50.

The chemicals in smoke are more dangerous in combination than individually
The cocktail of chemicals in tobacco smoke is even more dangerous as a mix.

Chemicals such as nitrosamines, benzo(a)pyrene, benzene, acrolein, cadmium and polonium-210 can damage DNA. Studies have shown that benzo[a]pyrene damages a gene called p53 that normally protects our cells from cancer. 51

One study found that chromium makes PAHs stick more strongly to DNA increasing the chances of serious DNA damage 52. Others have found that chemicals like arsenic, cadmium and nickel stop our cells from repairing DNA damage. 53 This worsens the effects of chemicals like benzo(a)pyrene and makes it even more likely that damaged cells will eventually turn cancerous.

The poisons in cigarettes can affect almost every organ in the body
The many toxins in tobacco smoke can harm many different parts of your body.

Many tobacco poisons can damage your heart and its blood vessels. By comparing the amounts and strengths of different chemicals, one study found that hydrogen cyanide and arsenic alone can cause major damage to our bodies’ blood network. 36

Acrolein, acetaldehyde and formaldehyde are most likely to cause diseases in our lungs and airways. 36 Gases like hydrogen sulphide and pyridine can also irritate our airways 35, radioactive polonium-210 deposits damage surrounding cells, and nitrogen oxide constricts the airways, making breathing more difficult. 54

A protein called haemoglobin carries oxygen round our bloodstream. But carbon monoxide and nitrogen oxide stick more strongly to haemoglobin than oxygen, and reduces the levels of oxygen in our blood. This starves our organs of this vital gas. 35

Toluene can interfere with the development of brain cells. It also disrupts the insulating sheath that surround nerve cells, making them less efficient at carrying signals. 55, 56

Nicotine is a very addictive drug
The Royal College of Physicians compared nicotine to other supposedly ‘harder’ drugs such as heroin and cocaine. They looked at many things including how these drugs cause addiction, how difficult it is to stop using them, and how many deaths they caused. The panel concluded that nicotine causes addiction in much the same way as heroin or cocaine and is just as addictive, if not more so, than these ‘harder’ drugs. 57

Smokers associate smoking with feeling good because nicotine makes the brain release dopamine - a chemical linked to feelings of pleasure. 57 Smokers can also make mental links between abstract things like the taste of cigarettes or the feeling of smoking. These behaviours can become just as addictive as the nicotine itself. 58

Smokers are still exposed to dangerous chemicals if they smoke filtered or ‘low-tar’ cigarettes
Filters do not block out the many toxic gases in smoke, such as hydrogen cyanide, ammonia and carbon monoxide. They also do nothing to reduce levels of sidestream smoke from the burning end of the cigarette.

Some of the most dangerous chemicals in tobacco smoke, like hydrogen cyanide, are present as gases, and do not count as part of tar. This means that cigarettes with less tar are not necessarily any less dangerous. 36

Besides, researchers have found that people who smoked low-tar brands smoked harder and more frequently to satisfy their nicotine cravings. 59 - 61 For example, in one study, low-tar smokers inhaled 40% more smoke per cigarette and ended up with similar nicotine levels as smokers who use normal brands. 60

And some smokers block filters with fingers or saliva. One Canadian study showed that over half of discarded cigarette butts showed blocked filters. 62

According to one study, low-tar smokers ended up inhaling about 80% more smoke, and had similar levels of cancer-causing chemicals in their blood. 63 They can also inhale over twice as much tar and nicotine as smokers of normal brands. 64

Alcohol and other substances worsen the effect of smoking
Tobacco, as well as alcohol, can cause mouth, oesophageal and liver cancers. Scientists have also found that together, their effects are much worse. 65 - 67 And while alcohol does not cause stomach cancer, it can worsen the risk of this disease in smokers. 68

One study found that together, smoking and drinking increased liver cancer risk by ten times. 65 And a Spanish team found that people who smoke and drink heavily could increase their risk of oesophageal cancer by up to 50 times. 67, 69 This problem is made even worse because heavy drinkers and smokers often have poor diets. 70

Smoking also interacts with many other cancer risk factors and worsens their effects. For example the lung cancer risk due to exposure to high levels of radon gas is 25 times higher in smokers than in non-smokers. 71

Second-hand smoking also causes cancer and kills thousands of people every year
Several studies have shown that breathing in other people’s smoke causes cancer in non-smokers. 2, 72  Second-hand smoke contains several cancer causing chemicals. Many of these chemicals are present in higher concentrations than in the smoke inhaled by the smoker themselves. 2

One study analysed 55 studies from around the world found that non-smoking spouses of people who smoke at home have 27% higher risks of lung cancer. 73 And a review of 22 studies found that people exposed to second-hand smoke in the workplace have 24% higher risks of lung cancer. Those who were exposed to the highest levels of second-hand smoke at work had twice the risks of lung cancer. 74

One study estimates that passive smoking may kill over 11,000 people every year in the UK from cancer, heart disease, strokes and other diseases. 75

Second-hand smoking also causes other health problems in non-smokers including asthma and heart disease. One study showed that even 30 minutes of exposure to second-hand smoke can reduce blood flow in a non-smoker’s heart. 76

Children are especially at risk from second-hand smoking.
Children are particularly at risk because they breathe faster than adults and have underdeveloped immune systems. A study by the Royal College of Physicians showed that about 17,000 children in the UK are admitted to hospital every year because of illnesses caused by second-hand smoke. 77

A large study of over 300,000 people found that children who were frequently exposed to cigarette smoke at home had a higher risks of lung cancer as adults. 78 Another study found that children in households where both parents smoke have a 72% higher risk of respiratory diseases. And the EPIC study found that exposing children to second-hand smoke increases the risk of bladder cancer later on in life by a third. 79

Childhood exposure to second-hand smoke had also been linked to a wide range of other conditions including asthma, Sudden Infant Death Syndrome (or cot death) 80, childhood meningitis 81 and mental disabilities. 82

Smoking while pregnant can harm your baby
Smoking during pregnancy hinders the blood flow to the placenta, which reduces the amount of nutrients that reach the baby. 83 Because of this, women who smoke while pregnant have lighter babies than those who don’t smoke. 84 And low birth weight can lead to higher risks of diseases and death in infancy and early childhood.

There is also evidence that women exposed to second-hand smoke during pregnancy also have lighter babies. 85

Smoking during pregnancy has also been linked to other pregnancy complications including miscarriage, stillbirth, ectopic pregnancy and cot death. It may also have consequences for the physical and mental development of the child. 86

Smokeless tobacco can also cause cancer
Smokeless tobacco, also known as chewing tobacco or snuff, is popular in South Asian communities in the UK. Many studies have shown that smokeless tobacco can cause oral cancer, and may cause pancreatic cancer. 87, 88 One study found that people who used smokeless tobacco had almost 50 times higher oral cancer risks than those who didn’t. 89

The most dangerous chemicals in smokeless tobacco are called tobacco-specific nitrosamines (TSNAs). One review found that people who use smokeless tobacco expose themselves to up to a thousand times more TSNAs than non-smokers, and up to 50 times more than smokers. 90

Smokeless tobacco is also as addictive as cigarettes. Some studies found that the amount of nicotine absorbed from smokeless tobacco is 3-4 times greater than that deliver by a cigarette. 91 The nicotine is also absorbed more slowly and stays in the bloodstream for a longer time.

A Swedish type of smokeless tobacco called snus is often promoted as “safe” but studies have found that even this can increase the risk of oesophageal, stomach and pancreatic cancers.

Bone Marrow Cancer Symptoms

Bone Marrow Cancer Symptoms
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Myeloma is a cancer that affects cells in the bone marrow called plasma cells. As the cancerous plasma cells fill the bone marrow, you are not able to make enough normal blood cells. This can lead to anaemia, bleeding problems and infections. Other symptoms include bone pain, fractures due to bone damage, and kidney damage. In many cases, treatment with chemotherapy and other treatments can control the disease, ease symptoms and prolong survival for a number of years.

What is myeloma / multiple myeloma?
Myeloma is a cancer of certain white blood cells called plasma cells. The cancerous plasma cells build up in the bone marrow. They also make a lot of one type of antibody. As a result, various symptoms develop. Myeloma is sometimes called multiple myeloma or myelomatosis.

Related articles q
Stem Cell Transplant
What are the bone marrow, plasma cells and antibodies?
The bone marrow is the soft sponge-like material in the centre of bones. The bone marrow is where blood cells are made by stem cells. Stem cells are the immature cells that can develop into mature blood cells. Stem cells constantly divide and produce new cells. Some new cells remain as stem cells, and others go through a series of maturing stages (precursor or blast cells) before forming into mature blood cells. The blood cells made by stem cells are red blood cells, white blood cells and platelets.

You make millions of blood cells every day. There is normally a fine balance between the number of blood cells that you make, and the number that die and are broken down. Various factors help to maintain this balance. For example, certain hormones in the bloodstream and chemicals in the bone marrow called growth factors help to regulate the number of blood cells that you make.

Plasma cells are one type of white blood cell. White blood cells are a main part of the immune system, defending the body from infection. There are various types of white blood cells including plasma cells.

Antibodies (immunoglobulins) are made by plasma cells. Antibodies are proteins that attach to, and help to destroy, germs such as bacteria and viruses. Normally, plasma cells make many different antibodies, each able to attack different bacteria and viruses.

What is cancer?
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cells in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and do not respond to normal control mechanisms. Large numbers of cancer cells build up either because they multiply out of control, or they live much longer than normal cells would do, or both. Myeloma is one type of cancer.

What happens in myeloma?
As with other cancers, what seems to happen is that the cancer starts with one abnormal cell. In the case of myeloma, one plasma cell at first becomes cancerous. This abnormal cell then multiplies to produce many identical abnormal plasma cells (a clone of cells). The cancerous plasma cells mainly collect in the bone marrow and continue to multiply without any control.

In the vast majority of cases of myeloma, the abnormal plasma cells make large quantities of one antibody. This single type of antibody is called a paraprotein (or sometimes called a monoclonal antibody, as it is an antibody which comes from a single clone of plasma cells).

There are several different types of antibody. (Antibodies are sometimes called immunoglobulins or Ig for short.) These are called IgM, IgG, IgA, IgD and IgE. Myelomas are sub-classified by the type of antibody that they make. For example, IgG myeloma is the most common type.

What causes myeloma?
It is not known why a plasma cell becomes cancerous. Factors such as infection, or chemicals, or other environmental factors may play a part in damaging cells and causing cancers such as myeloma. However, no factor has been proven as a cause for myeloma. It is not a hereditary disease.

How common is myeloma and who does it affect?
Myeloma is uncommon. It develops in about 4,000 people in the UK each year.

Most cases occur in people over the age of 50, and it becomes more common with increasing age. The average age of diagnosis is 70. Rarely, it occurs in younger adults, and it does not occur in children. Men are affected more often than women.

What are the symptoms and problems with myeloma?
There may be no symptoms at first in the early stages of the disease. Some people are diagnosed by chance because they have a blood test done for other reasons which may detect early myeloma. As the disease progresses, symptoms develop.

The symptoms and problems which develop are mainly due to the uncontrolled production of plasma cells in the bone marrow, and the excess amount of antibody (paraprotein) that the plasma cells make.

Bone damage and related problems
The increasing numbers of plasma cells in the bone marrow act like growing tumours (plasmacytomas) inside the bones. They also make a chemical that can damage bone. In time, small parts of bone are destroyed and are called lytic lesions. The term multiple myeloma is sometimes used which means there are multiple (lots of) areas in bones throughout the body which are affected.

The damage to bone can cause:

Bone pain. This is often the first symptom and can become severe. Any bone can be affected but the most common sites where pain first develops are the lower back, pelvis, and the ribs. The pain tends to be persistent, and made worse by movement.
Fractures. Affected bones may easily fracture (break) following a mild injury or even no injury.
Compression of nerves coming out of the spinal cord. The compression usually happens because of fractures of the vertebrae (the bones surrounding the spinal cord). This can cause a variety of symptoms such as weakness in muscles of the legs, numbness of areas of the body or legs, bladder or bowel problems, and pain. If you have any of these symptoms you need to seek urgent medical attention.
Hypercalcaemia. This means a high level of calcium in the blood (due to the bone breaking down). This can make you very thirsty and can cause nausea and vomiting, dehydration, constipation and also kidney damage.

Bone marrow failure
Much of the bone marrow fills with abnormal plasma cells. Because of this, it is difficult for normal cells in the bone marrow to survive and to develop into normal mature blood cells. Therefore, problems which can develop include:

Anaemia. This occurs as the number of red blood cells goes down. This can cause tiredness, breathlessness and other symptoms. You may also look pale.
Blood clotting problems. This is due to low levels of platelets. This can cause easy bruising, bleeding from the gums, and other bleeding-related problems.
Serious infections. The abnormal plasma cells only make one type of antibody. This does not protect against infection. There is a reduced number of normal plasma cells and other types of white blood cells which usually combat infection. Therefore, serious infections are more likely to develop.
Kidney damage
The kidneys may be damaged by an increased calcium level in the bloodstream, and/or by the high level of the abnormal antibody (paraprotein).

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Hyperviscosity
This means that the blood may become too thick due to a very high level of paraprotein. Symptoms of hyperviscosity occur in less than one in ten cases of myeloma and include problems such as bruising, nose bleeds, hazy vision, headaches, sleepiness and various other symptoms. If you develop these symptoms then you need to seek medical advice without delay.

Amyloidosis
This is an uncommon complication of myeloma. This is a condition where abnormal protein (amyloid) accumulates in various parts of the body. It can cause various symptoms.

How is myeloma diagnosed?
Tests commonly done to confirm the diagnosis of myeloma include:

A blood or urine test to detect the paraprotein. Other blood tests are also usually done - for example, to see if your are anaemic, to test for the function of your kidneys and to check your calcium level.
A bone marrow sample. For this test, a needle is inserted into the pelvic bone, or occasionally the breastbone (sternum). Local anaesthetic is used to numb the area. Then a small amount of marrow is removed. The sample is placed under the microscope to look for abnormal cells. The diagnosis is confirmed when large numbers of plasma cells are seen in the bone marrow sample. (See separate leaflet called 'Biopsy - Bone Marrow' for details.)
X-rays of bones. The areas of damaged bones often show up as typical patterns on X-ray pictures. MRI, CT or ultrasound scans may be done if X-ray tests do not give enough detailed information. (There are separate leaflets that give details of these tests.) Sometimes more specialised scans (for example, a PET scan) are performed.
These tests may be repeated from time to time to monitor the progress of the disease and also to monitor the response to treatment.

Other tests which are commonly done to assess the severity of the disease and to monitor the response to treatment include:

Blood tests to check on your kidney function.
Blood tests to check the level of calcium in your blood.
Blood tests to check the level of paraprotein in your blood.
Chromosome and gene testing of the myeloma cells. This can help to identify the exact type of myeloma so that doctors can decide which treatment is best.
Blood tests to measure proteins in the blood, called beta-2 microglobulin and albumin. The levels of these proteins are affected by myeloma and give an indication as to the severity of the disease.
Other disorders related to myeloma
The following are other plasma cell abnormalities. If you are diagnosed with any of these conditions, myeloma may develop sometime later, but not always.

Isolated (solitary) plasmacytoma of bone. In this condition only one plasma cell tumour is found in a bone. There is no other evidence of myeloma anywhere else in the body.
Extramedullary plasmacytoma. In this condition, one or more plasma cell tumours occur outside the bone marrow. These most commonly occur in the tonsils or the tissues around the nose.
Monoclonal gammopathy of unknown significance (MGUS). In this condition a paraprotein is found in the blood, without other symptoms or signs of myeloma. (Monoclonal gammopathy is another way of saying a high level of a monoclonal, or single type of, antibody.) This condition does not require treatment but needs monitoring. Around 1 in 100 people with MGUS develops myeloma in the future.
What are the aims of the treatment for myeloma?
Treatments may be used to treat and to control the myeloma itself; also, to ease symptoms and complications of the myeloma. Treatments options are briefly discussed below.

Treatment is usually given to those people with myeloma who have some organ or tissue damage due to the myeloma. For example, if you are anaemic or have some impairment in the function of your kidneys.

Treatment is not usually started in those people who have no symptoms from their myeloma. However, these people are normally monitored closely by a specialist as there is a chance that treatment may be needed in the future.

However, different treatments suit different people. You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the treatment options for myeloma.

Treatments to control the myeloma
In many cases, treatment can control the myeloma and put the disease into remission. Remission is not necessarily a cure. Full remission means that tests cannot detect the abnormal plasma cells in the blood or bone marrow, and the bone marrow is producing normal blood cells again. Some remissions are partial which means there is some improvement, often a great improvement, but some myeloma cells remain. In many cases where there is remission or partial remission, at some point in the future the disease returns (relapses). Further treatment may be considered if the disease relapses. However, in time, the relapses become more difficult to treat.

Treatments that may be used include one or more of the following:

Chemotherapy
Chemotherapy is a treatment which uses anticancer drugs to kill cancer (myeloma) cells, or to stop them from multiplying. Various drugs are used and myeloma may be treated with chemotherapy drugs given as tablets or injections. The exact combination of drugs used, and the length of the course of chemotherapy, depends on various factors. For example, the severity of the myeloma, the exact type of myeloma, if you have kidney damage, your age and general health. (See separate leaflet called 'Chemotherapy' for more details.)

If a course of chemotherapy achieves a remission, you may then be advised to take drugs as a regular maintenance treatment. These may include interferon, steroids, thalidomide, lenalidomide or bortezomib. This is, in effect, low-level chemotherapy which aims to keep you in remission for as long as possible.

Recent developments in drugs to combat myeloma have improved the outlook. For example, thalidomide, lenalidomide and bortezomib are relatively new and seem to be improvements on previous drugs. Various research trials of these drugs, and combinations of drugs, are underway.

Your doctor will be able to discuss with you the most suitable type of chemotherapy for you in more detail.

Stem cell transplant
A stem cell transplant may be an option. It is an intensive treatment that is not suitable in all cases. However, this treatment generally gives the best chance of a complete remission.

Stem cells are the immature cells that develop into mature blood cells in the bone marrow. Briefly, a stem cell transplant involves high-dose treatment with chemotherapy (and sometimes radiotherapy) to kill all the abnormal plasma cells. However, this also kills the stem cells that make normal blood cells. So, after the high-dose treatment, some stem cells are given to you via a drip into a vein (like having a blood transfusion). The stem cells are usually obtained from the blood of the patient with the myeloma before the high-dose treatment is started. The stem cells from the transfusion make their way to the bone marrow where they then multiply and make normal blood cells, including plasma cells. (See separate leaflet called 'Stem Cell Transplant' for more details.)

Treatments to ease symptoms
Depending on the effects of the myeloma, one or more of the following may be advised:

Painkillers - to ease any pain.
A bisphosphonate drug. Bisphosphonates are a type of medicine that is used to strengthen your bones. It is now recommended that all people with myeloma that is causing any symptoms should take a bisphosphonate.
Erythropoietin. This is a hormone that helps to increase the number of red cells made in the bone marrow. It may be used to help improve anaemia.
Blood transfusions to correct anaemia.
Plasma exchange or exchange blood transfusions if you have a very high level of paraprotein in your blood, which is causing hyperviscosity symptoms.
Antibiotics if you develop infections. If you develop any symptoms to suggest an infection you should go and see a doctor as soon as possible. Some people will need to have intravenous antibiotics in hospital if they develop an infection.
Surgery is sometimes needed to help heal fractured bones or to ease pressure on a trapped nerve due to fractures of the spinal bones.
Kidney dialysis if you develop kidney damage and kidney failure.
People with myeloma will also usually be advised to drink plenty of fluids (at least three litres a day). This helps to lower a high calcium level.

What is the prognosis (outlook)?
In general, with treatment, about half of people with myeloma are alive and well 3-4 years after diagnosis. However, this is the general overview. In some cases the disease responds very well to treatment and survival is much longer. In particular, a successful stem cell transplant gives a good chance of a complete remission. In some cases the disease does not respond to treatment very well, or life-threatening complications develop such as kidney failure.

The treatment of cancer and myeloma is a developing area of medicine. New treatments continue to be developed and the information on outlook, above, is very general. As mentioned above, there are some newer drugs that have been introduced in the last few years that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.

Eye Cancer Symptoms In Babies

Eye Cancer Symptoms In Babies
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Retinoblastoma (eye) in Children 

The Pediatric Solid Tumor Program at The Children's Hospital of Philadelphia consists of a multidisciplinary team of highly experienced and compassionate professionals who will provide expert management of your child's retinoblastoma. In addition, many of our pediatric oncologists are at the forefront of researching and developing new therapies to treat this type of cancer.

What is retinoblastoma?
Retinoblastoma is a rare cancer originating in the part of the eye called the retina. The retina is a thin layer of nerve tissue that coats the back of the eye and enables the eye to see. Most cases involve only one eye (unilateral), but both eyes may be involved (bilateral). If retinoblastoma spreads, it can spread to the lymph nodes, bones or the bone marrow. Rarely, it can involve the central nervous system (CNS).

Retinoblastoma is a malignant tumor composed of retinoblasts (immature baby cells) in the retina. These cells form the nerve tissues (rods and cones) at the back of the eye. Their job is to form images. The images are then transmitted by the optic nerve to the area of the brain responsible for sight.

Retinoblasts develop from a single cell during the early development of an infant in the womb. During gestation and early life, these cells are able to divide and multiply. This is the process that helps make enough cells to populate the retina. As children age, their cells undergo a process called differentiation and become mature rods and cones. The cells are no longer able to divide and multiply, which is why retinoblastoma occurs very rarely after the age of 5 years. Children may be born with retinoblastoma, but the disease is rarely diagnosed at birth.

We do not know what causes retinoblasts to turn into cancer cells but we do know that in order for retinoblastoma to develop there must be a change or mutation in both copies (one from each parent) of a gene called RB1. What precisely triggers this change or mutation is not known.
Most children who begin treatment before the retinoblastoma has spread beyond the eye are cured. A major goal of treatment in children with retinoblastoma is preserving vision.

Great strides have been made in treating retinoblastoma in recent years; many children retain their vision and more than 95 percent of children with retinoblastoma can be cured.

Who is diagnosed with retinoblastoma?
About 300 children are diagnosed with retinoblastoma in the United States each year. The disease occurs most often in children under 4 years old, and accounts for 2.8 percent of all cancers in children ages 0 to 14 years old. The average age of children with retinoblastoma is 18 months — and boys and girls are affected equally.

About 60 percent of children with retinoblastoma develop a single tumor in one eye only (unilateral). There is no increased risk of additional tumors later in life.

When retinoblastoma affects both eyes (bilateral), it is considered a genetic condition. Rarely, the genetic form occurs only in one eye. The genetic form of the disease occurs in the youngest children (rarely beyond 1 year old) and increases the child's risk of developing another cancer later in life. The risk of additional tumors is higher in children who receive radiation therapy to the orbit (eye socket) to preserve vision or to other parts of the body where the tumor has spread.

Hereditary retinoblastoma
Some children (40 percent of patients with retinoblastoma) are born with a change in one copy of the RB1 gene in every cell in the body, including the cells in the retina. If the second copy of the gene undergoes a change, a retinoblastoma tumor can develop. That's because every cell already has the first copy of RB1 mutated — making it relatively easy for more than one cell to undergo a change in the second copy or the gene. These children may have more than one tumor, and they usually have both eyes affected.
Most children (80 percent) with the genetic form do not have a parent with retinoblastoma. The change in the gene occurred in either the egg or the sperm of one parent before conception. Even if your child has the genetic form, if neither parent has the tumor there is less than a 1% chance that retinoblastoma will occur in another child in your family.

Children with the genetic form may also develop tumors in other parts of their body, such as the pineal gland in the brain. The pineal gland develops from cells that sense light and are similar to retinoblasts. As is the case with retinoblastoma, when these cells become mature and can no longer divide and multiply (sometime around age 5), they are much less likely to become cancer cells.

Nonhereditary retinoblastoma
Most children with retinoblastoma (60 percent) do not have the genetic form. They are not born with the RB1 gene mutated in every cell of the body. They develop a tumor in only one eye because both RB1 genes in a single retinoblast have undergone the mutation. We don't know how or why this occurs.
If neither parent has had retinoblastoma and the child is over 2 years of age at diagnosis, the probability of having the genetic form is very small. If eye tumor tissue is available for study, there is a blood test that can be done to determine whether a child with a unilateral tumor is one of the 10 percent of children with a tumor in only one eye who has the genetic form.

Your child's oncologist will discuss with you which form of retinoblastoma your child has and what this means for follow-up for the child and for other members of your family.

What are the signs and symptoms of retinoblastoma?
Sometimes children with retinoblastoma do not show any of the following signs or symptoms. Often, doctors find retinoblastoma on a routine well-baby examination. Most often, however, parents notice symptoms such as:

White (leukocoria) or red pupil instead of the normal black
Misaligned eyes (strabismus) looking toward the ear or nose
Reddened, painful eye
Enlarged pupil
Different-colored irises
Poor vision

How do we diagnose retinoblastoma in your child?
The diagnosis of retinoblastoma is made by examining the eyes. If a newborn has a family history of retinoblastoma, the baby should be examined shortly after birth by an ophthalmologist (medical eye doctor) who specializes in cancers of the eye.

If a white pupil or strabismus (crossed-eyes) is noticed by a parent or pediatrician, the child should be referred to an ophthalmologist familiar with the treatment of retinoblastoma. The doctor will do a thorough examination to check the retina for a tumor. Depending on the age of the child, either a local or general anesthetic is used during the eye examination. The ophthalmologist will make a drawing or take a photograph of the tumors in the eyes to provide a record for future examinations and treatments, and may use additional tests to confirm or detect tumors. These tests may include:

Imaging tests
Ultrasound. This test looks for tumors in the child's body using sound waves.
Computerized tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the child's body with an X-ray machine. A computer then puts these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye (a contrast medium) is injected into a vein to provide better detail. A CT scan helps the doctor find cancer outside of the eye.
Magnetic resonance imaging (MRI). MRI uses electromagnetic waves to create computer-generated pictures of the brain and spinal column. MRIs may create more detailed pictures than CT scans and provide the specialist with a picture of the inside of the eye and the brain.

Additional tests
Children who are diagnosed with retinoblastoma will require a complete physical examination and, if there are any additional symptoms or abnormal findings, may also undergo additional tests to determine if the cancer has spread elsewhere in the body. Some of these tests also will be performed when the child starts therapy.

Blood tests. These tests evaluate the blood and check for problems with the liver and kidneys. The doctor may also look at the blood for changes in chromosome 13. Chromosomes are the part of the cell that contains genes. In a few cases of retinoblastoma, these genes are either missing or nonfunctional.

Lumbar puncture (spinal tap). In this test, a small amount of cerebrospinal fluid is removed with a needle from the child's back and examined under a microscope to detect cancer cells.

Bone marrow aspiration. This procedure is performed to determine if any retinoblastoma cells have spread to the marrow. For this test, a small amount of bone marrow is removed from the hip with a needle and examined under a microscope.

MRI or CT scan of the brain. This may be recommended to determine if there is an abnormality of the pineal gland for children with the genetic form of retinoblastoma. This includes children with bilateral (in both eyes) disease and those with unilateral with a positive family history. Very young children with a tumor in one eye who do not have a positive family history may also be at risk, and these studies may be recommended for them. Scans may also be recommended years after treatment for children who have received external beam radiation, either as a baseline in the event that problems arise, or to follow-up on a symptom or sign.
Hearing test. Children with retinoblastoma taking certain chemotherapy drugs may have their hearing tested (audiology test) to make sure the drugs are not causing hearing loss.

Staging
After a retinoblastoma has been detected, the doctor will determine the extent of disease in the eye and if the disease has spread (metastasized) outside the eye. This is called staging, and it helps doctors plan treatment.
Staging categories include:

Intraocular. This means that cancer occurs in one or both eyes, but has not spread into surrounding tissues or other parts of the body.
Recurrent. The cancer has recurred (come back) in the eye or continued to grow after it has been treated.
Extraocular. The cancer has spread to tissues around the eye or to other parts of the body.

How do we treat pediatric retinoblastoma?
The goal of treatment is to prevent tumor cells from growing and spreading, and to preserve vision.
Standard treatment for retinoblastoma has changed over the years. A decade ago, treatment options included enucleation (removal of the involved eye) or radiation. When only one eye is involved, enucleation is usually the treatment of choice. Children adjust very well to the loss of one eye, and their vision does not suffer a great deal. However, if a child is very young, there is a risk that a tumor will develop in the other eye, so the goal in these children is to remove as much of the tumor as possible while preserving vision.
Small tumors can often be treated successfully using local measures, including:

Cryotherapy. Extreme cold may be used to destroy cancer cells. The procedure is done in the operating room. The child is discharged the same day after recovering from anesthesia.

Photocoagulation (laser therapy). Laser light may be used to destroy blood vessels that supply nutrients to the tumor. The procedure is done in the operating room. The child is discharged the same day after recovering from anesthesia.

Thermotherapy. Heat may be used to destroy cancer cells. Radioactive plaques, sewn into the back of the eye and removed after the required dose of radiation is delivered, are also successful.

Plaque radiotherapy. A radioactive device is implanted in the affected eye with a specific dose of radiation directly applied to the tumor. The procedure is performed in the operating room. The child will have to stay in the hospital for a few days while the implanted radiation plaque delivers the planned dose to the tumor.

Radiation therapy
The goal in treating children with tumors in both eyes is to save the child's life and preserve vision with a minimum of side effects. Radiation therapy has been the treatment of choice for children with bilateral disease. However, radiation may produce damage to the retina many years after it has been given. That damage can result in loss of vision.

Radiation when given to very young children also results in decreased growth of the bone surrounding the orbit. It can also increase the risk of second non-retinoblastoma cancers from 10 to 50 years after treatment.
Chemotherapy
Chemotherapy is medication used to destroy cancer cells. When tumors are too large to apply local measures, we may recommend chemotherapy to shrink the tumors so that local therapy can be used successfully.

Because chemotherapy can also affect normal cells along with cancer cells, certain side effects can occur. Any plan of chemotherapy will include a discussion of the potential side effects, the ways in which they can be prevented, and what tests we may need to do to look for them.

All of the chemotherapy medications given for retinoblastoma are given via an intravenous (IV) catheter placed in the arm or foot. Some children may require a semi-permanent type of IV catheter, called a central venous catheter, that is placed under the skin in the chest.

Each child is affected differently by chemotherapy. Before each cycle of chemotherapy, a pediatric oncologist will examine your child.

As with any cancer, the prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Great strides have been made in treating retinoblastoma in recent years. More than 95 percent of children with retinoblastoma can be cured. Many children with tumors in both eyes can retain vision.

Late effects/cancer survivorship
Some children treated for retinoblastoma develop complications years later. Our Cancer Survivorship Program provides information about the potential long-term effects of the specific treatment your child received, including ways of monitoring and treating these effects.

Diagnosed Of Liver Cancer

Diagnosed Of Liver Cancer
How is liver cancer diagnosed? 
HCC screening - high risk individuals for HCC (hepatocellular carcinoma) should have regular screenings for liver cancer. Liver cancer, if not diagnosed early is much more difficult to get rid of. The only way to know whether you have liver cancer early on is through screening, because you will have no symptoms. High risk people include those with hepatitis C and B, patients with alcohol-related cirrhosis, other alcohol abusers, and those that have cirrhosis as a result of Hemochromatosis.

Diagnostic tests may include:
Blood test - afp (alpha fetoprotein), a type of protein, is produced by liver tumors and can be detected in a blood test.
Imaging scans - either an MRI or CT scan.
Biopsy - a small sample of tumor tissue is removed and analyzed. The analysis can reveal whether the tumor is cancerous (malignant) or non-cancerous (benign).
Liver cancer is categorized into four stages:
Stage 1 - the tumor is just in/on the liver and nowhere else.
Stage 2 - either there are several small tumors, but all within the liver, or one tumor that has reached a blood vessel.
Stage 3 - either there are various large tumors, or there is just one that has reached the main blood vessel(s). Cancer may have also reached the gallbladder.
Stage 4 - metastasis. The liver cancer has spread to other parts of the body.
What are the treatment options for liver cancer? Unfortunately, because symptoms do not appear until the liver cancer is well advanced, currently only a small percentage of patients with HCC can be cured; according to the National Health Service (January 2010) only about 5%.

Liver cancer treatment options may include: Treating curable cancer:
Surgery - in the early stages when the tumor is small occupies just a very small part of the liver, it can be surgically removed (surgical resection). Even if part of the liver is removed during this procedure, the patient's health should not be significantly undermined.
Liver transplant - candidates for a liver transplant cannot have a tumor larger than 2 inches (5cm), according to the National Health Service (NHS), UK. If the tumor is larger the risk of the cancer coming back is too high, says the NHS.
Treating non-curable cancer - if the liver cancer has had a chance to advance, the likelihood of a cure is extremely small. However, there are things the medical team can do to treat symptoms and slow its advancement.
Ablative therapy - substances are injected directly into the tumor, such as alcohol. Lasers and radio waves can also be used.

Radiation therapy (radiotherapy) -
 radiation is directed at the tumor(s), killing a significant number of them. Patients may experience nausea, vomiting and fatigue.
Chemotherapy - medications are injected into the liver to kill cancer cells (chemoembolization). In chemoembolization the blood supply to the tumor is blocked surgically or mechanically and anticancer drugs (chemotherapy) are administered directly into the tumor.
Volunteer for clinical studies - when trials reach the human stage they are called clinical trials. Ask your doctor whether there are any available in which you may be able to take part.
Treatment options may vary, depending on the type of liver cancer. For cholangiocarcinoma the medical team may recommend photodynamic therapy, brachytherapy, radiotherapy or liver transplantation. For hepatoblastomas, doctors may use chemotherapy, radiation therapy, liver transplantation, or surgical resection. How can liver cancer be prevented? Alcohol:Long-term, regular high alcohol intake significantly increases the risk of cirrhosis of the liver, which in turn makes the likelihood of developing liver cancer much greater. It stands to reason, therefore, that moderating one's alcohol intake (or giving up completely) can significantly reduce the risk of developing liver cancer.

Hepatitis B: The following individuals should seriously consider receiving the hepatitis vaccine; drug addicts who share needles, individuals who engage in unprotected sex with partners who may be at risk of having hepatitis B, nurses, doctors, dentists and other individuals whose occupations raise their risk of becoming infected. Frequent travelers, especially those who go to parts of the world where hepatitis B is common should also consider being vaccinated.

Hepatitis C: Although there is no sure way of protecting oneself from hepatitis C, using a condom during sex may help reduce the risk of infection. There is no hepatitis C vaccination (July 2010).

Body pierceings and tattoos - make sure the establishment is reputable and new or very well sterilized needles are being used. If you have any doubt about the place, go somewhere else.

What Is Liver Cancer? What Causes Liver Cancer?

What Is Liver Cancer? What Causes Liver Cancer?
Liver cancer, also known as hepatic cancer is a cancer which starts in the liver, and not from another organ which eventually migrates to the liver. In other words, there may be cancers which start from somewhere else and end up in the liver - those are not (primary) liver cancers.

Cancers that originate elsewhere and eventually reach the liver are known as liver metastasis or secondary liver cancers, and are most commonly from cancer of the GI tract (colon cancer), lung cancer, renal cancer (kidney cancer), ovarian cancer and prostate cancer. Cancers that originate in the liver are known as primary liver cancers.

The liver, which is located below the right lung and under the ribcage is one of the largest organs of the human body. It is divided into the right and left lobes. Nutrient-rich blood is carried by the portal vein from the intestines to the liver, while oxygen-rich blood reaches the liver from the hepatic artery.

All vertebrates (animals with a spinal column) have a liver, as do some other animals. The liver has a range of functions, including detoxification (getting rid of toxins), synthesizing proteins, breaking down fats,, and producing biochemicals that are essential for digestion. We cannot survive without a liver.

Liver cancer consists of malignant hepatic tumors (growths) in or on the liver.

The most common type of liver cancer is hepatocellular carcinoma (or hepatoma or HCC), and it tends to affect males more than females. According to the National Health Service (NHS), UK, approximately 1,500 people in the United Kingdom die from HCC each year.

The World Health Organization (WHO) says that liver cancer as a cause of death is reported at less than 30 cases per 100,000 people worldwide, with rates in parts of Africa and Eastern Asia being particularly high.

Experts say that common causes of HCC are regular high alcohol consumption, having unprotected sex and injecting drugs with shared needles.

Risks and causes of liver cancer

Risks and causes of liver cancer
How common liver cancer is?
Primary liver cancer is relatively rare in the UK, but it is increasing in number. Worldwide, it is the 6th most common cancer. The highest rates are in Eastern Asia.

Around 4,300 primary liver cancers are diagnosed in the UK each year. It is more common in men than in women. Our risk of liver cancer gets higher as we get older. Almost 9 out of 10 cases are diagnosed in people over the age of 55 years.

Primary liver cancer is cancer that started from the cells of the liver. It is much more common in the UK to have cancer that has spread into the liver from somewhere else in the body (secondary liver cancer). If you have secondary liver cancer, this is not the right section for you. You need to look for information in the section of this website that relates to your type of primary cancer.

What risk factors are
Anything that increases your risk of getting a disease is a risk factor. Different cancers have different risk factors. Doctors and scientists do not know exactly what causes liver cancer. But we know of some factors that can increase the risk.

Even if you have one or more risk factors, it doesn't mean that you will definitely get the disease. Researchers are investigating various factors that in the future may turn out to increase the risk.

Cirrhosis
Cirrhosis means scarring of the liver due to previous damage. This scarring can cause problems with the way the liver works. Having cirrhosis increases your risk of getting liver cancer (hepatocellular carcinoma or HCC). The risk varies, depending on the cause of the cirrhosis. Cirrhosis can be caused by

Infection with a virus such as hepatitis B or C
Long term alcohol drinking
Inherited diseases such as iron overload disorder (haemochromatosis) and alpha 1 antitrypsin deficiency

 Alcohol
Drinking more than 80g alcohol (about 10 units) a day over a number of years increases the risk of liver cancer. This amount of alcohol is well above the current government guidelines for alcohol intake. Long term heavy drinking causes cirrhosis, and may also directly damage the DNA in liver cells.
Non alcoholic fatty liver disease
Non alcoholic fatty liver disease (NAFLD) is a group of conditions including mild hepatic steatosis and non alcoholic steatohepatitis. In these conditions fat builds up in the liver. The fat causes inflammation and damage, which may lead to cirrhosis. Non alcoholic fatty liver disease is common in people who have a group of symptoms called metabolic syndrome, including

Having extra weight around the waist
Using insulin less effectively than normal
Type 2 diabetes
High blood pressure
One study has estimated that people with non alcoholic fatty liver disease have a risk of liver cancer that is 4 times higher than people without this condition.

Infection with hepatitis viruses
Long term infection with hepatitis B or C virus increases the risk of developing primary liver cancer because it causes damage to the liver (cirrhosis). If you have hepatitis B or C infection, it is important not to drink alcohol. If you do drink, it can further increase your risk of developing cirrhosis or liver cancer.

Hepatitis A and hepatitis E do not seem to increase the risk of liver cancer.

Smoking
Smoking increases the risk of liver cancer. Researchers estimate that almost a quarter of liver cancers in the UK are caused by smoking. In smokers who also have hepatitis C or hepatitis B virus infection the risk is increased further. Smokers who drink large amounts of alcohol may have a risk that is up to 10 times higher than people who don't smoke or drink.

Low immunity
HIV and AIDS lower immunity. An overview of individual studies showed that people with HIV or AIDS have a risk of liver cancer that is five times higher than people who don't have HIV or AIDS.

After organ transplants, people have to take medicines to stop their body rejecting the transplant. These medicines lower immunity and people who take them have double the usual risk of liver cancer.

The increased risk of liver cancer may be because people with low immunity are more likely to become infected with hepatitis B or C.

Family history
An American study found that people who have a first degree relative (parent, brother or sister) diagnosed with liver cancer have double the risk of developing it. One study has also shown an increased risk of liver cancer in people with a father and brother diagnosed with prostate cancer.

Diabetes
People with diabetes have a higher risk of liver cancer than people who do not have diabetes. The higher risk may be due to the higher levels of insulin in people with diabetes or due to liver damage caused by the diabetes. The risk may be increased more in people who have other risk factors such as liver cirrhosis, drinking alcohol in large amounts, and hepatitis infection.

Some treatments for diabetes such as metformin may reduce the risk of liver cancer.

Gallbladder removal
People who have their gallbladder removed (cholecystectomy) to get rid of gallstones may have an increased risk of liver cancer. The increased risk may be due to raised pressure in the bile duct causing long term inflammation in the liver tissue.

Radiation from X-rays or CT scans
Radiation from X-rays or scans can increase the risk of liver cancer but the risk is still very small. It is important to remember that X-rays and scans are very important in diagnosing illness so that people can have the right treatment.

Body weight
Two reviews have shown that the risk of liver cancer is higher in overweight and obese people. Diabetes and non alcoholic fatty liver disease are more common in people who are overweight, so this may partly explain the link.

The European Prospective Investigation into Cancer and Nutrition (EPIC) study is looking into links between diet and cancer. It found that the risk of liver cancer is higher in people who have a lot of weight around their waist (the apple shaped body).
Betel quid
Some studies have shown that people who chew betel quid have an increased risk of liver cancer. Betel quid is a combination of betel leaf, areca nut and slaked lime. It may also contain tobacco. There is a small amount of evidence that betel quid, even without the tobacco causes liver cancer. But more research is needed.

Aflatoxin
Aflatoxin is a substance found in mouldy peanuts, wheat, soya beans, groundnuts, corn and rice. People from Africa and Asia who have eaten these over a long period of time have an increased risk of developing hepatocellular liver cancer. The risk is increased further in people who also have hepatitis B infection.
Chemicals
There is evidence that exposure to the chemical vinyl chloride increases liver cancer risk. There is also limited evidence that exposure to arsenic, polychlorinated biphenyls and trichloroethylene may do so. People may come into contact with these chemicals through their work.

Factors that may lower risk of liver cancer
Some research has shown that people who drink 1 or 2 cups of coffee a day may reduce their risk of liver cancer by 23% to 43%. But the evidence for this is limited.

Symptoms Of Liver Cancer

Symptoms Of Liver Cancer
Weight loss
Doctors usually define significant weight loss as more than 10% of your body weight - a stone for every 10 stone you weigh. Obviously losing weight doesn't mean you are ill if you are dieting or there is some other reason. But if there is no obvious explanation for your weight loss, you should see your doctor.

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A swollen tummy (abdomen)
Swelling of the abdomen can happen in liver cancer for 2 reasons. The liver itself can get bigger from the growing cancer. This can cause swelling over the right side of your abdomen. Or you can have generalized swelling of the abdomen caused by a build up of fluid. This is called ascites.

Diagram showing fluid in the abdomen (ascites)

The fluid builds up because the liver is congested. This squeezes the blood vessels inside the liver and the blood that normally flows through it gets backed up in the veins. The pressure in these veins increases and forces fluid to leak from the veins into the abdomen. The veins may grow in size so much that they can be seen underneath the surface of the skin. If the liver is not able to make blood proteins as it should, fluid also tends to leak out of the veins and into the abdominal cavity. 

You can have ascites without having liver cancer, for example with liver cirrhosis.

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Jaundice
Jaundice means yellowing of the skin and whites of the eyes. It may also make the skin itch. It means that your liver is not working properly or there may be a blockage in the bile duct.

Jaundice is due to a build up of bile salts in the blood. If there is a blockage, the bile cannot drain away into the bowel as it normally would. So bile salts build up in your blood and body tissues. The bile salts make your skin look yellow and feel itchy (doctors call itching pruritis). The bile's yellow pigment is excreted through the kidneys, so your urine appears darker than normal. And because the bile is not passing into your bowel, your stools will be much paler than normal.

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Other symptoms
You may have some discomfort or pain in the tummy (abdomen) caused by the liver getting larger. You may also have pain in the right shoulder. This is caused by the enlarged liver stimulating the nerves under the diaphragm, which are connected to nerves in the right shoulder (referred pain).

Other symptoms you may have include

Loss of appetite over a period of a few weeks
Being sick
Feeling full or bloated after eating, even after a small meal
Itching
A sudden worsening of health in somebody with known chronic hepatitis or cirrhosis
A high temperature and sweating
Many of these symptoms are vague, and can be caused by conditions other than cancer. But if you do have any symptoms you should see your doctor.

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More information
The earlier a cancer is picked up, the easier it is to treat it and the more likely the treatment is to be successful. So it is important that you go to your GP as soon as possible if you notice worrying symptoms.