Medina,+Carlos


 * Cancer Project - Part I: The Cancer**

__Of Thieves and Victims: Hepatocellular Carcinoma__  It came quietly, with carefully measured steps. Like a thief that treads in the shadows and steals into the night after seizing treasure, it too lay patiently in wait, in calculating subterfuge. But unlike a thief, it did not come to steal gold and diamonds. Instead, it came to steal the health, and ultimately the life, of Eugene Edwards. Its target was his liver. Hepatocellular carcinoma changed Mr. Edwards’ life forever, from the day of his diagnosis to the marked struggle of his final weeks. The case of Mr. Edwards underscores the forceful resilience with which this cancer strikes and survives.  The doctors were certain of Mr. Edwards’ condition when he reported bloating, a loss of appetite, and persistent abdominal pain, among other symptoms [1]. When considering the history of their patient, the doctors were not surprised. The patient contracted Hepatitis C from an earlier incident of intravenous drug use and previously received a blood transfusion that may have been contaminated. Now a fifty-year old man with three children, Eugene Edwards’ chronic Hepatitis C led to cirrhosis of his liver, the point at which his liver was unable to heal itself [2]. A CT scan finally revealed a significant mass on his liver. The liver is essential. Much in the same way that a carbon filter will purify drinking water, the liver is the processing plant that detoxifies blood and breaks down nutrients appropriately. Loss of liver function leads to an accumulation of toxicities and impurities in the blood, leading to an eventual deterioration of health [3].  The last time Mr. Edwards had felt such an intense anxiety was the day he had to give a conference to an audience of hundreds. He felt the same way on the evening of his diagnosis. After the kids had been put to bed, Mr. Edwards and his wife sat down together to talk. “Your AFP levels are really elevated,” the doctors had told him. Serum alpha-fetoprotein was normally made in the liver of unborn babies and was a marker present in pregnant women. In healthy men and non-pregnant women, there was either no AFP or very low levels. A high level of AFP in any other case is often indicative of cancer. In combination with CT scan imaging, hepatocellular carcinoma was confirmed. It came in the form of a fat, foreboding tumor with a class B rating : moderate tumor size, vascularization, and liver function.  Most of what Mr. Edwards understood was what the doctors had told him and what the pamphlet had said. Hepatocellular carcinoma usually manifests itself in patients suffering from either Hepatitis B or C, or those with alcoholism-induced cirrhosis; it is most often secondary to one of these conditions [3-4]. About twenty-thousand new cases arise every year in the United States alone. Men are affected more often than women, usually between the ages of 45 and 60 [3]. But at this time, Mr. Edwards didn't fully understand the nature of his condition; in all likelihood, he never did. He didn't know that the Hepatitis C virus was causing his own immune system to attack his liver. He didn’t understand how his cytotoxic T cells were driving spears into his liver cells, and in doing so damaging them severely, in an attempt to eradicate the virus concealed within. He didn’t know that extensive scar tissue had formed from endothelial cells undergoing fibrosis, which slowly prevented his liver from adequately detoxifying his blood, or that continuous tissue damage led to impaired function and eventually tumor formation.  Over the next year, Mr. Edwards underwent numerous procedures, all with a hopeful longing that the next one would be the one to finally stabilize him and allow him to regain a normal life. First was chemoembolization, wherein anti-cancer drugs (in this case mitomycin, Adriamycin, and carboplatinum [2]) were injected directly into the blood vessel that fed into his liver. Though a surgical resection could have been performed, the location of the tumor provided the opportunity to eliminate the tumor with pharmaceuticals instead. By the middle of the following year, there was a drop in AFP values, closer to normal. The tumor disappeared for some time, but the intense treatment had damaged his liver. Mr. Edwards received a liver transplant [2]. Before long, Hepatitis C returned and the body began to reject the transplanted liver. Then, cirrhosis became evident again and hepatocellular carcinoma returned with a greedy vengeance. Mr. Edwards passed about a year and a half after his initial diagnosis.  Eugene Edwards did not think of cancer in terms of a Hepatitis C virus that was causing his immune cells to attack his liver or the thorny tumor that leeched the life of his liver. Rather, cancer was anxiety and stress. Cancer was pain and suffering. It was fear and uncertainty. Cancer was an obstacle, a threat that could prevent him from ever seeing his wife and kids again. It was because of cancer that he may never be able to play catch with his son again, or manage his daughter’s Girl Scout troop, or have another candlelit dinner with his wife. To Mr. Edwards, hepatocellular carcinoma was a thief, one who was about to steal from him everything that he ever cared about. It was a stubborn tumor defying the will of its host.  Mr. Edwards’ case is not unique. Worldwide, many people suffer and die from hepatocellular carcinoma. Unfortunately for Mr. Edwards, he died in this struggle. Despite everything doctors did for him, the series of treatments and procedures were not enough. Mr. Edwards is survived by his wife and three children, who must now live and find new light in a world without their husband, or father, respectively. Many families must also continue living without a loved one - they have also had loved ones stolen from them by hepatocellular carcinoma, despite all efforts to the contrary.


 * REFERENCES **
 * 1) Case-Lo, Christine. "Cirrhosis and Hepatitis C: Their Connection, Prognosis, and More." //Healthline//. 11 Apr. 2014. Web. 24 Apr. 2016. .
 * 2) Schiff, Eugene R. //Management of Patients with Hepatitis, Case Study: Hepatocellular Carcinoma//. Paris: APHC, 2004. //Paris Hepatitis Conference//. Web. 19 Apr. 2016. .
 * 3) El-Serag, Hashem B. "Hepatocellular Carcinoma." //The New England Journal of Medicine// 365 (2011): 1118-127. //NEJM//. Web. 18 Apr. 2016. .
 * 4) <span style="font-family: 'Times New Roman',serif; font-size: 10pt;">Yuan, Zhiyong, Ming Gao, Yang Dong, and Jingsheng Wang. "Medically Inoperable Primary Liver Carcinoma." //Accuray: Case Study// (2009): 1-4. Web. 18 Apr. 2016. <http://www.accuray.com/sites/default/files/500717.a_primary_liver_case_study.pdf>.
 * 5) <span style="font-family: 'Times New Roman',serif; font-size: 10pt;">Munson, Ronald. //Intervention and Reflection: Basic Issues in Medical Ethics//. 1st ed. Belmont, CA: Wadsworth Pub., 2014. Print.

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> <span style="font-family: 'Times New Roman',serif;"> Tumor classification is used for liver transplantation purposes. Classification is based on how sick a patient is, in what is called a Model for End-Stage Liver Disease (MELD) score. Different categories (among them tumor size, tumor number, tumor vascularization, etc.) are scored and the sum determines the final MELD score and class of tumor. A higher score denotes a worse condition [2, 5]. <span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> <span style="font-family: 'Times New Roman',serif;"> Surgical resection refers to the removal of the tumor and surrounding liver tissue, while attempting to preserve enough liver to allow for continued normal liver function; this offers the best chance for survival when caught very early [3].