Potential biomarkers for the early detection of bone metastases

Understanding Hepatitis C: Symptoms, Causes, And Treatment Options

Hepatitis C is a serious condition that can greatly affect your liver and overall health. The culprit is a virus called hepatitis C virus (HCV), which typically gets into a person's system through direct contact with infected blood. Once inside the body, it hones in on liver cells and might stay hidden for years. Some folks experience obvious symptoms pretty quickly, while others don't notice anything until the virus has done some damage. Unfortunately, when the infection goes unnoticed, it can quietly cause long-term harm to the liver [1].

Table of Contents

Global Impact and Why It Matters

Hepatitis C continues to pose a big global challenge, even compared to Hepatitis E and Hepatitis B. According to estimates, somewhere between 57 and 71.1 million people around the world live with chronic hepatitis C [1, 3]. Each year, roughly 300,000 individuals die from serious complications like advanced liver disease and liver cancer. Experts often label HCV as the top cause of chronic liver disease internationally. That's why it's so essential to raise awareness and support prevention strategies [10].

How Hepatitis C Spreads (Transmission)

The virus mostly spreads through blood contact [8]. Years ago, before tests became strict, blood transfusions were a leading cause of infection. But with better screening today, the risk of infection from donated blood is way down. Another issue is the re-use of needles and syringes in healthcare settings or among people who use drugs, as that can directly pass HCV from one person to another. People who inject drugs are especially at risk if they share needles or other equipment [3]. Understanding these pathways helps experts tackle this ongoing public health concern.

Hepatitis C vector illustration. Labeled viral infection explanation scheme.

(VectorMine)

Noticing the Warning Signs: Symptoms to Watch For

Many people with hepatitis C don't have any noticeable symptoms early on [2]. Acute hepatitis C, which is the initial phase, can sneak in without showing any big red flags. On average, it takes about seven weeks for signs to appear, and only around one-third of people see any real problems in the acute stage, such as tiredness, joint aches, or a slight fever. If the virus isn't cleared, the infection might become chronic [9]. About 85% of acute cases progress to chronic hepatitis C if not treated [7]. Over years or decades, this prolonged infection can damage the liver to the point of triggering problems like jaundice (yellowish skin and eyes), fluid buildup in the belly, or weakness.

Inside the Body: The Pathogenesis of Hepatitis C

HCV is basically a thread of RNA, which is genetic material, that specifically attacks liver cells. One of its sneakier moves is dodging the immune system; in most infected individuals, the immune system never fully clears it [4]. What's interesting is that HCV usually doesn't kill liver cells directly. Instead, your immune system's response does much of the damage. Over time, this ongoing battle between the virus and the immune defenses leads to scars in the liver, which can bring on more severe issues down the line [10].

Complications Linked to Chronic Infection

If hepatitis C isn't controlled, it tends to wear down the liver bit by bit. A major concern is cirrhosis, which is when the liver develops a lot of scar tissue, making it tougher for the liver to handle its usual tasks. Cirrhosis can show up after 20 or 30 years of chronic infection, but it can happen sooner, too, depending on other factors. In worse cases, cirrhosis progresses to decompensated liver disease, meaning the liver can't keep up with what your body needs. Another risk is hepatocellular carcinoma (HCC), a dangerous liver cancer that can arise in people with long-term HCV [1, 6].

Who's More At Risk: Factors That Affect Disease Progression

Certain things can make hepatitis C more severe or speed up its complications. People who get infected later in life sometimes experience liver damage at a faster rate than those infected at younger ages. Gender and race may also influence how quickly the disease develops, though researchers are still finding out exactly why. Drinking alcohol is another major factor—it puts added stress on the liver, possibly pushing liver damage along faster [4]. Knowing these risks helps doctors and patients pinpoint strategies to prevent further harm.

Staying Ahead of Hepatitis C

The upside is that awareness, testing, and effective therapies have come a long way lately. Modern antiviral medications can do a great job of clearing the virus and heading off more serious damage [5]. Getting diagnosed early is key, because it gives people a chance to start treatment before cirrhosis or other advanced problems set in. Prevention is also super important. Simple but crucial measures, like sterilizing medical tools, improving safe injection practices, and rigorously screening blood donations, drastically reduce transmission. Around the globe, ongoing medical research aims to curb or even completely eliminate hepatitis C as a health threat in the future.

Closing Thoughts

Hepatitis C is a wide-reaching liver infection that can quietly linger without causing immediate trouble. If nobody catches it early on, the infection can stick around for years, eventually leading to serious complications like cirrhosis and liver cancer. Because HCV mainly travels through blood contact, reducing exposure to infected blood and staying informed about how the virus spreads can make a big difference. Recognizing the symptoms, understanding your own risk factors, and getting tested as needed are all vital steps. Medical advances give hope that, through early detection and better treatments, we can slash new cases, successfully cure existing infections, and lessen the worldwide toll of hepatitis C.

References

[1] Martinello, M., Solomon, S. S., Terrault, N. A., & Dore, G. J. (2023). Hepatitis C. Lancet (London, England), 402(10407), 1085–1096. Https://doi.Org/10.1016/S0140-6736(23)01320-X

[2] Simmonds P. (2013). The origin of hepatitis C virus. Current topics in microbiology and immunology, 369, 1–15. Https://doi.Org/10.1007/978-3-642-27340-7_1

[3] Spearman, C. W., Dusheiko, G. M., Hellard, M., & Sonderup, M. (2019). Hepatitis C. Lancet (London, England), 394(10207), 1451–1466. Https://doi.Org/10.1016/S0140-6736(19)32320-7

[4] Kohla, M., & Bonacini, M. (2006). Pathogenesis of hepatitis C virus infection. Minerva gastroenterologica e dietologica, 52(2), 107–123. Https://pubmed.Ncbi.Nlm.Nih.Gov/16557183/

[5] Manns, M. P., & Maasoumy, B. (2022). Breakthroughs in hepatitis C research: from discovery to cure. Nature reviews. Gastroenterology & hepatology, 19(8), 533–550. Https://doi.Org/10.1038/s41575-022-00608-8

[6] Puchades Renau, L., & Berenguer, M. (2018). Introduction to hepatitis C virus infection: Overview and history of hepatitis C virus therapies. Hemodialysis international. International Symposium on Home Hemodialysis, 22 Suppl 1, S8–S21. Https://doi.Org/10.1111/hdi.12647

[7] Hoofnagle J. H. (1997). Hepatitis C: the clinical spectrum of disease. Hepatology (Baltimore, Md.), 26(3 Suppl 1), 15S–20S. Https://doi.Org/10.1002/hep.510260703

[8] Dustin, L. B., Bartolini, B., Capobianchi, M. R., & Pistello, M. (2016). Hepatitis C virus: life cycle in cells, infection and host response, and analysis of molecular markers influencing the outcome of infection and response to therapy. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 22(10), 826–832. Https://doi.Org/10.1016/j.Cmi.2016.08.025

[9] Delahooke T. E. (2004). Hepatitis C: What is the nature of the problem?. Journal of viral hepatitis, 11 Suppl 1, 5–11. Https://doi.Org/10.1111/j.1365-2893.2004.00569.X

[10] Boyer, N., & Marcellin, P. (2000). Pathogenesis, diagnosis and management of hepatitis C. Journal of hepatology, 32(1 Suppl), 98–112. Https://doi.Org/10.1016/s0168-8278(00)80419-5

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Liver Cancer Surgery

How is surgery for liver metastases improving survival rate?

Nancy Kemeny, MD

In the past, it was not useful to remove more than 3 metastases, that you would not have a long range survival. It was bad, and now with what we're doing, with resection, working with the surgeons, we're taking the tumors out. 30% live 5 years. We never had anybody alive 5 years before. So 30% live 5 years if we can get the tumor out, and now with the new work that we're doing with the hepatic arterial therapy, which means that we're putting the chemotherapy directly into the liver, we have 56% alive at 5 years, and 40% at 10 years. So we have patients with liver metastasis where you know they used to be dead in 8 months, now alive for 10 years, so we've really made progress there.

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How is surgery for liver metastases improving survival rate?

Nancy Kemeny, MD

In the past, it was not useful to remove more than 3 metastases, that you would not have a long range survival. It was bad, and now with what we're doing, with resection, working with the surgeons, we're taking the tumors out. 30% live 5 years. We never had anybody alive 5 years before. So 30% live 5 years if we can get the tumor out, and now with the new work that we're doing with the hepatic arterial therapy, which means that we're putting the chemotherapy directly into the liver, we have 56% alive at 5 years, and 40% at 10 years. So we have patients with liver metastasis where you know they used to be dead in 8 months, now alive for 10 years, so we've really made progress there.

Heat Treatment For Liver Cancer (thermal Ablation)

Ablation means to destroy. Doctors can use heat to destroy cancers that started in the liver (primary liver cancer). There are 2 types of thermal ablation used to treat liver cancer. These are: Thermal ablation is a treatment for primary liver cancer. Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases. When you might have thermal ablation Your doctor might recommend RFA or MWA if you can't have surgery to remove your cancer. This could be because: the position of the cancer makes surgery difficult (for example, if it is near a major blood vessel or the gallbladder) you are not well enough to have surgery For a very small cancer in the liver you might have thermal ablation instead of surgery. Thermal ablation is not a suitable treatment if the cancer is larger than 3cm. Or if it has spread into the blood vessels, lymph nodes or other parts of your body. You need to be generally healthy, and the rest of your liver must be working well. You can have treatment several times. You might have RFA or MWA alone, or with other treatments. Some people have thermal ablation during liver resection surgery. How do you have thermal ablation? Preparing for treatment You may have an appointment at the pre assessment clinic about a week before your treatment. This is to prepare you for the treatment and check you are well enough to have it. You might need tests such as blood tests and an ECG to check your heart. Tell your doctor if you're having medicine that changes how your blood clots. This includes: aspirin clopidogrel arthritis medicines warfarin or heparin apixaban or rivaroxaban ticagrelor Your doctor will tell you if you need to stop taking these or any other medicines for a while before your treatment. You can't eat for 4 to 6 hours before the ablation but you might be able to drink sips of water up to 2 hours before your appointment. Your doctor or nurse gives you written instructions about this before. Talk to your doctor if not eating could be a problem for you. For example, if you have diabetes. Having treatment You go into hospital on the day of your treatment or the evening before. A specialist doctor called an interventional radiologist carries out the procedure. Radiographers and nurses will also be with you in the room. First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into your arm or back of your hand. They use the cannula to give you any medicines you might need, such as antibiotics, sedation, or pain relief. Your nurse regularly checks your heart rate and blood pressure. You might have oxygen through a small plastic tube or sponge which sits just inside your nostril.  You might have RFA or MWA under general anaesthetic, which means you are unconscious. Or you will have a drug that makes you very sleepy (sedation) and a local anaesthetic to numb the skin above the liver. You will also have strong painkillers during treatment. Your radiologist uses either an ultrasound scan or a CT scan to guide a special needle through your skin into the cancer. Once it is in the correct place, the needle is heated using electrical or microwave energy. The needle heats the cancer cells and destroys them.  The time your treatment takes can vary. It can take anything from 30 minutes to a couple of hours in total.  After treatment Your doctor removes the needle when the treatment has finished and covers the area with a dressing. You go back to the ward where your nurse will monitor you. Let them know if you feel sick or have any pain. You usually have to stay in bed for a few hours after the procedure. You can start eating and drinking once you are fully awake and feel up to it. You usually stay in hospital for the night. You should be back to doing your normal activities after about a week. You usually have a scan about 4 to 6 weeks after ablation treatment to check how well it has worked. What are the side effects of thermal ablation? As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of the treatment outweighs these risks. Possible side effects of thermal ablation include: Discomfort or pain You will probably have some discomfort or mild pain where the needles went into your skin. Treatment to the liver can also cause shoulder pain. This is caused by pain travelling along a nerve near the liver, which connects to nerves in the shoulder. It's called referred pain.   You will have painkillers to take home, although you may not need to use them. Contact your healthcare team if your painkillers are not working. Also let them know if your pain isn't getting better, or if the pain gets worse.  Flu-like symptoms (post ablation syndrome) Some people have flu-like symptoms that start about 3 to 5 days after treatment. You feel tired, generally unwell, have body aches and you may feel sick. This might last 1 to 2 weeks. This is due to a side effect called post ablation syndrome. Before you go home, your healthcare team will explain this syndrome. They will go through what medicines you can take to relieve your symptoms. Contact your healthcare team if you feel unwell after this time or have a temperature above 38°C. You may have an infection that needs treatment.  Damage to the surrounding area During the procedure, there is a small risk of damaging structures near the liver. For example, damage to the bile ducts, bowel or gallbladder. This is rare because the doctor uses scans to help guide the probe to the right place. The heat only travels a short distance, so it doesn't generally affect the rest of your liver tissue. Bleeding There is a risk of bleeding caused by the needle going into the liver. This is rare. Your doctor and nurses monitor you closely during and after treatment. So if this happens, they deal with it straight away. You might need to have a procedure, such as an angiogram, to stop the bleeding. You may also have a blood transfusion if you have lost a lot of blood. Risk of your cancer coming back There is a risk that thermal ablation does not completely get rid of the cancer. Or that it grows back (recurs). You may be able to have the area treated again. This can be done a few weeks after the first ablation.

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