British tennis star and former women's number one, Elena Baltacha, has died of liver cancer at the age of 30.
Baltacha died at her home early on Sunday morning surrounded by friends and family and with her husband Nino Severino at her side.
The sports star was diagnosed with the illness in January, just two months after retiring from tennis and only weeks after she married her long-term coach.
According to the NHS, liver cancer is a rare but serious form of the disease.
In the UK, almost 4000 new cases of liver cancer are diagnosed each year. Around 60% of cases affect men and 40% affect women. The number of people affected by liver cancer rises sharply with age, about 70% of cases involve people 65 years of age or older.
We spoke to consultant medical oncologist at London Bridge Hospital, Dr Debashis Sarker, to find out more.
What different types of liver cancer are there?
There are two main types of liver cancer. Hepatocellular cancer (HCC) is the most common type of liver cancer, accounting for approximately 2/3 of cases, and originates from the main cells within the liver (hepatocytes) that are responsible for production of key proteins, making bile and cholesterol and breaking down toxins.
HCC usually occurs in patients with underlying long term liver damage leading to liver cirrhosis. Cholangiocarcinoma is the other main type of liver cancer and arises from the bile ducts within the liver that drain bile from the liver to the small bowel.
What are the main symptoms of the disease?
The symptoms can be quite variable and sometimes non-specific but may include jaundice, abdominal pain, nausea, weight loss, itching and fever. Some patients have very few symptoms and are diagnosed incidentally when they are being investigated for other abdominal complaints such as urine infection or gallstones.
Who is most at risk from liver cancer?
On the whole, liver cancer is more common in men than women except in younger age groups. In the UK the incidence of liver cancer is strongly related to age and an average of 70% of cases are diagnosed in men and women aged 65 years and over.
How is liver cancer usually treated?
Treatment depends on the type of liver cancer, the extent of any underlying liver damage and how far the cancer has spread.
For HCC, treatment options include liver transplantation or surgery for patients with early cancer. Other localised therapies for HCC include heating the tumour using radio waves (radio frequency ablation) or injecting chemotherapy directly into the liver and blocking off the blood supply to the tumour (chemo-embolisation). For patients with more advanced cancer drug therapy with sorafenib is often used, but HCC is often resistant to other commonly used chemotherapy drugs.
For cholangiocarcinoma, surgery is the main treatment in patients with localised disease. In more advanced cases or where the cancer has spread, chemotherapy is often used.
Elena Baltacha may have been at risk of the disease as she had primary sclerosing cholangitis - are there any other medical issues that are commonly associated with liver cancer?
Primary sclerosing cholangitis (PSC) is a very rare condition where the bile ducts inside and outside the liver become inflammed,leading to scarring, narrowing and blocked ducts, potentially causing a build-up of bile in the liver, and in some cases cirrhosis. Patients with PSC are at a high risk of developing liver cancer, especially cholangiocarcinoma.
More commonly HCC is associated with liver cirrhosis caused by hepatitis B and C viruses, chronic heavy alcohol consumption and a condition associated with diabetes and obesity called NAFLD (non-alcoholic fatty liver disease) where fat builds up in the liver and causes inflammation. Smokers also have a higher risk of developing HCC.
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