2015 How can we increase the survival rate of people with cancer? JOSH, DARREN AND DANE IVANHOE GRAMMAR SCHOOL | [Company address] 1 What is cancer and cell growth? Cancer is a group of more than one hundred separate diseases. These diseases are all characterized by an abnormal and unregulated growth of cells. This growth destroys surrounding body tissues and may spread to other parts of the body in a process that is known as metastasis. Cells are continuously receiving messages form their genes and other cells, some tell them to grow and others tell them to stop. A cancer cells messages to grow are altered and the messages to stop the growth of cells are missing. Then the cells begin to divide uncontrollably and too often. How long do cancer cells live for? Every time a normal cell divides, the ends of its chromosomes become shorter. Once they have worn down, the cell dies and is replaced. Cancer cells are different from this system - they retain their long chromosomes by continually adding bits back on. This process allows cancer cells to live forever. Cells from Henrietta Lacks, an American woman who was diagnosed with cervical cancer in 1951, are still growing. They are used in research laboratories all over the world, many years following her death. How do cancer cells travel around the body? 2 Most of the normal cells inside your body just stay put around its surroundings and are stuck to each other. If they are attached to something they are able to multiply at a steady rate. However once the normal cells are detached to from their neighbours they are unable to multiply and produce more cells, thus they commit suicide by using a process called apoptosis. In cancer cells the instruction to self-destroy doesn’t work and even though they are not attached to anything they can still multiply at a fast rate. This allows the cancer cells to spread though out the body, travelling via the bloodstream and start more tumours on parts of the body (this is also known as metastasis). Why are genes lost in cancer cells? When healthy human cells divide, they copy all of genes which are bundled up into 46 chromosomes. The that does this is very complicated and goes through checkpoints to ensure that each cell gets an immaculate copy. In cancer cells the checkpoints are missing. The result of this is chaos as parts of chromosomes may be lost, rearranged or copied many and the genes are more likely to acquire further mutations. of these may allow the cell to escape other checking and mechanisms. Why are cancer cells so powerful? 3 their process several often times Some repair All the cells in your body normally work together to help each other. However the reason cancer cells are so powerful is because once it acquires a gene mutation it starts to multiply unnaturally. These cells then become the dominant ones and spread throughout the body, while other cells die. Eventually, the abnormal cells acquire mutations in more genes, causing uncontrolled growth. This is like natural selection in evolution, where a species that produces more offspring has a better chance of survival. They are also able to avoid apoptosis because cancer cells don’t have the order to self-destroy itself. Why don’t cancer cells die normally? In normal cells, gene damage is usually quickly repaired. If the damage is too severe, the cell is forced to die. An important protein called p53 checks for gene damage in normal cells, and kills them if the damage is too great to repair. However, in cancer cells these checking mechanisms are defective. Cancer cells often have an altered p53 protein, which does not work properly, allowing cancer cells to survive, despite their dangerously garbled genetic material. 4 What is the liver? The liver is in the upper right part of the abdomen. It has many functions which include: Storing glycogen (fuel for the body) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream. Helping to process fats and proteins from digested food. Making proteins that are essential for blood to clot (clotting factors). Helping to process and/or remove alcohol, many types of medicines, toxins and poisons from the body. Making bile which passes from the liver to the gut down the bile duct. Bile breaks down the fats in food so that they can be absorbed from the bowel. What is primary liver cancer? Cancer of the liver can be divided into primary liver cancer and secondary liver cancer: Primary liver cancer means that the cancer started (originated) in the liver. In the UK, primary liver cancer is uncommon. There are around 3,000 cases of primary liver cancer each year in the UK. It occurs most commonly in people aged over 65 years. However, worldwide, it is one of the most common cancers. Secondary (metastatic) liver cancer means that a cancer which started in another part of the body has spread to the liver. Many types of cancer can spread to the liver. Most commonly, cancers of the bowel, pancreas, stomach, lung or breast. The behaviour, treatment and outlook of secondary liver cancers are often quite different to primary liver cancer. There are different types of primary liver cancer which include: Hepatoma. This is the most common type (about 9 in 10 cases). It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. (The bulk of the liver is made up from hepatocytes). A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis (scarring of the liver) or types of hepatitis (liver inflammation). Fibrolamellar hepatoma is a rare subtype of hepatoma. It typically develops in a liver which was previously healthy. 5 Cholangiocarcinoma. This is uncommon. It develops from cells which line the bile duct. Hepatoblastoma. This is a rare cancer which occurs in some young children. Angiosarcoma. This is rare. It develops from blood vessel cells within the liver. What causes primary liver cancer? A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. Most people who develop a primary liver cancer have one or more of the following risk factors which seem to make liver cells more prone to becoming cancerous: Cirrhosis. This is a condition which causes scarring of the liver. It tends to progress slowly. In the UK, the common causes of cirrhosis are heavy alcohol drinking, and infection with hepatitis C. However, there are various other causes of cirrhosis. Long-term infection with the hepatitis B or hepatitis C virus. It typically takes 20-30 years after first becoming infected to develop primary liver cancer. Infection with these viruses is not common in the UK, but it is becoming more common. However, these are common infections worldwide, particularly in Asia and Africa. Many young children in these areas are infected with the hepatitis B virus. This is why primary liver cancer is a common cancer in young adults in these areas of the world (developing 20-30 years after first being infected). Ingesting some poisons or toxins. For example, a known risk factor is a poison called aflatoxin which contaminates some foods (for example, mouldy peanuts), mainly in developing countries. Some conditions which cause persistent inflammation of the gut increase the risk slightly of developing a cholangiocarcinoma (an uncommon type of primary liver cancer). There is some evidence that smoking can increase the risk. A parasitic infection (liver fluke) which mainly occurs in Africa and Asia increases the risk of developing a cholangiocarcinoma. What are the symptoms of primary liver cancer? There may be no symptoms in the early stage of the disease. As the cancer grows, the first symptoms to develop may be quite vague and nonspecific. For example, feeling generally unwell, feeling sick (nausea), loss of appetite, weight loss and tiredness. Many people who develop primary liver cancer will already have symptoms associated with cirrhosis. If you already have cirrhosis and your health becomes worse quite quickly, the cause may be a liver cancer which has developed. As the cancer develops further, more specific symptoms which may also develop include: 6 Abdominal pain over the liver area. Jaundice. Jaundice is when you go yellow. You tend to first notice it when the whites of the eyes become yellow. It is due to a build-up of the chemical bilirubin which is made in the liver. This occurs if the bile duct becomes blocked by the cancer. Bile and bilirubin cannot drain out from the liver and so leak into the bloodstream. Itch (caused by the jaundice). Swelling of the abdomen. This can be due to the growing cancer itself. It may also be due to ascites which is fluid that builds up in the abdomen which occurs with various liver disorders. How is cancer of the liver diagnosed and assessed? Screening Screening using ultrasound, and sometimes also a blood test for alpha-fetoprotein (AFP), at 6- to 12-month intervals, has been recommended for people at high risk of liver cancer. This includes people with liver cirrhosis associated with infection with hepatitis B or hepatitis C virus. This can detect liver cancer at an earlier stage and therefore improve the chance of successful treatment. Initial assessment If liver cancer is suspected, you are likely to have a number of tests. These aim to: Confirm that you have a cancer in the liver. Also, that the cancer is a primary liver cancer and not a secondary liver cancer. Assess the stage of the cancer. That is, how much of the liver is affected and whether the cancer has spread to other parts of the body. Assess the state of your liver function and your general health. Therefore, a range of tests are usually needed. They may include: Scans such as ultrasound scan, CT scan or MRI scan. These can help to show the exact location and extent of the cancer. A liver biopsy. This is usually done to confirm the type of cancer. A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. Blood tests help to assess the liver function and your general health. Other tests may be done if the above do not clarify the situation. For example, alaparoscopy is sometimes done. This is a small operation to look inside the abdomen with a flexible telescope. 7 What is the outlook? Overall, the outlook is poor. Many people who develop primary liver cancer are already in poor health with cirrhosis. The best chance of a cure is with surgery when the cancer is small, has not spread from the liver, and the rest of your liver is relatively healthy. However, this situation only occurs in a minority of cases. The various other treatments described above may delay the progression of the disease, but are not often curative. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment. 8 Prostate Cancer What is the prostate? Only men have a prostate. It is a small gland that sits below the bladder near the rectum. It surrounds the urethra, the passage in the penis through which urine and semen pass. The prostate gland is part of the male reproductive system. It produces most of the fluid that makes up semen that enriches sperm. The prostate needs the male hormone testosterone to grow and develop. The prostate is often described as being the size of a walnut and it is normal for it to grow as men age. Sometimes this can cause problems, such as difficulty urinating. These problems are common in older men and not always symptoms or signs of cancer. What is prostate cancer Prostate cancer Is the abnormal growth of cells inside the prostate, and sometimes can be spread to other parts the body outside of the prostate. Research hasn't yet found an exact cause of prostate cancer, but on a basic level prostate cancer is caused by the changes of DNA in the prostate cells. Prostate cancer is generally a slow growing disease and the majority of men with low grade prostate cancer live for many years without symptoms and without it spreading and becoming life-threatening. However, high grade disease spreads quickly and can be lethal. What are the symptoms of prostate cancer? During the early stages, there may be no symptoms. In the later stages, some symptoms of prostate cancer might include: Feeling the frequent or sudden need to urinate Finding it difficult to urinate (for example, trouble starting or not being able to urinate when the feeling is there or poor urine flow) Discomfort when urinating Finding blood in urine or semen Pain in the lower back, upper thighs or hips. However having these symptoms may not mean you have prostate cancer, but if you experience any of them, it is recommended that you go see a doctor. 9 What are the risks of developing prostate cancer? Age: The risks of developing prostate cancer increase with age. The risk of men getting prostate cancer by the age of 25 is 1 in 7 men. By the age of 85 the chances will increase to 1 in 5 men. Family history: The chances of getting prostate cancer will also increase if you have a male relative that had been diagnosed with prostate cancer in the past. Genetics: Genes are found all over the body in every cell. They control the way our cells behave. Every person have thousands of genes that were pasted on from their parents, changes to these genes can increase the risks of prostate cancer. Although prostate cancer can't be inherited, it can increase the risks of getting prostate cancer. Diet: There is some evidence to suggest that eating a lot of processed meat or food that is high in fat can increase the risk of developing prostate cancer. Lifestyle: There is evidence to show that environment and lifestyle can affect the risk of developing prostate cancer. How is prostate cancer detected? A doctor will usually do both a blood test and a physical test to check the health of the prostate. Blood test: The result shows whether there is an increase in this specific protein. Depending on the result, you might need further investigation by a specialist. A high PSA test result does not necessarily mean cancer. Prostate diseases other than cancer can also cause a higher than normal PSA level. Digital Rectal Examination (DRE): Because of where the prostate is located, the doctor inserts a gloved, lubricated finger into the rectum to check the size of the prostate and sees if there are any abnormalities. A normal DRE result does not rule out prostate cancer. How does prostate cancer get treated? If you do happen to have prostate cancer the first step Is a biopsy. A biopsy is the only way a firm diagnosis of prostate cancer can be made. A urologist removes small samples of tissue from your prostate, using very thin, hollow needles guided by an ultrasound. The prostate is either accessed through the rectum or the perineum (transperineal), which is the area between the anus and the scrotum. A biopsy is usually done as an out-patient procedure and the doctor will likely advise a course of antibiotics 10 afterwards to reduce the chance of infection. The tissue is sent to a pathologist to identify whether the cells are malignant (cancerous) or benign (not cancerous). 11 Brain Cancer What Is Brain Cancer?: Brain cancer depends on there being a tumor in the brain. This tumor starts in the brain and generally never spreads to another part of the body. Secondary tumours (or metastases) are caused by a tumor in another part if the body. There are over 40 major types of brain tumours, these are grouped in two main types, benign and malignant. Benign tumours take time to grow and are more than likely to not spread. Some of the common benign tumours are meningiomas, neuromas, pituitary tumours and cranio-pharyngiomas. Malignant tumours on the other hand are very cancerous and can easily spread to other areas of the brain or spinal cord. Common types include astrocytomas, oligodendrogliomas, ependymomas, glioblastomas and mixed gliomas. Statistics about Brain Cancer: 2010: In Australia 1,680 people were diagnosed with brain cancer Brain tumours are the leading cause cancer-related deaths in children (male and female) under the age of 20 (with leukemia being the first) Brain tumours are the second leading cause of cancer-related deaths in males aged 20-29 (with leukemia being the first) Brain tumours are the fifth leading cause of cancer-related deaths in women aged 20-39 This year there will be nearly 70,000 new cases of brain cancer will be diagnosed this year. More than 4,600 children aged between the ages of 0-19 will be diagnosed with a brain tumor this year. Brain and central nervous systems tumours are the most common cancers amoung children aged 0-19 There is nearly 700,000 people in the U.S living with a brain tumor This year, nearly 14,000 people will die of a brain tumor There are more than 120 types of brain tumours (Statistics sourced from; http://www.abta.org/about-us/news/brain-tumorstatistics/) 12 How Do We Treat Brain Cancer?: There are many ways of treating brain cancer, some of these treatments include: Surgery Radiotherapy Chemotherapy Steroids Surgery is used to: Find out what type of tumor that the patient has Try to remove the whole tumor or try to cure it Try to remove as much of the tumor as possible to slow the growth and improve symptoms Try to remove as much of the tumor as possible to improve the effectiveness of other treatments Insert chemotherapy wafers into the tumor Put in a tube (shunt) try drain fluid from the brain and relieve pressure Put in a small plastic capsule (an Ommaya reservoir or ventricular access device) under the scalp so that cancer drugs can be injected into it Radiotherapy is used to: Radiotherapy is carried out by using high energy waves (X-rays) to treat the brain tumor. If a surgeon tried and couldn’t remove the brain tumor radiotherapy could be used as a main treatment To treat any tumor that a surgeon couldn’t remove To try and lower the risk of the brain tumor coming back in the future Radiotherapy is generally performed over a 5-7 week period. A patient wanting radiotherapy will have to go to the hospital and have it performed every day for the 5-7 week period from Monday-Friday. Sometimes patients will be required to come in and have the treatment twice in one day. If you’re having a shorting radiotherapy course it would generally last for a two week period. 13 Patients may have chemotherapy for any of the following situations: After surgery chemotherapy is can be used to prevent the tumor from coming back Chemotherapy may be used in company with radiotherapy, this would be the most efficient approach. To treat a tumor that has already been treated but has come back again. Chemotherapy does not work for every type of brain tumor. So it is not suggested that is it used for every type. The following will list will list the brain tumours that would be effected by chemotherapy: High grade glioma Gliomas in children Oligodendroglioma Ependymoma High grade meningioma that has come back Primitive neuroectodermal tumours (PNETs) in children Primitive neuroectodermal tumour that has come back Germinomas of the pineal gland Other pineal region tumours Spinal tumours in children Primary lymphoma of the central nervous system A secondary brain tumour that has spread to the brain from cancer somewhere else in the body (Cancers sourced from; http://www.cancerresearchuk.org/) How can we prevent getting brain cancer?: Although we cannot prevent brain cancer, early detection is looking like a very promising way to minimize the risk of getting cancer in later life. Nobody really knows what causes brain cancer, especially primary cancer. 14 What Organisations are Focusing On cancer Research? What are They Doing to Find a Cure? Cancer is a massive problem in our lives, cancer is continuing to become more aggressive and effect many more people per year… 3 in 10 of Australian deaths are a result of cancer, also 1 in 2 men and 1 in 3 women in Australia will be diagnosed with cancer in their lifetimes. So what are we all doing to minimize these figures?? There are many organisations trying to work on a cure and accumulate enough funding money to eliminate all cancers from our lives. Some of these organisations are… Australian Cancer Council (ACC) American National Cancer Institute (NCI) World Health Organisation (WHO) International Agency for Research On Cancer (IARC) Union for International Cancer Control (UICC) American Association for Cancer Research (AACR) These are just some of the popular Australian and international cancer research foundations that are focusing on finding a cure for cancer… What cures for cancer do we already use clinically? What will we be researching further in the future? Currently there are many ways of trying to get rid of cancer, yet they are improvements on what we have had in the past, they are not ideal, some of these treatments are… Surgery: Surgery can be used to remove a cancerous tumor/s that are attached to an organ or causing bleeding inside of the body. Radiotherapy: Radiotherapy (often called radiation therapy or x-ray therapy) uses high energy radiation to eliminate cancer cells or to stop the cells growth. Radiotherapy is generally performed externally, through the skin, but the radiation can also be delivered internally (brachytherapy) in small quantities in or near where the cancer is located. Radiotherapy is generally accompanied by 15 other treatment, it is usually used to also relieve pain and discomfort associated with incurable disease. Chemotherapy: Chemotherapy is generally always used with other forms of cancer treatments; chemotherapy is not able to destroy most solid cancers when used without an alternative treatment. Many cancers rely on particular hormones to be able to grow. Chemotherapy suppresses the body’s hormone production so the cancer does no longer have the sources that it needs to be able to survive, therefore the cancer is weakened or destroyed. Hormone Therapy: Hormone therapy is affectively used by surgically removing glands that are in charge of producing particular hormones that some cancer rely on to grow. Hormone therapy is generally used for breast, prostate and uterine cancers Complementary and Alternative Treatments: There are also treatments that are used to help cure cancer but many to all of them are not recommended by the ‘Cancer Council’ because they are not the most absolute and affective forms of treatment. These treatments mentioned above are working fairly efficiently for now, but with the rise in cancer cases and deaths, we need to discover a more affective and widespread cure. Cancer researchers around the world are working and competing to be the first to find the cure for cancer, so now we will look at some new and upcoming approaches from around the world that possibly could revolutionise the medical world. Some upcoming approaches to curing cancer are. Drugs: Similar to chemotherapy, the drug that is looking promising is one that targets a particular protein called Her2. Some tumours have been found to have abnormally high amounts of the protein Her2 in them, this suggests that the tumor needs this protein to grow. Therefore this drug will be able to diminish a certain amount of Her2 from the body, taking effect on the tumor and delaying or completely stopping its growth. Toxic Compounds: Toxic compounds are a promising approach to curing cancer because it involves directly injecting a compound into the cancer cells and 16 destroying them. This method is effective because much like the drug mentioned above, toxic compounds target proteins like Her2 that are abundant on the surface. Antibodies targeting these proteins can be infused with a toxin, or made to carry an enzyme that cleaves a harmless ‘prodrug’ into a toxin molecule. In the future the one molecule of an enzyme can then produce a large quantity of toxic molecules. Another plus to using this method is that the enzyme, after it has killed the first tumor, can then carry on to find any neigh boring tumor cells, this increasing the chance of that tumour to also be killed, even if the enzyme wasn’t originally injected there in the first place. Attack On p53: This ingenious method of killing cancers cells relies on the cancer cells having a lack of p53 (The tumor suppressor gene is found mutated in about half of human cancers, It encodes a gene regulatory protein that is activated by damage to DNA and is involved in blocking further progression through the cell cycle; definition sighted from, http://www.ncbi.nlm.nih.gov). This method is performed by infecting the cancer cells with a certain virus like the papillomaviruses and the adenoviruses. These viruses take effect by encoding proteins that bind to and disable the host cells p53 attaching to and disabling the p53. This allows the viruses to outsmart the p53’s poor defences and freely mutate their own genomes inside of it. These proteins continually grow inside of the cancer cell and them eventually burst outside if the host cell and attach to the neighbouring cell. Although this method is highly effective for killing cancer cells with p53 present inside of them, cancer cells not containing p53 will remained unharmed. Due to this, if the toxic proteins are directly injected into a tumor, it would be expected that only the cells with p53 present will be destroyed, leaving cancer cells not containing p53 unharmed. This method is currently undergoing clinical trials. These methods of curing cancer mentioned above are all positive up and coming ways of dealing with this horrible problem that we are facing in modern society. We are very close to being able to take control and kill many of the cancers that are killing thousands of people per year. 17 Our interview with Nick hoogenraad, a scientist here at latrobe university, was interesting, and raised many good questions. According to Professor Nick Hoogengraad, we are well on our way to curing cancer. He and some of his fellow scientists have been working on killing FN14. This is a cell receptor present in all cancer cells and present in no healthy cells. They found out about this protein through serendipity. Right now, Professor Hoogengraad and his team expect this drug to be on the shelves in anywhere up to eighteen years. He also needs more funding, and he says, “Australia is putting money into blowing up the earth, rather than being clever”. He believes that the government is not helping Australia by cutting rates, but is narrowing its future. 18 How can we decrease the risk of getting cancer? Having a healthy body weight: It has been proven that over 5% of cancers in the UK are linked to being overweight or obese. Being overweight can affect the risk of cancer because fat tissues in the body produce hormones and growth factors that can affect the way our cells work. Research has shown that there are a number of different cancers such as breast cancer, in women after menopause, bowel cancer, womb cancer, oesophageal (food pipe) cancer, gastric cardia cancer (a type of stomach cancer), pancreatic cancer, kidney cancer, gallbladder cancer and aggressive prostate cancer. More than 64% of men and about 57% of women are either overweight or obese. All together 25% of all adults are obese. A simple task like eating healthy every day and resisting the urge to get junk food can decreases the chances of becoming obese and decreasing the risk of getting cancer. Not drinking Alcohol: It has been scientifically proven that drinking alcohol can increase the risk of several different types of cancer. Every year alcohol cause around 4% of cancers around the UK which is about 12800 cases of cancers. Drinking alcohol regularly can increase the risk of mouth cancer, pharyngeal cancer (upper throat), Oesophageal cancer (food pipe), Laryngeal cancer (voice box), breast cancer, bowel cancer and liver cance 19 Rare Cancers: how far have we come? Around one fifth of Australians who are diagnosed with cancer and one third of Australians who die of cancer might reasonably have their disease classified as a rare cancer. An incidence degree of <6 cases per 100,000 population per year is what classifies a rare cancer.1 But, the average result for patients with a rare cancer is substandard to those with more recurring cancers when analysed discretely within these data ranges. For the 50% of cancer patients identified to have a common cancer type (breast, bowel, lung, melanoma, prostate and liver), five-year survival rates improved between 1982-1987 and 2006-2010.2 In contrast, there has been little change (5% or less) in the five-year survival rate for people with other rare cancer types over the same period. For example, for cervical, laryngeal and pancreatic cancer.3,4 Despite increases in five-year survival rates for liver, gall bladder and unknown primary cancers and stable rates for brain cancer, five-year survival rates remained very low for these rare cancer types (~20% or less) between 2006-2010. Better outcomes were seen for testicular (91% to 98%) and thyroid (84% to 96%) cancer. Most other patients diagnosed with one of many types of rare cancers endure a long road to diagnosis, with little specific information or evidence-based care available, even after a diagnosis is finally made. Nevertheless, three categories of rare cancer - childhood cancers, hematologic malignancies and sarcoma - have been associated with notable improvements over the last three decades, and these serve as useful guides as to how we may improve the outcome for rare cancers in general. What if we suddenly cured cancer? Would it increase the survival rate of people with cancer? If we suddenly cured cancer, we would probably increase the survival rate of people with cancer, BUT, it would not decrease the amount of people that actually get cancer. This is because cancer is not infectious, from person to person contact. The only way to stop cancer is to get it early. We can scan, use surgery, and also look for particular symptoms. We could do this by getting the education out to the population of Australia. We would also have to know what cancer each person 20 Our Answere to the big question: will we be able to increase the survival rate of people with cancer? Josh : I believe that in the near future, it will be possible to decrease the amount of peopple who die from cancer. We have already produced one type of cure for breast cancer, and we are working on a magic bullet called FN14. But I don’t believe we will be able to stop cancer from happening in the near future. This is because we would have to live in plastic to stop it from happening. Darren : I believe that in the future we will be able to increase the survivial rates of people who have cance because we have already got some cures, and a lot of funding is going into cancer research. This means that many scientists will have better facilities to better the cures that we already have, and to create new ones. As society is becoming more advanced we are able to use better technology and equipment that may help us during cancer treatment and prevention. Dane: …………… 21 Glossary Hepatitis B = A liver illness caused by hep B virus. The virus affects people differently: Most adults clear their infection and have no further problems.Many babies and children don't clear it and may have liver problems later in life. Hepatitis C = A liver illness caused by hep C virus. Most people don't clear the virus and have the illness for life. The illness can cause liver problems. Aflotoxins = The aflatoxins are a group of chemically similar toxic fungal metabolites (mycotoxins) produced by certain moulds of the genus Aspergillus growing on a number of raw food commodities. Aflatoxins are highly toxic compounds and can cause both acute and chronic toxicity in humans and many other animals. Ultrasound scan = sound or other vibrations having an ultrasonic frequency, particularly as used in medical imaging. MRI scan = Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, MRI gives different information about structures in the body than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan. 22 Websites: http://www.abta.org/ http://www.cancer.org.au/ http://www.ncbi.nlm.nih.gov/ http://www.cancerresearchuk.org/ http://www.cancer.org.au/about-cancer/faq.html http://www.sciencemuseum.org.uk/about_us/~/link.aspx?_id=540545C11DAF417DA4BC56661C6A6203&_z=z https://acrf.com.au/on-cancer/liver-cancer/ http://canceraustralia.gov.au/affected-cancer/cancer-types/liver-cancer/liver-cancer-statistics http://cancerforum.org.au/ http://cancerforum.org.au/Issues/2015/March/Forum/Rare-Cancers-how-far-have-we-come.htm http://www.cancerresearchuk.org/about-cancer/type/liver-cancer/treatment/the-stages-of-primary-liver-cancer https://acrf.com.au/cancer-research-grants/cancer-research-projects/ Books: Gatta G, van der Zwan JM, Casali PG, et al. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011;47(17):2493-2511. AIHW. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. CAN 65. Canberra: Australian Institute of Health and Welfare 2012. Keat N, Law K, McConnell A, et al. International Rare Cancers Initiative (IRCI). Ecancermedicalscience. 2013;7:ed20. Australia RC. A Little More Time, Report. 2014. 23