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Author Topic: Liver Cancer post-hep C treatment  (Read 15575 times)

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Offline lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Liver Cancer post-hep C treatment
« on: July 01, 2016, 11:08:54 pm »
A few months back, some of us were alarmed to read about liver cancer risk post-hep C treatment. I just finished reading Alan Franciscus's snapshot about some recent research http://www.hcvadvocate.org/:
Quote
Article: Alcohol intake increases the risk of hepatocellular
carcinoma in patients with hepatitis C virus-related compensated
cirrhosis: a prospective study—A Vandenbulcke et al.
Source: J Hepatol. 2016 May 12. pii: S0168-8278(16)30184-2. doi: 10.1016/j.jhep.2016.04.031. [Epub ahead of print]
Study Aims and Results
The current study looked at the effect of alcohol consumption
and hepatitis C (HCV) treatment cure on the
risk of the development of liver cancer (hepatocellular
carcinoma (HCC)). The study authors collected information
on the amount of alcohol consumed by 192 HCV
p atients with HCV-related compensated cirrhosis.
Seventy-four patients consumed an average of 15 grams
of alcohol a day—the equivalent of a little more than one
12-ounce beer a day. Sixty-eight patients were cured
of HCV. The patients in the study were followed for an
average of 58 months. Thirty-three patients developed
liver cancer. Fifty-three patients experienced at least
o ne decompensation event (varices, asities, etc.,).
The 5-year cumulative incidence rate of liver cancer
was 10.6% in alcohol abstainers vs. 23.8% in alcohol
consumers. In persons who were treated and cured of
HCV, the liver cancer was 2.0% compared to 21.7% in
the patients not cured of HCV.
Those who did not drink alcohol and were cured of HCV
had the lowest incidence of liver cancer –0% followed by
t h ose who did drink alcohol but were cured of HCV (6.2%).
Patients who did not drink alcohol and who did not
achieve a cure of HCV had a cancer rate of 15.9%
compared to those who had consumed alcohol and not
c ured of HCV had a cancer incidence of 29.2%.
Importantly, it was noted that alcohol intake did not
i n fluence the risk of decompensation or death.
Editorial Comments
This was a small study, but it is important because it does
point to the fact that alcohol combined with HCV-related
cirrhosis can contribute to the development of liver cancer.
The people who drank alcohol in the study consumed
small amounts of alcohol. This study makes it clear that
p eople with cirrhosis should abstain from alcohol.
There is a need for more studies on the role of alcohol
and liver cancer.

Why this is important - these numbers are small (as were the post-treatment data showing risk of liver cancer), but it brings up the question that alcohol use may be the problem. Even a small amount raised the risk. This convinced me to recommend no alcohol use, even if one is cured.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline BillT

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Re: Liver Cancer post-hep C treatment
« Reply #1 on: July 02, 2016, 12:41:07 pm »
I'm not sure you can tie the Hep C cures to this Lucinda.People with cirrhosis are much more likely to get liver cancer to begin with.If they're drinking on top of that they're playing with fire.It's a interesting study but I don't think it's really anything new.If the incidence of liver cancer in those that are non-cirrhotic went up after treatment then I would say new research would need to be done.   
« Last Edit: July 02, 2016, 12:55:25 pm by BillT »
Contracted 1973 Military
Diagnosed 1980
Pegintron treatment 2004 unsucessful
Genotype 1b
FibroScan 10 (F2)
Start Viekira 10.17.2015

AST 40 ALT 69
VL 440k
10.31.2015/Week 2 Labs : AST 14/ALT 17
No VL done
10.14.2015/Week 4 labs : AST 14/ALT 14
VL UNDETECTED!!!
12.11.2015/Week 8 Labs : AST 12/ALT 13
No VL done
01.05.2016/EOT labs : AST 15/ALT 13
VL UNDETECTED!!!

12 WEEK SRV:UN-BLOODY DETECTABLE !!!!!!!!

24 WEEK SVR:UNDETECTABLE!!!! Thank You God.

Fibroscan 6Mo. Post Treatment 7.15.2016-5.3(F1)

Offline lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Re: Liver Cancer post-hep C treatment
« Reply #2 on: July 03, 2016, 07:32:34 pm »
I don't think we can tie them together, but I also think that we have to be careful about rushing to conclusions regarding the data we are seeing. Mostly I am making an appeal for open-mindedness.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline BillT

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Re: Liver Cancer post-hep C treatment
« Reply #3 on: July 04, 2016, 08:41:15 am »
I agree.These are new drugs so there's a lot of long term data that needs to be looked at.I know some people are having post treatment problems,but the majority of us coming out fine.Each and every one of us are handling these treatments differently.
Contracted 1973 Military
Diagnosed 1980
Pegintron treatment 2004 unsucessful
Genotype 1b
FibroScan 10 (F2)
Start Viekira 10.17.2015

AST 40 ALT 69
VL 440k
10.31.2015/Week 2 Labs : AST 14/ALT 17
No VL done
10.14.2015/Week 4 labs : AST 14/ALT 14
VL UNDETECTED!!!
12.11.2015/Week 8 Labs : AST 12/ALT 13
No VL done
01.05.2016/EOT labs : AST 15/ALT 13
VL UNDETECTED!!!

12 WEEK SRV:UN-BLOODY DETECTABLE !!!!!!!!

24 WEEK SVR:UNDETECTABLE!!!! Thank You God.

Fibroscan 6Mo. Post Treatment 7.15.2016-5.3(F1)

Offline dragonslayer

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Re: Liver Cancer post-hep C treatment
« Reply #4 on: July 04, 2016, 03:58:02 pm »
Kind of scary...  The cohort for this study was only patients who have cirrhosis, correct?
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Re: Liver Cancer post-hep C treatment
« Reply #5 on: July 04, 2016, 04:19:14 pm »
Yes, they all had cirrhosis. But if you look at liver cancer studies in general, alcohol use increases the risk. What is especially disturbing about this study is the amount of alcohol associated with the risk of liver CA was quite small.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline dragonslayer

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Re: Liver Cancer post-hep C treatment
« Reply #6 on: July 05, 2016, 02:22:38 pm »
Yes, they all had cirrhosis. But if you look at liver cancer studies in general, alcohol use increases the risk. What is especially disturbing about this study is the amount of alcohol associated with the risk of liver CA was quite small.

Thats what impressed me; the tiny amount of alcohol required to cause these negative results... Ive been clear of virus for about a year and a half; both of my biopsies had me in the 0-1 stage, and I never was told I had any liver damage nor have any tests ever indicated liver problems other than the liver function tests which since treatment have been solid in the low normal range..... Ive felt pretty great since treatment ended, and hence, I've allowed myself the occasional beer.    The fact that Ive felt no ill effects from doing so has positively reinforced this behavior.   I feel that since all signs are normal, this behavior will have no worse effects for me and my liver than it would for the average joe..  Am I deluding myself?   My consumption would best be described as light to moderate  with moderate for men being described up to the equivalent of 2 beers/day, but I dont do this every day...  Thanks.
« Last Edit: July 05, 2016, 02:26:22 pm by dragonslayer »
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline lporterrn

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  • LucindaPorterRN
    • LucindaPorterRN
Re: Liver Cancer post-hep C treatment
« Reply #7 on: July 05, 2016, 08:23:38 pm »
Honestly, I can't answer that. I am blessed by the fact that I can't drink for other reasons, and I don't know what I'd do if I could drink. These little joys, such an occasional beer, are part of life's pleasures. However, alcohol inflames, and does nothing to improve the liver, or cancer in general. I think we weigh the risks and decide what we can live with. You don't have cirrhosis, so the risk is likely small.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline Lynn K

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  • Get tested, get treated, get cured, fight Hep c!
Re: Liver Cancer post-hep C treatment
« Reply #8 on: July 05, 2016, 10:36:11 pm »
For me with well established cirrhosis diagnosed 8.5 years ago this just takes away the thought of maybe having a glass of champagne on any new years celebration

Maybe when I am 90

Cheers
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline dragonslayer

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  • Posts: 873
Re: Liver Cancer post-hep C treatment
« Reply #9 on: July 06, 2016, 12:19:54 pm »
Hey Lynn.... I feel ya!  Any chance some of that damage will revert?  Ive read of some people having pretty amazing results...

While I was on treatment, and for about a year before, I abstained pretty much completely..  I had nothing on treatment, and for the year before, maybe had a total of 4 glasses of wine.   Im thinking one of the reasons my liver remained so relatively undamaged, considering I had the disease for near 40 years, since the early 70s, is that from about 1985 through about 2009, I didnt have a drop.   I had no idea I even had it until 2008 when I was diagnosed.. Interestingly, I was diagnosed with hepatitis back around 1972.  I turned yellow, peed brown, itched like a mosquito factory, and had to take a semester off from college.   I assumed it was hepatitis B, and I still carry those antibodies, but since my HCV diagnosis, Im thinking maybe that was when I got HCV infected as well.  My nefarious behavior continued on another couple of years after that 1972 diagnosis, so its possible I could have gotten it then, but all that behavior stopped in 1975.

So if longevity of infection were that predictive of liver health, Id be in the ground already...... While weaning myself off that bad behavior, I was drinking plenty regularly, but that pretty much stopped in 1985.

Maybe one day theyll figure out more precisely why two people with the same disease and the same behavior can have such different liver outcomes.

Best to you!
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

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Re: Liver Cancer post-hep C treatment
« Reply #10 on: July 06, 2016, 02:02:43 pm »
Thanks Paul

I was a moderate to occasionally heavy drinker until I was told on my Jan 08 biopsy I had cirrhosis. Stopped drinking then. With each biopsy over the years I went from F1 (1993) to F2 (1998) to F3 (2003) to F4.

I have some edema in my lower legs and I have had some ascities seen on ultrasound but that was not seen on my most recent one (yay) and I had esophageal varicies that required banding. My platelets were around 80 to 90 range but in last CBC they were up to 110. My pre treatment fibroscan was 27 (Oct 2014) my repeat fibroscan in April 2016 was 33.

I have read 50% with cirrhosis may regress some have said the odds are better than that so far I have had small improvements as shown by the platelet count and the ascities apparently gone but my fibroscan score not so much.

But none the less my liver is still limping along so if this is the best I can get I am fine with that as long as I don't get HCC I will be ok with what I have.
« Last Edit: July 06, 2016, 02:08:03 pm by Lynn K »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline FutureThinker

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  • Posts: 711
  • Onward and upward!
Re: Liver Cancer post-hep C treatment
« Reply #11 on: July 06, 2016, 02:59:27 pm »
One thing I've really learned to appreciate on this forum is just how totally amazing the liver is!!! I am hopeful that all of us get on to having normal lives with good liver function again. What a journey.......  FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Lynn K

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Re: Liver Cancer post-hep C treatment
« Reply #12 on: July 06, 2016, 03:15:35 pm »
A lot depends on how much liver tissue remains and how much is totally dead scar tissue. In cirrhosis that is what occurs, healthy liver tissue is replaced by scar tissue that is incapable of regeneration so it all depends on how much viable liver tissue is available.
« Last Edit: July 06, 2016, 05:05:46 pm by Lynn K »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Liver Cancer post-hep C treatment
« Reply #13 on: July 06, 2016, 03:21:04 pm »
You are absolutely right, and this is the primary reason this disease must be treated early, before significant fibrosis occurs!! This nonsense by the ins. industry asking most of us to "wait to get more sick" is just that -- malpractice and nonsense.  FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Lynn K

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  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: Liver Cancer post-hep C treatment
« Reply #14 on: July 06, 2016, 05:09:22 pm »
And for those of us who treated before without success until these new medicines became available and already with cirrhosis we will just have to see what happens if we do have any improvement with time
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline dragonslayer

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Re: Liver Cancer post-hep C treatment
« Reply #15 on: July 06, 2016, 05:17:29 pm »
Just as early treatment is vital, so is early diagnosis.   If you dont know you have it, you cant alter your behavior accordingly, as of course, you should.    Just knowing about it at least gives you a fighting chance to mend your evil ways before your liver is trashed...  But without knowing, you dont really have a chance.   
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

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Re: Liver Cancer post-hep C treatment
« Reply #16 on: July 06, 2016, 05:35:55 pm »
Back when I was diagnosed with hep c my gastro said I could drink about 12 alcohol drinks a year and not all at once I was F1 then. Drank like that or less at times and at other times I did tie on on maybe half a dozen times over the years.

So it is what it is for me anyway...
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline dragonslayer

  • Member
  • Posts: 873
Re: Liver Cancer post-hep C treatment
« Reply #17 on: July 06, 2016, 06:02:16 pm »
Back when I was diagnosed with hep c my gastro said I could drink about 12 alcohol drinks a year and not all at once I was F1 then. Drank like that or less at times and at other times I did tie on on maybe half a dozen times over the years.

So it is what it is for me anyway...

To me, that doesnt sound like all that much.   Truth is, you really dont know now much of a factor in your F4 status that was.. Dont beat yourself up too much about it; it might have had relatively little to do with it.
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Lynn K

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  • Get tested, get treated, get cured, fight Hep c!
Re: Liver Cancer post-hep C treatment
« Reply #18 on: July 06, 2016, 07:21:10 pm »
I just decided as there was no cure for me I just wanted to live my life who knows if it made any difference and all water under the bridge now any who ;)
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline gnatcatcher

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Re: Liver Cancer post-hep C treatment
« Reply #19 on: July 07, 2016, 02:04:25 am »
To me, that doesnt sound like all that much.   Truth is, you really dont know now much of a factor in your F4 status that was.. Dont beat yourself up too much about it; it might have had relatively little to do with it.

Yeah, Lynn -- no need to beat yourself up -- I got to F4 without drinking any alcoholic beverages ;)
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline Onefluover

  • Member
  • Posts: 41
Re: Liver Cancer post-hep C treatment
« Reply #20 on: July 07, 2016, 10:53:20 pm »
I made hundreds of gallons of "pruno" in the hole of San Quentin. I never once drank a single drop of it. I did it out of boredom and either flushed it or gave it to the guys down the tier. I didn't drink it because I have always viewed alcohol as poison. Not a delicious, harmless drink... This from a guy who on many occasions had to "tie off" several cellies by choking their necks so they could inject themselves with heroine into their jugglers because their other veins were wiped out. In my opinion, alcohol is no different than heroine. It's poison. It's just a couple steps from turpentine which will kill you almost instantly. Anyone who has had Hepatitis C and has had the grace to of been cured should never take the drug, alcohol, again. It is not our friend.
51 M HAV/HBV Im., HCV-G3a
Fibrospect 2 <16 (F0/1) VL 4M
Expsd 1984-1992 (?) dx 1992
First tx attempt 2015
Liver 18.6 cm, relatively course & echogenic w/ diffuse hepatocellular process. 
Abnormal labs: ALT 163, AST 73, Chol 118, HDL Chol 30, IGA .05, Ferritin 648, Iron Bind Cap 296, Iron Sat 60%
Signs & symptoms: Freq. severe headache, very high BP, abdominal pain, distentia, joint pain, dbl vis., white nails, Schamberg's Dis., nausea, mild Jaundice, dark urine, non-hereditary Hemochromatosis.

 


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