Hepatocellular carcinoma (HCC) is a prevalent form of liver cancer. A stroke occurs when blood flow to a part of the brain is interrupted, either by a blockage (ischemic stroke) or a burst blood vessel (hemorrhagic stroke). This article explores the connections between HCC and an elevated risk of stroke.
How Liver Cancer Increases Stroke Risk
Advanced HCC can lead to hypercoagulability, an increased tendency for blood to clot. This heightened clotting risk can make both ischemic and hemorrhagic strokes more likely. Patients with HCC and cirrhosis often exhibit hypercoagulable changes that contribute to their increased thrombotic tendency.
Fragments of the tumor, called tumor emboli, can break off and travel through the bloodstream. These fragments may block blood vessels in the brain, leading to an ischemic stroke. Tumor emboli are a rare but serious complication in cancer patients.
Certain HCC treatments can also influence stroke risk by affecting blood vessels or clotting pathways. Anti-angiogenic drugs, which inhibit new blood vessel formation, can increase the risk of thromboembolic events like stroke. Sorafenib, for example, has been linked to an elevated risk of arterial thromboembolic events.
In some instances, cancer can produce substances that affect other bodily systems, including blood clotting, leading to paraneoplastic syndromes. These syndromes can cause thrombocytosis, an increase in platelet count, contributing to a pro-thrombotic state. Paraneoplastic syndromes are observed in a significant percentage of HCC patients.
Recognizing Stroke Symptoms
Recognizing stroke signs quickly is important for immediate medical attention. The “FAST” acronym provides an easy way to remember the key symptoms: Face drooping, Arm weakness, Speech difficulty, and Time to call emergency services. Facial drooping is suggested if one side of the face droops, is numb, or if a smile is uneven.
Arm weakness is indicated if a person cannot fully lift both arms and keep them raised due to weakness or numbness in one arm. Speech difficulty may involve slurred words or trouble speaking clearly and understanding others. If any of these signs appear, even if subtle or temporary, call emergency services immediately.
Additional stroke symptoms include sudden numbness or weakness on one side of the body, including legs, hands, or feet. Other signs can involve sudden blurred vision or loss of sight in one or both eyes, confusion, or difficulty finding words. A sudden headache, dizziness, unsteadiness, or a sudden fall also warrant immediate medical evaluation, especially for individuals with HCC due to their increased stroke risk.
Managing Stroke in Liver Cancer Patients
Managing a stroke in a patient with underlying liver cancer is complex. Liver dysfunction, common in HCC patients, can affect how the body metabolizes medications and regulates blood clotting, making treatment decisions challenging. The potential for bleeding, particularly in patients with advanced liver disease, must also be carefully balanced against the need for clot-dissolving medications or anticoagulants.
Treatment decisions require a multidisciplinary medical team to consider both the stroke and the liver cancer. This tailored approach ensures that interventions for the stroke do not worsen the liver condition or interfere with cancer treatment. The patient’s overall health status and prognosis also play a role in guiding these complex management strategies.
General stroke treatment principles may include clot-busting medications, such as tissue plasminogen activator (tPA), for ischemic strokes, though these are used with caution in HCC patients due to bleeding risks. Procedures to remove clots, known as endovascular thrombectomy, may also be considered. For hemorrhagic strokes, managing bleeding is the primary focus. Following acute treatment, rehabilitation is part of recovery, aiming to restore physical function and quality of life.