You are on page 1of 10

See discussions, stats, and author profiles for this publication at: https://www.researchgate.



Article · January 2015


1 134

10 authors, including:

Muhammad Hanif Akhtar Ahmed
Karachi Institute of Radiotherapy and Nuclear … Karachi Institute of Radiotherapy and Nuclear …


Some of the authors of this publication are also working on these related projects:

Cancer incidence View project

FDG-PET View project

All content following this page was uploaded by Muhammad Hanif on 09 September 2015.

The user has requested enhancement of the downloaded file.

Their liver function tests and serological tests. it is the sixth infection is hard to quantify as large number of most common cancer worldwide. Hepatitis B (HBV) and considered as one of the most challenging tumors Hepatitis C (HCV) infections are the main causes of with high incidence. Salman Habib2. However. prevalence and mortality rates liver disease worldwide. no adverse effects were observed. A total of 30 HCC patients (66% were chronic hepatitis patients) treated with four well known herbal aqueous extracts (viz Bergenia ciliata. KIRAN. All on medication patients showed remarkable improvement and reduction in the size of tumor. Karachi. Shah Abdul Latif University. To obtain a convincible data it is proposed to treat all the patients approximately for a minimum period of 5 years. around the world. Amir Awan4. University of Karachi. It occurs HCC used to be described as a tumor with an with great frequency and is becoming more common ultimately poor prognosis. All others were HBV/HCV negative. Rafiq1. Muhammad Hanif2. to determine the status of HBV and HCV were also performed. Karachi 5 Department of Microbiology. Moreover. 11 cases were HCV positive and one case with co-infection HBV and HCV viruses. Hepatoma INTRODUCTION related to its rapid progression and its aggressive biological behavior that leads usually to the diagnosis Liver cancer (Hepatocellular carcinoma. Traditional herbal ABSTRACT Prognosis of Hepatocellular carcinoma (HCC) is very Research Article CODEN: IJPNL6 TREATMENT OF INCURABLE LIVER CANCER (HEPATOMA) BY FOUR TRADITIONAL HERBAL MEDICINES M. Long time of survival is possible only in cases of full surgical excision or liver transplantation. Karachi 4 Jinnah Hospital. 5(1): 289-297 ISSN 2249-1848 International Journal of Pharmacy Journal Homepage: http://www. Khairpur 2 Karachi Institute of Radiotherapy and Nuclear Medicine. HCC) is at an advanced stage [3]. Hamdard University. Pakistan *Corresponding author e-mail: hanifmuhammad@hotmail. especially in Asia [5. Asim Awan3. 6].*. 2010 report. Chemotherapeutic agents in allopathic medicines are hardly effective. Human hepatocellular carcinoma almost identical to the mortality rate.pharmascholars. Nigella sativa. Use of herbal medicine in the treatment of liver cancer and other cancers has a long tradition. some of them were confirmed additionally with MRI and tissue biopsy. According to WHO. Int J Pharm 2015. This poor prognosis is as a complication of chronic Hepatitis B or Hepatitis www. Akhtar Ahmed2. CT scan and alpha fetoprotein. et al. The incidence of HCV [1] . All individuals were diagnosed as HCC and further monitored on ultrasound. Over all six cases were HBV 289 . accounting for 7% patients are asymptomatic and no vaccination is of all cancers and an estimated incidence that is effective yet [4]. Ten patients showed remarkable reduction in their size of tumor/mass and are still on medication. Ajaz Rasool4. Keywords: Hepatocellular carcinoma. Karachi 3 Department of Eastern Medicine. it (HCC) is one of the most common malignancies all represents the third cause of cancer related deaths [2]. Eight patients were having non compliance who had started treatment but either left in the mid of treatment or lack of follow up while the two patients were passed away.pharmascholars.Hanif. cassia fistula and Picrorhiza scrophulariflora) in which 17 patients were females and 13 males in age group ranges from 42-72 years. Miandad Zardari1 1 Department of Microbiology. Out of 30 confirmed HCC patients 10 showed hundred percent improvements displaying no evidence of mass in liver.

hepatitis C and more. Classical tumors for chemoprevention/chemotherapy to check chemotherapeutic agents are barely effective. oils and extracts of N. reversing China. male gender and higher antifungal agent. time of life is possible only in cases containing surgically full-excision or liver transplantation. The bioactive constituents of various recent discoveries have shown that this little black herbs seem to be promising targets for isolation. Though the hepatitis B virus (HBV) is still traditional Hakeems for the cancer treatment either the main etiological agent for HCC in many Asian for specific cancer or group of cancers. Methanolic and Many therapeutic approaches have been applied aqueous extract of Bergenia ciliate rhizome were clinically such as surgery. such as diabetes. glucose. Nigella remedies for various diseases. metarbin. 21]. gallicin. seed is effective in destroying cancer cells. The methanolic in about 60 – 70% of cases. physical or chemical methods development of drug that might be used to target [12] . Cassia fistula linn and Picrorhiza atherosclerosis by decreasing the serum low density scrophulariflora. 18]. 3. MS. it is effective in the diminishing the risk of sativa). toxicological activity. although lagging behind its age-standardized rate of HCC in Pakistan is about 7. medicines of plant origin because of their affordability and accessibility with minimal side Ingredients of N. which is the most common genotypes in antitussive. The root and leaves extract were alkaline phosphatase. Finally. The modern scientific research oxidative stress and modulating different molecular with the investigation of anticancer activity of N. It was observed patients [9. but ancient times. 11]. the seeds. 4. including reducing HCC dominance appears to be related to this higher power.13-16. Genotype 3a of HCV. For following four herbs Bergenia ciliate.8% of preventive Medicine [16. 11].8 for major chemical constituents of plant include tannic females. In this study we have specifically selected the against many diseases. are also seen in the majority of HCC hypoglycemic. including Cancer since sativa was used to treat migraines and allergies.Hanif. The DNA protection.5% for HBV surface antigen [9. 8]. 10. Ayurveda and the Chinese system of medicine high risk for HCC and possibly other cancers. 5(1): 289-297 ISSN 2249-1848 C [4. herbal preparations may offer a cost effective sativa have been used as an anticancer agent by protective alternative to individuals known to have a Unani. et al. It is. HCV related HCC is seen peroxidation inhibition potential. In a country of about 200 million. antibacterial. Originally. Pacific countries. 11] . ciliata rhizome extracts were found to and 2. however. 7.6:1. antioxidant. that have originated from the Arab. Other significant factors associated that root and leaves extract were promising as with HCC were older age. Only about 20% of cases extract displayed greater potential in all antioxidant are positive for HBV and 10 – 15% is non-B non-C. Most of the patients present in their 5 th and 6th bergenin. Pakistan. also known as black cumin. sativa have beneficial effects effects. Alzheimer’s products.000 persons per year for males and 2. it mostly tested earlier by herbalists. interventional or micro. The male to female ratio for HCC is acid.pharmascholars. Kalonji and Haba al-barakah (Arabic name) has Herbal medicine and their extract in the treatment of been proven with countless peer reviews to liver cancer have a long tradition [13]. Pleuroetus oustreatus and Candida albicans[17].6 methanolic counterpart as an antioxidant [16]. gallic acid.ciliata bears potent anti-neoplastic activities that disease is the single largest cause of HCC in Pakistan may have prospective clinical use as precursor for [9. black seed. hepatitis C virus (HCV) related B. Ind-Bangla and through maintaining cell integrity. botanists and exerts therapeutic and protective effect in diabetes by www. Bergenia ciliata was decade. 290 . and genotype D of subjected to bioactivity analysis. interesting to note that the High contamination rates with aflatoxin in Pakistan aqueous extract demonstrated considerably higher also contribute to liver carcinogenesis [9. free radical scavenging activity and lipid prevalence of hepatitis C. Clongi (Nigella example. 17. All of these plant(s) have been tried lipoprotein cholesterol level and increasing the serum and reported individually for cancer treatment and high density lipoprotein cholesterol levels[20. 10. The compounds effectively treat cancer. herbs and spices have been used as disease. antiulcer. HCC prognosis is very poor. Nigella sativa. (+)-catechin. effective against Microsporum canis. 11]. including cancers. pathways in preventing carcinogenesis [15]. albumen. 10. The sativa is a comparatively recent affair (for the last current trend of cancer research is the investigation of 2~3 decades) [19]. There have been more than derived from the herb and herbal composites are of 450 peer reviews in the past 40 years for a wide range considerable interest among oncologists [14]. Int J Pharm 2015. Natural of diseases. Long neoplastic growth and malignancy. 10. Methanolic and general population is positive for anti-HCV antibody aqueous B. For cancer activity screening and clinical evaluation. thousands of year. The plant has hepatitis B. HCV possess antioxidant activity. The per 100. assays. found to have promising potential towards the traumatic techniques.

(2'S)-7. 5-(2. notably the status of hepatic virology were also performed. Main property of Cassia fistula is mild group was 50 to 72 years. Four new compounds. the female age laxative and also used as a purgative due to the wax group was in the range of 42 to 70 years. and 88% inhibitory effect antiphosphodiesterase. some of them were confirmed has been reported to possess antitumor. while. on HepG2 was found after 24-hr incubation with antiasthmatic.methylchromone. stearic and palmitic acids as major initiating the herbal treatment. Cassia fistula linn and Picrorhiza [32] . traditional herbal plants viz. changing the hepatic enzyme activities[23]. choleretic. Clongi were also isolated from the seeds of Cassia fistula (Nlgella sativa). A wide range of kidney tissue against oxygen free radicals. antitumor. chrysophanol and chrysophanein. antioxidant and antiradical activities. The plant has a high therapeutic hepatoma on histopathology. Before starting the study. derivatives.hydroxy-3. leishmanicidal activities. Bergenia ciliate. MRI and Tissue Biopsy. molluscicidal and different concentrations (0–50 mg/ml) of the N. while traces of three groups viz. to determine important source of secondary metabolites. All aloin and has been used to treat many intestinal individuals were diagnosed with HCC and/or disorders like ulcers. ultrasound.Hanif. the Amazon. hypolipidemic. additionally with. The cytotoxic activity of N. promising prophylactic agent against chemical commonly used in the treatment of liver disorders [33]. The crude extracts of plants were obtained in Picrorhiza scrophulariiflora extensively used in different solvents but water extract was found most traditional as well as modern medicinal system in effective in different clinical trials (According to India. its oil protects enhancer of neuron growth [33]. The seeds are rich in glycerides with CBC and an ultrasound was also performed before linoleic. together with four known compounds. On follow up fatty acids together with traces of caprylic and (minimum 6 months) all patients were monitored by myristic acids. an treatment of various immune-related diseases. tested on the human hepatoma HepG2 cell line by antiviral. hepatoma confirmed patients in which 13 males and and Sri Lanka and is extensively diffused in various 17 females were selected for this study. Besides phenolics and their either ultra sound or C. 5(1): 289-297 ISSN 2249-1848 decreasing morphological changes and preserving used as antidiabetic. cardioprotective. 6-dimethoxybenzoate. China. C (Hepatitis C and Hepatitis B Non-Reactive). In phenolic compounds [31].. immunomodulatory. It Alpha fetoprotein. antidiabetic. it is antiulcer and anticancer activity. intervention was undertaken at Department of hydroxymethylfurfural. Nepal and Sri Lanka for the ICH-GCP guidelines). flavonoids and flavan-3-ol registration of all subjects a repeat liver function test. 27. MATERIAL AND METHODS Cassia fistula belonging to the family Leguminosae Casesalpinaceae is commonly called as Amaltas an Patient samples: A total of 30 HCC/and or Indian Laburnum and is native to India. Similarly. and of ancient medical literature (manuscripts) regarding benzyl 2β-O-D-glucopyranosyl. hydroxyphenoxymethyl) furfural. CT scan and value and it exerts antipyretic and analgesic effects. cardioprotective. derivatives. neuritogenic. carcinogenesis and toxicity in hepatic cancer [30]. purgative. preventing biological activities have been attributed to iridoids. The male age countries [31].. et al. Thabrew et al. a purified reductase and glutathione transferase and makes TQ a fraction of Silybum marianum (Asteraceae). Int J Pharm 2015.6-dimethoxy herbal medicinal plants used as therapeutic benzoate. hepatopro. These tective. a certain amount of alkaloids have also The samples of patients were further divided into been reported in the flowers. After anthraquinones. scrophulariflora were finally selected for this study. Their Cassia fistula plant organs are known to be an liver function tests and serological tests. (2005) [29]. persons opted to be treated with herbal remedy. Herbal Drugs Used: To achieve this goal a survey benzyl-2.T scan or 291 . B and C. 3. Group A (Hepatitis C triterpenes have been observed in both flowers and Reactive) Group B (Hepatitis B Reactive) and group fruits. Tibet. antiasthmatic. oleic. and a selective effective against hypertension[24. antifertility. and antioxidant properties. pancreatic beta-cell integrity[22] and by beneficially anti healing. antioxidant.5. renal dysfunction and morphological abnormalities[26. Nagi and Almakki (2009) reported that hepatoregenerative and hypolipidemic effects of oral administration of Thymoquinone (TQ) is Picroliv. 25]. 28] . Botany. (2'S)-7-hydroxy-2-(2'. university of Karachi and Hamdard hydroxypropyl)-5. the preparation was shown to have similar effective in increasing the activities of quinone or more potent activities than silymarin. the sativa extract. A. sativa seed was anti-inflammatory.hydroxy-5- hydroxymethyl-2-(2'-hydroxypropyl) chromone. antispasmodic. Following four candidate oxyanthraquinones. The herb contains some cases Bone Scan was also performed.pharmascholars. It is www. and two University Karachi. such as antihepatotoxic.

Among other eight cases of hepatoma one is HBV positive 4 were HCV positive. and treatment was also effective in improving the disease AFP level. and weakness. effective in reducing their cancer-related pain. 29]. All on medication www. Extraction of Plant Material: 5 gram of plant materials was extracted three times with 100 ml of Many studies were published on the role of herbal distilled water. 31] or on cell lines[17. These lab investigations were done as a symptoms and the quality of life of the participants. The alternate solution for the harmful effects of Among these six hepatoma cases five were HCV synthetic agents is the use of medicinal plants [36]. and medication and responded very well and all are AFP level. In this study. Kidney function test. few patients reported to have mild oral and local Improvements were also observed in the lab stomach irritations which were successfully investigations like Complete Blood Count (CBC). one has liver mets from gall the cure of cancer causes the adverse and toxic side bladder one has liver mets from pancreas and two had effects therefore fails to control the cancer disease [34] liver mets but were basically breast cancer patients. tumor (Table 1). pancreas and a prolonged period of time. 24. all plants have been tried and reported earlier for cancer treatment and mostly Out of 30 confirmed Hepatoma or HCC patients 10 tested by herbalists. Moreover. fatigue. ] extract was than filtered and vacuum dried for use for some studies are on individual plant extracts[16-20. four were negative for both HBV and HCV while one case had both HBV and HCV positive report. CT scan and AFP results (Table 1). These were also confirmed in size of tumor/mass monitored on ultrasound. Our herbal Liver Function Test (LFT).Hanif. constipation and potential against various cancers [35].pharmascholars. nausea and vomiting. 20. most of these studies are on animal models[23. nausea. These were also adverse side effects were observed however. under reflux for three hours. 26. Their presented). patients and both had no history of HBV and HCV. CT after examining the participants clinically (data not scan and AFP and are still on medication. All of these patients responded very These chemical substances produce physiological well soon after the start of treatment and on action on the human body. 33] further research investigations as a therapeutic and very few on group of plants and their interventions. 30. The medicinal plants both breast cancer patients were negative for both contain chemical constituents of therapeutic 292 . 34. and weakness. nausea and vomiting. Among these 10 patients six cases had diagnosed Chemotherapy as well as conventional treatment for liver cancer (Hepatoma). ultrasound. CT scan and Alpha fetoprotein (Table 1). 18. part of their routine clinical checkups (data not Almost all patients reported that the therapy was presented). very confirmed after examining the participants clinically.23. persons approximately for a minimum period of 5 In these ten cases also two were breast cancer years. . no improving appetite. constipation and improving Other ten patients also showed remarkable reduction appetite. Kidney function test. Improvements were also observed in the follow up results are evident of regression in size of lab investigations like Complete Blood Count (CBC). Eight patients were having non compliance who have started treatment but either left in the mid of treatment or lack of follow up while two patients were passed away. To obtain a reduction in pain. convincible data it is proposed to treat all the enrolled constipation and improving appetite. et al. 5(1): 289-297 ISSN 2249-1848 approval from ERB and patients informed consent patients showed remarkable improvement and was obtained. and weakness. RESULTS AND DISCUSSIONS Among our study plants. fatigue. ]. These lab investigations were done as a happy with treatment and reported similar results of part of their routine clinical checkups. 35. extracts [14. 31. HCV and HBV. vomiting fatigue. 15. reduction in size of tumor as is evident from their ultrasound. Int J Pharm 2015. botanists and traditional patients showed hundred percent improvements Hakeems for the cancer treatment either for specific having no evidence of mass in liver confirmed by cancer or group of cancers. It has been shown subsequent visits all of these patents reported that the currently by clinical studies and phytochemical therapy was effective in reducing their cancer-related investigation that many herbs exhibit anti tumor pain. The medicines in treating liver cancer patients [14-18. positive and one was HBV positive while among The plants have been used for the cure of cancer from patients having Mets either from GB. Although these patients are still on Liver Function Test (LFT). controlled by the supportive cares.

0 cm Mass Kafeel 7-5-2009 hypertension 10-5-2009 2) u/s 9-9-2009 2) 1. GB negative 2) CT 5-5-2010 2) not present to Liver 3) u/s 6-8-2010 3) 2.6cm Focal mass 3-8-2013 2) u/s 21-3-2014 2) 2.9cm not present 3) 6-6-2014 3) Not seen 2 Surayya 55 F Hepatoma HCV +Ve CLD/Splenomegaly AFP 1) u/s 22-6-2004 1) 5.2x1. Ascitis 1) u/s 3-8-2013 1) 3x2.7x1. Int J Pharm 2015. et al.2cm of mass seen 31.No. Ascitis AFP 1) u/s13-12-2012 1) 2.0 cm disappears 3) 1-6-2010 3) 1.5IU/ml 3) u/s 26-8-2004 3) 4) MRI 6-9-2004 4) Not seen 3 Kishwer 59 F Neoplastic HBV/HCV Liver Mets from GB 1) u/s 30-4-2010 1) 293 . stages & Hepatoma and on Follow up visits F/U stages 1 Salma Bibi 60 F Hepatoma HBV +Ve Cirrhosis.4x1.0 cm 4) 13-1-2011 4) Not seen 5) 14-11-2011 5 Naseem 58 F Hepatoma HCV +Ve Cirrhosis.2x1.6mm No evidence Qamar 22-6-2004 Cirrhosis 29-6-2004 2) CT 8-7-2004 2) 1.4x1.0 cm Focal mass Sultanan mass. 5(1): 289-297 ISSN 2249-1848 Table 1: History of patients.2 cm 4) 10-2-2011 4) Not seen 4 Nargis 51 F Hepatoma HCV +Ve Liver cirrhosis/ portal AFP 1) CT 7-5-2009 1) 2.Hanif. followup and status of tumor(s) on different stages of treatment 1) 2) 3) 4) 5) 6) 7) S. clinical diagnosis. Name of Age Sex Diagnosis Viral Status of Liver at Tumor CT/ Ultrasound /MRI Size of Tumor/ Remarks patient Yrs.8x2.2x2.0x1.2 cm No Obvious Akhtar 25-4-2013 Splenomegaly 24-4-2013 2) CT24-12-2012 2) 2x1 cm mass seen 3) u/s 4-4-2013 3) Not seen 6 Abdul 71 M Hepatoma HBV/HCV Normal 1) CT 19-12-2012 1) 22x16 mm No Obvious Haleem 01-2-2013 negative 2) CT 20-12-2012 2) No mass seen mass seen Mets from 3) ERCP 18-12-2012 3) No mass seen pancreas 4) u/s 26-8-2013 4) No mass seen 5) u/s 28-10-2013 6) u/s 3-3-2014 7 Saeeda 28 F Hepatoma HBV/HCV Normal 1) CT 18-8-2012 1) 7x9 mm in Focal mass Mets from negative 2) CT 30-1-2013 right lobe not present breast 3) u/s 26-9-2013 2) No mass seen cancer 3) No mass seen www.pharmascholars. & date profile prsentation marker on diff.

0 1) u/s 03-05-2014 1) 5. 5(1): 289-297 ISSN 2249-1848 8 Qudsia Khalid 63 F Hepatoma HCV +Ve Liver cirrhosis/ portal AFP 1) CT 2-4-2011 1) 2.0x3.5x6.9x0. Int J Pharm 2015.9 cm mass seen 6) u/s 16-11-2012 3) No hepatic mass 10 Johar Begum 50 F Hepatoma HBV/HCV Normal CA-15-3 1) u/s 24-9-2009 1) 9x5 cm Remarkable METS negative 22-3-2013 2) u/s 13-8-2010 2) 10.0 cm not presen Splenomegaly 3) u/s 1-4-2012 3) No mass seen 9 Zulfiqar 52 M Hepatoma HCV +Ve Liver cirrhosis/ portal AFP 4) CT 27-1-2012 1) 2.Hanif.1 cm On 14-05.8x6.5 cm medication 2013 2-9-2013 3) u/s 20-6-2014 3) 8.4x4.9 cm Focal mass 2-4-2011 hypertension/ 2) CT 26-4-2011 2) 3.pharmascholars.3x2.0x3.9 cm 6) u/s 28-3-2014 6) 0. On Mets from negative 2) u/s 28-2-2014 consist with mets medication breast 3) u/s 13-6-2014 1) 3.8 cm medication 23-5-2014 14 Arifa 48 F Hepatoma HCV +Ve Liver cirrhosis/ AFP 224.7x7.0 1) u/s 31-8-2013 1) 4.6 cm size of 20-4-2009 4) u/s 15-11-2012 4) 8.6 cm On 5-02-2014 negative 2) u/s 7-4-2014 2) 2.9x2.1x1.1 cm cancer 2) 3.0 cm No hepatic 27-1-2012 hypertension 5) CT 14-5-2012 2) 2.2 cm On 3-05-2014 Splenomegaly IU/ml 2) CT 27-05-2014 2) 5.4x2.3 1) u/s 14-5-2014 1) 2.0 cm medication 13 Tanveer Raja 46 M Hepatoma HCV +Ve Liver cirrhosis/ AFP 883.4 cm 15 Hadia Samar 43 F Hepatoma HBV/HCV Hepatospleenomegaly 1) u/s 12-9-2013 Multiple nodules.7 cm medication 2014 17-5-2014 12 Raham Jan 50 F Hepatoma HBV/HCV Normal 1) u/s 5-2-2014 1) 1.8 cm reduction in from breast 3) u/s 4-7-2012 3) 9.2x3.4 cm hepatoma 5) u/s 20-9-2013 5) 6. et al.4x2.9 cm 11 Ishrat Murtaza 50 F Hepatoma HBV +Ve Normal AFP 31.3x5.4x5. IU/ml 2) CT 20-5-2014 2) 2.1 cm On 294 . Splenomegaly/ Ascitis IU/ml 2) u/s 04-3-2014 2) 7.2 cm www.3x2. 295 .0 1) CT 5-5-2014 1) 10.3 cm medication 4) u/s 3-4-2014 4) 6.0 1) u/s 17-9-2013 1) 9.5 cm Size reduced.8x2.5x7. Aslam Babu 65 M Hepatoma HCV +Ve Liver cirrhosis/ AFP 9.5x3.2x11.3x8.6 cm 17 Jan 50 M Hepatoma HCV +Ve Enlarged liver AFP 650.3 cm On Mets from negative 2) u/s 27-6-2014 4) 3.0 cm On Bux HCC positive IU/ml 2) CT 17-6-2014 2) 10x11 cm medication 10-6-2014 3-6-2014 19 M.7.9 cm On Mahar 5-5-2014 medication 18 Muhammad 47 M Hepatoma HBV/HCV Hepatospleenomegaly AFP 274.Hanif.B mass HBV/HCV Normal 1) u/s 1-2-2012 1) 6.0 cm Non infiltrating negative 2) CT 4-12-2012 compliance into Liver 1-12-2012 24 Zainul Islam 53 M Multifocal HBV +Ve Normal AFP 71.0x8. 5(1): 289-297 ISSN 2249-1848 16 Said 62 M Multifocal HBV/HCV Ascitis AFP 200.7 cm On 19-2-2014 18-9-2013 3) u/s 3-10-2013 3) 6.2 cm medication CA breast 21 Haji Zain 56 M Hepatoma HBV +Ve CLD.1 cm Size reduced. Splenomegaly.0 1) u/s 17-1-2013 1) 2x2 cm Non HCC ng/ml 2) CT 10-7-2013 2) 1x1 cm compliance 17-1-2013 15-6-2013 www.0x8. Muhammad 5-05-2014 IU/ml 2) u/s 19-6-2014 2) 8.8 1) u/s 3-9-2013 1) 3x3 cm Size increased HCC Splenomegaly/ portal ng/ml 2) CT 12-9-2013 2) 2. ng/ml compliance 2013 19-5-2013 23 Arshad Ali 55 M G.pharmascholars. et al.7x7. AFP 1) CT 8-11-2013 1) 7.0 1) CT 10-6-2014 1) 10.5 cm after TACE 3-9-2013 hypertension 13-6-2014 3) CT 16-11-2013 3) No change Now on 4) u/s 15-2-2014 4) No lesion seen herbal 5) CT post TACE 5) New lesion medication 14-6-2014 identified 20 Saeeda Noor 30 F Hepatoma HBV/HCV Normal 1) CT 24-6-2014 3) 6.8x6.8 cm Non 19-03. Int J Pharm 2015. Muhammad HCC negative IU/ml 2) CT 26-9-2013 2) 10.5 cm Non 8-11-2013 Ascitis 5-9-2013 2) CT 29-10-2013 compliance 3) CT 13-11-2013 22 Maqsood Bibi 60 F Hepatoma HBV +Ve Splenomegaly AFP 1360 1) u/s 19-3-2013 1) 10.8x8.

4 cm TACE 2) 2.8x4.pharmascholars.Hanif.6x4. CT.0 cm 26-3-2014 28-3-2014 30 M. Riaz 61 M HCC HCV +Ve Liver cirrhosis AFP 39.0x4. five year followup is advised.0x4. LNH or other well known registered departments.0x4. Size of tumor were recorded on each follow up usually estimated by radiologist or sonologist in comparison of previous reports 7. KIRAN.5x1.0 cm Passed away HCC negative hypertension ng/ml 2) CT 28-3-2014 2) 4. www. MRI and tumor marker reports. et al.5x5.8 1) u/s 08-01-2014 1) 6.0 cm compliance 19-2-2014 24-3-2014 3) CT 27-03-2014 29 Najma Khatoon 70 F Multifocal HBV/HCV Liver cirrhosis/ portal AFP 820. Based on Ultrasound and CT scan interpretation 4.9 cm Size reduced 22-04.4 cm Non HCC IU/ml 2) u/s 24-03-2014 2) 6. 5(1): 289-297 ISSN 2249-1848 25 Haji M. CT scan and MRI were from ARC.8 cm Non 8-01-2014 IU/ml 2) CT 9-01-2014 2) 6. In cases of complete regression (disappearance of mass).0 1) u/s 19-02-2014 1) 2. Remarks are copied from radiology reports.4 cm but Non 2014 9-4-2014 compliance 26 M.5x5.6 cm compliance 8-1-2014 28 Pinda Jan 50 F Multifocal HCV +Ve Liver cirrhosis AFP 200. All patients were already diagnosed based on Histopathology.5 cm compliance 17-1-2013 28-1-2014 27 Shahnaz Bibi 45 F Hepatoma HBV +Ve Hepatomegaly AFP 372. Non compliance is not due to side effects of medication. Israael 64 M Multifocal HBV/HCV Normal AFP 20. Serology reports (Anti HCV and HBs-Ag) of all patients and PCR reports of positive patients were recorded 3. Ultrasound reports were also from these departments and usually followed up from same departments. 6. Tumor markers of only selected patients for diagnostic purpose were 296 .7 3) u/s 24-4-2014 1) 7.5x2. AKU.5 1) u/s 26-3-2014 1) 4. Int J Pharm 2015. Few patients were showed promising results but they could not follow up.8 cm Non HCC negative IU/ml 2) CT 2-01-2014 2) 7. negative IU/ml 4) CT 24-4-2014 2) 6.0 1) CT 15-6-2013 Patchy multiple Passed away 15-6-2013 IU/ml 2) CT 30-9-2013 mass H/O post 23-9-2013 3) CT 29-5-2014 1) 2.4x7. Akram 71 M Hepatoma HBV/HCV Enlarged liver AFP 58.6 1) u/s 01-01-2014 1) 6.1x5.9 cm HCC 3) 10x2. not for followup treatment 5.7 cm 1. All radiological tests including X-rays.7x6. Ultrasound. Liver METS were also considered as Hepatoma 2.5 cm 4) 1.1x5.

13. Parihar P. Beena J A. 2013. Jehangir A. 22:447–452. Phytother Res. 9.. Butt AS. 14: 6955-9. Eldin WS. Rehman RU. et al. 1 (2): 22-37 34. Akbas A. Kamsa-ard S. Phytother Res. doi:10. htm. Asian Pac J Cancer Prev. Nagi MN. 29. Rahoo AA. 2348 – 0335. 5: 968-9. 17. Ghufran M. Bayrak R. Shahzad M and Azam Zia. Rehman JU. Pharm. Bayrak O. 2011. Liang T. 2014. M Youssof. 4: 536-45. jaya dwivedi. Janmajoy Banerjee. Karatas OF. Hassan ZK. Sankaranarayanan C. 17:72–74. Akcay A. 2011. Evidence-Based Complementary and Alternative Medicine. Kanbay M. Nurhazalini-Zayani CG. Attia A. Rasool S A. Vinay Kumar Varshney. Thabrew MI. Isomura S. et al. 21:410–414. 6. Gwack J. Gafur. Abbas Z. 2012. Korean J Hepatol. 25.pharmascholars. Unal D. 5: 1818-35. Bayrak R. 9th Asian Pacific Association for the Study of the Liver (APASL) STC on HCC. 2012. Asian Pac J Cancer Prev. 2009. Zekri AR. Javed AA. MA Fawzy. Cimentepe E. 4385-4394. 30. 5.. Suddek GM. Rashid H. Kassas M.. Tang H. Shin HS. Khan MA. 2011. Aktas C. 31. 2013. 12:6023. Pakistan J Biol Sci. Esmat G. Nader MA. Turgut FH. dwivedi J. Morsy MA. Luo ZY. Saudi J Kidney Dis Transpl. Afr J Tradit Complement Altern Med. vol. Mousumi Tania1 and Dian-zheng Zhang. Shoker A. 35. Kaya A.. 14: 4509-13. Int. AW Mahmoud. Memon RA. Jit Narayan Sah. et al. Uz E. Chauhan R. International Journal of Pharmaceutical Sciences Review and Research. 2012. Nagi MN. 26. Rishi Ram Parajuli. et al. Ruby K. 13: 1065-8. Scientific reports. Kamkhah AF. et al. 2013. Arch Pharm Res. J Mol Histol. 14. 2009. Pari L. 22. 2010. 2007. 2009. 2009. J Med Plant Res. 2014. 85:830–834. Li B. Parihar L. Uz E. Awan A. Bavbek N. Priyanka Pokhrel. 2: 773. 2002. 297 View publication stats . Sharma H. Kim HJ. 2013. Rev. Sultana S. Yildirim E. 16. 20. Zardari M 2009. Suwanrungruang K. 2012. Sadik. 32. Akpolat M. Journal of the College of Physicians and Surgeons Pakistan. Nagi A H. 33. Chandiol AM. 36. Ahmad A. Mitry RR. Asian Pac J Cancer Prev. MH Nazmy. Asian Pac J Cancer Prev. Dehkordi FR. 20:741–752. Butt AS. Joji Reddy L. treatment and prevention. Mao YM. Abdel-Hamid NM. J Ayub Med Coll Abbottabad. 77:1319–1330. Rahman MAA. 18. World Health Organization 2010. Catal F. 3. 8(S):226-232. Abbas Z. 2013. Amish Kumar Tiwari.. Elbarbry F. Ahmad B. Lee SS. Sharma S. 2. 2012.13(1): 100-110. Life Sci. Bayrak O. 26. Almakki HA. Asif HM. Fundam Clin Pharmacol.1093/ecam/neq044 15. el-Agamy DS.13: 1039-42.14: 6227-31. 2010. Biomedica. Journal of Applied Pharmaceutical Research. Kanter M. Rafiq M. Bahnassy AA. 18: 48-55. 2005. Akcay A.23 11: 769-770. 19. Wiangnon S. Asian Pac J Cancer Prev. J. 2008. Khattab MM.. Life Sci. www. 14 pages. 5(1): 289-297 ISSN 2249-1848 REFERENCES: 1. Bavbek N. 2011. Rajani chauhan. Hanif. Jafri W. 23:1295–1298. Hamid S. et al. Abstract in 5 th IAS Conference on HIV pathogenesis. Han-chun Chen. Am J Nephrol. 23:2206–2212. 2012. J Cancer Therapy. GM. 2011. 21. Yan Li and Robert Martin C G.iarc. 12. 33:637–643. Yeo Y. Dahri AH. Hughes RD. 28. 15 (11). Kang S. Asian Pac J Cancer Prev.. Nephrol Dial Transplant. 40:379–385. Elbaz T. 3: 5433-8. Norsa’adah B. Ragheb A. Int J Pharm 2015. World journal of hepatology 2011. Korea. Yamamoto N. Nazar HM. Chen EQ. Akhtar N. 28:517–522. Asian Pac J Cancer Prev. 15(2): 04. 11. Hepat Mon. American Journal of Essential Oils and Natural Products.. 7. 2013. Hu TY. Ruby KM. Sci. 2013. 3(7): 175. 20-23. 24. 2008. 27. Uz B. 2012. Available from: http://www-dep. Res. 4. 2008. 8. 10. Gazarin S.