Transcript Hepatocellular Carcinoma(ppt بحث التخرج)

HEPATOCELLULAR CARCINOMA
(HCC)
Hepatocellular Carcinoma(HCC)is macroscopically classified
into four categories,which may be correlated with
clinical,histologic and prognostic patterns:
(a)typeI-nodular form with single or multiple nodules with
apseudocapsule.
(b)typeII-adominant mass with satellite nodules
.
(c)typeIII-adiffuse form with extensive tumor infiltration in
parenchymal
tissue.
(d)typeIV-invading adjacent structures such as the diphram and
stomach.
*Epidemiology:
-Hepatocellular Carcinoma(HCC) is the most
common primary malignancy of the liver.
-Hcc has avariable geographical distribution
around the world.Especially in Saudi Arabia,liver
cancer acounts for 6-9% of all newly
diagnosed cancer according to the most recent
cancer.
-Male to Female ratio is 3:1 of all liver
cancer,hepatocellular carcinoma accounts for
88% in Saudi Arabia. The median age at
diagnosis is 65 years for Males and 60 years for
Females.
-The incidence of Hcc is expected to increase
dramatically in the kingdome in the next 30
years.
Statics:
*Risk Factor:
-Hepatitis B is considered the
strongest risk factor
associated with Hcc in the
majority of countries,but more
important in Asia and Africa.
-The annual incidence of Hcc in
hepatitis B patients with
cirrhosis exceeds 2%.
-Hepatitis B virus is thought to be
carcinogenic both directly and
indirectly,because HBV DNA
is integrated into cellular DNA
of host and can be
demonstrated in Hcc cells in
95% of the cases.
.*FIGURE:This woman is
suffering from liver cancer
caused by Hepatitis B.
-Hepatitis C is considered the
most important risk factor
for Hcc in different
countries.
-Almost all Hcc in patients
with hepatic C occurs in
patients who have dvelop
cirrhosis.
-This suggests that hepatic
disease plays amajor role
in the development of
cancer in this disease.
-Cirrhosis is the major risk factor for the development of Hcc
regardless of the cause.
-The annual incidence of Hcc in patients of cirrhosis is about 3%.
-Male sex,age,and duration of cirrhosis are associated with
increased risk of Hcc in patients with cirrhosis.
HCC
Cirrhosis
Hepatitis B
Hepatitis C
*other risk factor:
-Alcohol is the risk factor of Hcc is increase up to 40%,in
astudy,the risk of Hcc was found to be 13 times greater in
drinkers than in non-drinkers.
-Alfatoxin B1 is an important risk factor for Hcc in parts of
Africa and Asia.
-Smoking are conflicting but this is probably
Aminor risk factor.
*The classic features of Hcc:
-Weight loss.
-Weakness.
-Abdominal swelling.
-Acute deterioration of liver function,in patient with
stable cirrhosis and acute intra-abdominal bleeding.
-Physical finding:
*Stage of disease.
*Mass of tumor.
*Hcc is known to cause many paraneoplastic syndromes.
*Hypoglycemia may be seen early in the disease.
*Polycythemia may be seen in less than 10% of patients.
*Hypercalcemia may also be seen in the absence of bone
invasion.
How is hepatocellular carcinoma
diagnosed?
In addition to a complete
medical history and
physical examination,
diagnostic procedures for
hepatocellular carcinoma
may include:
1-biopsy - a sample of
tissue removed from the
tumor and examined under
a microscope; the surgeon
may also look at the liver
using an instrument called
a laparascope, a small
tube with a light on the end
2-complete blood count (CBC) - a measurement of size,
number, and maturity of different blood cells in a specific
volume of blood.
3-additional blood tests - may include blood chemistries,
evaluation of liver and kidney functions, and genetic studies.
4-multiple imaging studies, including:
(a)computerized
tomography scan (also
called a CT or CAT scan)
- a diagnostic imaging
procedure that uses a
combination of x-rays
and computer
technology to produce
cross-sectional images
(often called slices), both
horizontally and
vertically, of the body. A
CT scan shows detailed
images of any part of the
body, including the
bones, muscles, fat, and
organs. CT scans are
more detailed than
general x-rays.
(b)x-ray – a
diagnostic test
which uses invisible
electromagnetic
nergy beams to
produce images of
internal tissues,
bones, and organs
onto film
(c)magnetic resonance
imaging (MRI)
- a diagnostic procedure
that uses a combination
of large magnets,
radiofrequencies, and a
computer to produce
detailed images of
organs and structures
within the body .
(d)ultrasound (also called
sonography)
- a diagnostic imaging
technique which uses
high-frequency sound
waves and a computer
to create images of
blood vessels, tissues,
and organs.
Ultrasounds are used to
view internal organs as
they function, and to
assess blood flow
through various
vessels.
(e)liver scans - pictures or x-rays taken of the liver after a dye has
been injected that is absorbed by liver tissue. These are used
to detect tumors and liver
abnormalities.
5 -alpha-fetoprotein (AFP) test - alpha-fetoprotein (AFP)
levels in the blood can be used to diagnose and follow
response to treatment
*Management:
-Hepatic resection ,major advanced in the field of
hepatobililary surgery have occured. Although tumor
resection removes the visible portion of the cancer,it is
clearly inferior to transplantation in that it can not guarantee
the removal of invisible tumors seeding,in that it leaves the
remaining portions of the liver which is at high risk of
malignancy, and in that it doesn’t improve hepatic function.
-We feel that the best treatment option in a cirrhotic with large
tumor is probably chemoemobilization rather than surgical
resection.
-Even if it’s technically feasible,and surgical
resection should be preserved for patients
who are not cirrhotic or patients with
compensated cirrhosis with small tumors.
-We feel that in patients with no liver cirrhosis
or early liver cirrhosis(indicate by normal
billirubin and no signs of portal
hypertension),liver resection should be
considered.
-Ablation:this could be done by either chemical
means(absolute alcohol or trichlroacetic acid)or physical
means(radiofrequancy ablation) .
-In RFA, thermal destruction is achieved with an electric current
that passes to the tumors tissues via an electrode tip under
imaging guidance,resulting in heat generation and
coagulation necrosis.This technique seems to be very
effective with low recurrence
rate.
*Prevention of infection:
-Vaccination is a very powerful measure to reduce the infection
rate with hepatitis B and hence reduce the incidence Hcc.
-No effective vaccine is available for hepatitis C.