Transcript Liver cancer Hepatocellular carcinoma

Hepatocellular
carcinoma
Diagnosis, Treatment,
Prognosis + Quiz
Vinko Bubic
Mentor: A. Žmegač Ho
Diagnosis
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Physical examination - enlarged, tender liver
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Elevated serum alpha fetoprotein (normally :
40mg/l)
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Elevated liver enzymes (ALT, AST, Alpha-1
antitrypsin, serum bilirubin, urine bilirubin...)
Diagnosis
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CT
CT
Computed tomography - medical
imaging method employing tomography
(imaging by sections or sectioning)
 Large series of two-dimensional X-ray
images taken around a single axis of
rotation, computer integration
 Iodine dye through vein for better
visualisation (allergy)
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MRI
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Magnetic resonance imaging
The body - mainly composed of water molecules
Electromagnetic field causes protons to absorb
some of its energy
Scanner detects release of proton energy (tumor
tissue releases different frequency)
Greater contrast than CT
Modern 3T MRI
Biopsy
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Definitive diagnosis of hepatocellular
carcinoma
Hyperchromatic, clear cells with large red
cytoplasm
Treatment
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Liver transplatation (cadaver liver or live
donor lobe)
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Surgical resection (best prognosis for
long-term survival, but possible in only
10-15% of cases)
Treatment
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Percutaneus ethanol injection - small (< 3 cm)
solitary tumors
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Transcatheter arterial chemoembolization
(TACE) - more than 3 cm and less than 4 cm in
diameter
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Sealed source radiotherapy (brachytherapy) radioactive source is placed inside or next to
area requiring treatment
Prior to ethanol ablation
After
Transcatheter arterial
chemoembolization
Other techniques
Radiofrequency ablation (RFA)
 High intensity focused ultrasound (HIFU)
 Chemotherapy (antiestrogen + tamoxifen)
 Cryosurgery - destruction of abnormal
tissue using sub-zero temperatures
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HIFU
Cryosurgery
Iceball
HCC complications
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Gastrointestinal bleeding
Cachexy
Portal hypertension -> esophageal bleeding
Liver failure
Metastasis (lymph nodes around pancreas,
aorta, lungs, adrenal glands, bones)
Rupture of tumor -> abdominal bleeding
Prognosis
Usually poor outcome
 Only 10 - 20% of hepatocellular
carcinomas can be removed completely
 If not, disease usually deadly within 3 to 6
months
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Quiz:
The definitive HCC diagnosis is
confirmed by:
 a) spider nevus by inspection
 b) auscultation
 c) biopsy and microscopy
 d) MRI
 e) esophageal reflux
Ethanol:
 a) dehydrates cells
 b) hydrates cells and cracks them
 c) activates IL-8
 d) causes apoptosis
 e) nothing from above
In cryotherapy, tumor is frozen by:
 a) flucloxacillin
 b) Iodine
 c) liquid nitrogen
 d) surgeon’s eye
 e) cocaine
What did you eat today?
This maybe? 
Thanks ! ! !
References:
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http://www.cancer.gov/cancertopics/types/liver/
http://www.mayoclinic.com/health/livercancer/DS00399
Medicinski leksikon, Leksikografski zavod
“Miroslav Krleža”, Zagreb 1992.
PATOLOGIJA, urednici Damjanov, Jukic, Nola,
izdanje 2007.