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Hepatocellular Carcinoma <ul><li>One of the most common malignancies </li></ul><ul><li>Incidence: 1 M (annual) </li></ul><...
Table 88-1 09/20/10
Etiologic Factors <ul><li>Hepatitis C Virus: </li></ul><ul><li>US: 4M carriers    10%    cirrhosis   </li></ul><ul><li>...
Table 88-2 09/20/10
Clinical Features <ul><li>Abdominal pain </li></ul><ul><li>Anorexia </li></ul><ul><li>Weight loss </li></ul><ul><li>Weakne...
Paraneoplastic  syndromes <ul><li>Hypoglycemia </li></ul><ul><li>Erythrocytosis </li></ul><ul><li>Hypercalcemia </li></ul>...
Table 88-4 09/20/10
Laboratory Investigations <ul><li>Ultrasonography </li></ul><ul><li>Alpha Feto Protein </li></ul><ul><li>CT Scan </li></ul...
HCC Screening <ul><li>High risk groups: cirrhosis, HBV, HCV, </li></ul><ul><li>+Family history of HCC </li></ul><ul><li>AF...
Therapy <ul><li>Surgical resection </li></ul><ul><li>Local ablation: RFA – heat; 3-4cm size </li></ul><ul><li>Injection th...
Figure 88-1 09/20/10
Other tumors <ul><li>Cholangiocarcinoma: mucin-producing </li></ul><ul><li>AdenoCA arising from bile ducts; acc to anatomi...
Hepatic metastases <ul><li>Colon </li></ul><ul><li>Pancreas </li></ul><ul><li>breast </li></ul>09/20/10
Benign tumors <ul><li>Hemangioma </li></ul><ul><li>Adenoma </li></ul><ul><li>Focal nodular hyperplasia </li></ul><ul><li>P...
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Hepatocellular carcinoma

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Transcript of "Hepatocellular carcinoma"

  1. 1. Hepatocellular Carcinoma <ul><li>One of the most common malignancies </li></ul><ul><li>Incidence: 1 M (annual) </li></ul><ul><li>Ratio 4M:1F </li></ul><ul><li>US: MR 1.9/100,000/year (low incidence) </li></ul><ul><li>Africa: 5-20/100,000/year (moderate) </li></ul><ul><li>Asia: 23-150/100,000/year (high) </li></ul>09/20/10
  2. 2. Table 88-1 09/20/10
  3. 3. Etiologic Factors <ul><li>Hepatitis C Virus: </li></ul><ul><li>US: 4M carriers  10%  cirrhosis  </li></ul><ul><li>5%  HCC (20,000) </li></ul><ul><li>Hepatitis B Virus: </li></ul><ul><li>High association with HBeAg+ </li></ul><ul><li>High HBVDNA viral load </li></ul>09/20/10
  4. 4. Table 88-2 09/20/10
  5. 5. Clinical Features <ul><li>Abdominal pain </li></ul><ul><li>Anorexia </li></ul><ul><li>Weight loss </li></ul><ul><li>Weakness </li></ul><ul><li>Ascites </li></ul><ul><li>Jaundice </li></ul><ul><li>Hematemesis </li></ul><ul><li>Bone pain </li></ul><ul><li>asymptomatic </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Ascites </li></ul><ul><li>Abdominal bruits </li></ul><ul><li>Splenomegaly </li></ul><ul><li>Muscle wasting </li></ul><ul><li>Jaundice </li></ul><ul><li>Dilated superf veins </li></ul><ul><li>Palmar erythema </li></ul><ul><li>edema </li></ul>09/20/10
  6. 6. Paraneoplastic syndromes <ul><li>Hypoglycemia </li></ul><ul><li>Erythrocytosis </li></ul><ul><li>Hypercalcemia </li></ul><ul><li>Hypercholesterolemia </li></ul><ul><li>Dysfibrogenemia </li></ul><ul><li>Carcinoid syndrome </li></ul><ul><li>Gynecomastia, testicular atrophy </li></ul><ul><li>Thrombocytopenia </li></ul><ul><li>Leukopenia </li></ul>09/20/10
  7. 7. Table 88-4 09/20/10
  8. 8. Laboratory Investigations <ul><li>Ultrasonography </li></ul><ul><li>Alpha Feto Protein </li></ul><ul><li>CT Scan </li></ul><ul><li>MRI </li></ul><ul><li>Others: Hep B, Hep C, HBV DNA </li></ul><ul><li>Liver biopsy </li></ul>09/20/10
  9. 9. HCC Screening <ul><li>High risk groups: cirrhosis, HBV, HCV, </li></ul><ul><li>+Family history of HCC </li></ul><ul><li>AFP determination </li></ul><ul><li>Ultrasonography </li></ul><ul><li>Biannual </li></ul>09/20/10
  10. 10. Therapy <ul><li>Surgical resection </li></ul><ul><li>Local ablation: RFA – heat; 3-4cm size </li></ul><ul><li>Injection therapy: ethanol; 3x; 3 cm size </li></ul><ul><li>Liver transplant </li></ul><ul><li>Systemic chemotherapy </li></ul><ul><li>Regional chemotherapy: TACE </li></ul><ul><li>(doxorubicin, cisplatin) </li></ul>09/20/10
  11. 11. Figure 88-1 09/20/10
  12. 12. Other tumors <ul><li>Cholangiocarcinoma: mucin-producing </li></ul><ul><li>AdenoCA arising from bile ducts; acc to anatomic sites – intrahepatic, hilar, peripheral; Klatskin(CBD bifurcation); Asians Chlonorchis sinensis ( liver fluke); surgery for distal and hilar lesions </li></ul><ul><li>Gall bladder CA: worse prognosis; 4F:1M; </li></ul><ul><li>Calculous cholecystitis; surgery </li></ul>09/20/10
  13. 13. Hepatic metastases <ul><li>Colon </li></ul><ul><li>Pancreas </li></ul><ul><li>breast </li></ul>09/20/10
  14. 14. Benign tumors <ul><li>Hemangioma </li></ul><ul><li>Adenoma </li></ul><ul><li>Focal nodular hyperplasia </li></ul><ul><li>Predominantly females </li></ul>09/20/10
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