This document discusses liver cancers. It covers the anatomy of the liver, epidemiology, etiology, prognostic factors, workup, and staging of liver cancers. Some key points include: - Liver cancer is the 5th most common cancer in men worldwide and the second leading cause of cancer death. Incidence is highest in East Asia and lowest in Northern Europe. - Major risk factors for liver cancer include hepatitis B and C infections, alcohol use, and metabolic diseases like hemochromatosis. - Staging involves radiological imaging like CT scans and tumor markers like AFP. Biopsies may also be used for pathological examination. - Prognostic factors include tumor size, number, vascular invasion,

1. LIVER CANCERS
Dr. MANISH DUTT

2. • ANATOMY
• EPIDEMIOLOGY
• ETIOLOGY
• PATHOLOGY
• PROGNOSTIC FACTORS
• WORKUP
• STAGING

3. anatomy

4. Couinaud segments

5. Clinical significance
Each segment can be resected without
damaging those remaining
resections must proceed along the
vessels
Dual blood supply:
Portal vein: 3/4
Hepatic artery:1/4
Venous outflow:
Hepatic veins: left, right and middle
Drains into IVC

6. HEPATIC LOBULES

8. EPIDEMIOLOGY
• 782,000 new cases worldwide 2012
• fifth most common cancer in men, 7.5% of
the total) and the ninth in women (3.4%)
• high incidence in Eastern and South-Eastern
Asia (ASRs 31.9 and 22.2 respectively)
• lowest rates in Northern Europe (4.6) and
South-Central Asia (3.70
• second most common cause of death from
cancer 746,000 deaths in 2012 (9.1% of the
total)
• prognosis very poor (overall ratio of mortality
to incidence of 0.95

10. INDIAN STATS
• men 0.9-7.5 per 100,000
• women 0.2 -2.2 per 100,000
• male:female ratio for HCC in India is 4:1
• age of presentation 40 to 70 years
• highest AAIR was reported from Sikkim(7.5)and
Mizoram(6.4)
• 4–8% of the cancers were due to HCC
• annual incidence rate of 1.6% (Paul et al) in cirrhotics
• age standardized mortality rate for men is 6.8 ,women
5.1/100,000.
• incidence of HCC in cirrhotics in India is 1.6% per year
• 70–97% of patients with HCC at the time of diagnosis
had underlying cirrhosis of liver
• incidence of HCC is increasing in India

11. ETIOLOGY
• Viral hepatitis- HBV
1. 98 fold greater risk
2. Asymptomatic HbsAg+ - 12
times RR
3. MECHANISM-indirect/direct
4. 70% HBV related HCC- with
cirrhosis
5. Risk of HCC in hepB cirrhotic
0.5%
• HCV-
1. Chronic infection(60-80%)
2. 20 fold more and advanced
cirrhosis
3. Risk of HCC in hepC cirrhotic
5%
Mi-R-155 accumulation

12. Etiology contd.
• Alcohol- carcinogenic, acetaldehyde, oxidative stress
• NASH(24%)
• METABOLIC DISEASES-haemochromatosis, Wilson,
alpha1 AT def.
• Chemical carcinogens- aflatoxin
• Anabolic steroids, estrogens
• Pesticides, insecticides
• Obesity, DM
• Cumulative tobacco use
• Male, old age, specific promotor mutations, higher
viremia levels

13. STAGING

14. PROGNOSTIC FACTORS
• large size,
• multiple tumors
• vascular invasion
• lymph node spread
• Macroscopic or microscopic
vascular invasions
• severity of underlying liver
disease- CHILD PUGH, CLIP, V-
CLIP, (JIS), BCLC

15. DIAGNOSTIC W/U
• Labs: CBC, LFTs, chemistries,
coagulation panel, serum
AFP(10–15% false negative),
Hepatitis B/C panels.
• Abdominal CT scan (special
contrast protocol).
• FNAC can be performed but is
not always needed.

16. W/U Contd.
Radiological/non invasive
• Lesions>2cm-
• arterial hyperenhancement on two
different imaging modalities, or on one
imaging modality alongside with a serum
AFP of 400 ng/dL
• both arterial hyperenhancement and
venous washout in a single imaging
modality concomitant with an AFP >200
ng/mL
• sensitivity and specificity of 64.9% and
62.8%
pathological
• Core biopsies- liver/portal vein
• stromal invasion
• sensitivity and specificity of 89.1%
and 100%