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Hepatocellular Carcinoma

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Shot overview of HCC

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Hepatocellular Carcinoma

  1. 1. Hepatocellular Carcinoma Dr Shatdal Chaudhary
  2. 2. Incidence • One of most common malignancy world wide • Annual 1 million case • M:F 4:1 • Mean Age 56 ± 13 • Associated with – cirrhosis 81% – No cirrhosis 19%
  3. 3. • Etiology – Cirrhosis from any cause – Hep B&C chronic infection – Chronic ethanol consumption – NASH/NAFLD – Mycotoxin- Alfatoxin B1
  4. 4. • Unusual – Pri biliay cirrhosis – Hemachromatosis – Α1 Antitrypsin def – Glycogen storage disorder – Wilson disease
  5. 5. C/F • Symptoms (%) – Abdominal pain 40 – Weight loss 24 – Appetite loss 11 – Weakness 15 – Jaundice 5 – Cirrhosis Symptoms 18 – No Symptoms 24
  6. 6. Physical Signs • Hepatomegaly 50-90% • Ascites 30-60% • Splenomegaly • Abdominal bruit • Fever 10-50% • Signs of cirrhosis
  7. 7. • Paraneoplastic syndromes – Hypoglycemis – Erytherocytosis – Hypercalcemia – Hypercholesterolemia – Dysfibrogenemia – Carcinoid synd – Chage in sexual characteristic
  8. 8. Staging • Okuda Classification + - – Tumor extent ≥50% <50% – Ascites + - – Albumin ≤3(g/L) >3 – Bilirubin ≥3 <3 • Stage 1 all- • Stage 2 1/2 + • Stage 3 3/4 +
  9. 9. CLIP staging • 0 1 2 • Tumor number single multiple - • Tumor extent <50 <50 >50 • Child Pugh score A B C • AFP <400 >400 - • Portal vein thromb No Yes - • CLIP 0, CLIP1, CLIP2, CLIP3.
  10. 10. Investigation • USG- Liver mass with hyper vascularity Portal vein thrombosis • Helical CT Scan • Serological assay – AFP 50% – AFP-L3 80% – DCP/PIVKA-2 • USG guided Core Liver Biopsy/FNAC
  11. 11. Treatment Treatment option • Surgery: Resection/ Liver Transplant • Local Ablative therapies – Cryosurgery – Radiofrequency Ablation – Percutaneous ethanol injection
  12. 12. • Regional Therapies – Transarterial chemotherapy – Transarterial embolization – Transarterial chemoembolization – Transarterial radiotherapy • Conformal External-Beam radiation • Chemotherapy • Immunotherapy
  13. 13. Stages 1 and 2 HCC • Surgical resection/RFA/ Local injection – Child A, Noncirrhotic, No Metastasis, Single lesion – Child B, C – Orthotopic liver trasplant – Percutaneous ethanol injection
  14. 14. Stages 3 and 4 • Poor prognosis • If no meastasis – transplant • Chemotherapy – Doxorubicin – Cisplatin – Mitomycin C – Oral Sorefenib

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