Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, presents with various clinical features that can help diagnose and stage the disease. These features, along with imaging studies and laboratory tests, aid in determining the extent and severity of HCC. Here are the key clinical features and staging considerations:
Clinical Features:
Abdominal Pain: HCC can cause pain or discomfort in the upper right abdomen due to liver enlargement or tumor growth.
Jaundice: Yellowing of the skin and eyes (jaundice) may occur when the tumor affects liver function or obstructs the bile ducts.
Weight Loss: Unintentional weight loss may result from factors such as decreased appetite or cancer-related wasting.
Fatigue and Weakness: HCC patients often experience persistent fatigue and generalized weakness.
Loss of Appetite and Nausea: HCC can lead to reduced appetite, resulting in nausea and vomiting.
Abdominal Swelling: Ascites, the accumulation of fluid in the abdomen, may cause abdominal distension and discomfort.
Enlarged Liver: As HCC progresses, the liver may become palpable due to its enlargement and the presence of a tumor.
Staging: HCC staging helps determine the extent and spread of the cancer, guiding treatment decisions. The most commonly used staging system for HCC is the Barcelona
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
This lecture is about Spectrum of HCV infection presented by Dr. Muhammad Mostafa Abdel Ghaffar, Head of Tropical Medicine Department, Ahmed Maher Teaching Hospital.
The lecture was presented in the scientific meeting of Internal and Tropical Medicine departments, Ahmed Maher Teaching Hospital titled (Towards Eradication of HCV in Egypt) in celebration of World Hepatitis Day on July 28, 2016.
https://www.facebook.com/AMTH.IM
https://www.facebook.com/events/1072758396145209/
http://www.no4c.com
A wonderful slide for tumor markers in GI surgery. Cancer biomarkers are often used in monitoring response in cancer.
Tumor marker, biomarkers in common practice.
Kinds of Liver Cancers diagnosis and TreatementsSumit Roy
Wockhardt Hospitals has proved its medical one-upmanship yet again by successfully performing a major liver re-resection on a 58 year old man. In a case of a recurrent cancerous liver tumor which many hospitals worldwide would shirk from taking up for a second surgery, the expert team at Wockhardt Hospitals led by Dr S K Mathur took the challenge and skillfully excised the tumors in an arduous 11- hour surgical procedure
Presentazione a cura del Dottor Claudio Puoti - "HOT TOPICS IN GASTROENTEROLOGIA - I TUMORI DELL'APPARATO DIGERENTE: cosa è cambiato e cosa bisogna sapere" - Roma 10/11/2018
Renal cell carcinoma (RCC) often presents with vague symptoms in its early stages, and patients may remain asymptomatic. As the disease progresses, common clinical features may include:
Hematuria: Blood in the urine is a common sign, often presenting as either visible blood or microscopic hematuria.
Flank Pain: Discomfort or pain in the side or lower back, potentially associated with tumor expansion or pressure on surrounding structures.
Palpable Abdominal Mass: A palpable lump or mass in the abdomen may be felt during a physical examination.
Weight Loss and Fatigue: Advanced stages may lead to unintended weight loss and fatigue.
Paraneoplastic Syndromes: Some RCCs produce hormones or cytokines, leading to paraneoplastic syndromes, such as elevated erythropoietin levels causing polycythemia.
Pathology:
Histological Subtypes: Clear cell, papillary, chromophobe, and other rare subtypes exist. Clear cell is the most common and typically associated with worse prognosis.
Genetic and Molecular Alterations: Mutations in tumor suppressor genes (e.g., VHL, PBRM1, BAP1), chromosomal deletions, and alterations in cellular pathways contribute to RCC development.
Tumor Grading: Fuhrman grade and ISUP grading system assess tumor differentiation, with higher grades indicating a poorer prognosis.
Tumor Necrosis: Histologic coagulative tumor necrosis is an independent predictor of outcome.
Imaging:
CT Scan: High-resolution computed tomography (CT) imaging is the primary modality for RCC diagnosis and staging, providing detailed visualization of the tumor, surrounding structures, and potential metastases.
MRI: Magnetic resonance imaging (MRI) offers additional soft tissue contrast and is particularly useful for characterizing renal masses.
Ultrasound: Ultrasound may be used for initial assessment and is effective in detecting solid masses but may have limitations in characterizing complex lesions.
Nuclear Medicine: Positron emission tomography (PET) scans can be used for staging and detecting distant metastases.
Prognosis:
TNM Staging: The tumor, node, metastasis (TNM) staging system stratifies patients based on the extent of disease.
Anatomic Factors: Invasion into the renal vein or inferior vena cava, perinephric fat extension, and involvement of the urinary collecting system impact prognosis.
Histopathological Factors: Clear cell histology, higher tumor grade, and tumor necrosis are associated with a worse prognosis.
Molecular Markers: Various molecular markers, genetic alterations, and gene expression profiles can provide additional prognostic information.
Survival Rates: Prognosis varies widely, with early-stage disease having better survival rates compared to advanced stages. Advances in targeted therapies and immunotherapy have improved outcomes for some patients with advanced RCC.
Liver Tumors and Hepatocellular carcinoma supported by Hepatoblastoma. Most of the text are from Robbins Pathological basis of disease 9E, Goljan Review of pathology.
Euthanasia, derived from Greek words meaning "good death," is a complex and controversial ethical and legal issue revolving around the deliberate ending of a person's life to relieve suffering. It is often a topic of intense debate within medical, legal, religious, and ethical circles.
Types of Euthanasia:
Voluntary Euthanasia: This occurs when a competent person makes a voluntary and informed decision to end their life with the assistance of a medical professional or loved one.
Non-voluntary Euthanasia: In this scenario, the decision to end a person's life is made by someone other than the individual, typically when they are unable to make decisions for themselves due to being in a coma or having advanced dementia.
Involuntary Euthanasia: This is the termination of a person's life against their will or without their consent, often performed in situations where the person's suffering is deemed unbearable or where their quality of life is deemed too low by others.
Assisted Suicide: This involves providing a person with the means or information necessary to end their own life, such as prescribing lethal medication, while the individual ultimately carries out the act themselves.
Ethical Considerations:
Autonomy vs. Sanctity of Life: Supporters of euthanasia argue for individual autonomy and the right to die with dignity, while opponents often cite the sanctity of life and the potential for abuse or slippery slope arguments.
Quality of Life: Discussions often revolve around the subjective nature of suffering and the quality of life, with some arguing that euthanasia can alleviate unnecessary suffering, while others raise concerns about the potential devaluation of certain lives.
Medical Ethics: Euthanasia raises questions about the role of healthcare professionals in end-of-life care, the distinction between killing and allowing to die, and the obligations of physicians to relieve suffering while upholding ethical principles.
Legal Status:
The legality of euthanasia varies greatly around the world. Some countries, such as the Netherlands, Belgium, and Canada, have legalized certain forms of euthanasia under strict conditions, while others, including many U.S. states, maintain its illegality. In some regions, there are ongoing debates and court cases seeking to clarify or change existing laws.
Conclusion:
Euthanasia remains a deeply divisive and emotionally charged issue, touching on fundamental questions about life, death, autonomy, and suffering. As medical technology advances and societal attitudes evolve, discussions surrounding euthanasia are likely to persist, challenging individuals, communities, and policymakers to navigate the complexities of this sensitive topic with compassion and integrity.
Management of locally advanced ovarian, fallopian tube, and peritoneal tumors requires a comprehensive and multidisciplinary approach. Locally advanced tumors are those that have spread beyond the ovaries or fallopian tubes and may involve nearby structures, such as the peritoneum or adjacent organs. Here's a brief overview of the management strategies:
Surgery:
Debulking Surgery: The primary treatment for locally advanced tumors involves cytoreductive or debulking surgery. This aims to remove as much of the tumor as possible. Surgeons may perform a total hysterectomy, bilateral salpingo-oophorectomy, and removal of involved peritoneal tissues.
Lymphadenectomy: Lymph node dissection is often done to assess the extent of the disease spread and to remove involved lymph nodes.
Chemotherapy:
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery to shrink the tumor, making surgery more effective.
Adjuvant Chemotherapy: Following surgery, chemotherapy is typically recommended to target any remaining cancer cells. Platinum-based chemotherapy regimens are commonly used.
Targeted Therapies:
PARP Inhibitors: Poly (ADP-ribose) polymerase inhibitors, such as olaparib and niraparib, have shown efficacy in treating ovarian and related cancers with specific genetic mutations, like BRCA mutations.
Immunotherapy:
Checkpoints Inhibitors: Immune checkpoint inhibitors, like pembrolizumab and nivolumab, may be considered in cases with specific molecular profiles.
Radiation Therapy:
External Beam Radiation: In some situations, radiation therapy may be used to target specific areas affected by the tumor.
Clinical Trials:
Participation in clinical trials may be an option for patients with locally advanced disease, offering access to innovative treatments and therapies.
Follow-up Care:
Regular monitoring and follow-up care are crucial to assess treatment effectiveness and detect any signs of recurrence.
Palliative Care:
Palliative care should be integrated into the management plan to address symptom control, improve quality of life, and provide support for both the patient and their family.
A personalized treatment plan should be developed based on the specific characteristics of the tumor, the patient's overall health, and individual factors. Regular communication among a multidisciplinary team, including surgeons, medical oncologists, radiation oncologists, and other specialists, is essential for optimizing the management of locally advanced ovarian, fallopian tube, and peritoneal tumors.
More Related Content
Similar to Hepatocellular carcinoma: clinical feature.pptx
A wonderful slide for tumor markers in GI surgery. Cancer biomarkers are often used in monitoring response in cancer.
Tumor marker, biomarkers in common practice.
Kinds of Liver Cancers diagnosis and TreatementsSumit Roy
Wockhardt Hospitals has proved its medical one-upmanship yet again by successfully performing a major liver re-resection on a 58 year old man. In a case of a recurrent cancerous liver tumor which many hospitals worldwide would shirk from taking up for a second surgery, the expert team at Wockhardt Hospitals led by Dr S K Mathur took the challenge and skillfully excised the tumors in an arduous 11- hour surgical procedure
Presentazione a cura del Dottor Claudio Puoti - "HOT TOPICS IN GASTROENTEROLOGIA - I TUMORI DELL'APPARATO DIGERENTE: cosa è cambiato e cosa bisogna sapere" - Roma 10/11/2018
Renal cell carcinoma (RCC) often presents with vague symptoms in its early stages, and patients may remain asymptomatic. As the disease progresses, common clinical features may include:
Hematuria: Blood in the urine is a common sign, often presenting as either visible blood or microscopic hematuria.
Flank Pain: Discomfort or pain in the side or lower back, potentially associated with tumor expansion or pressure on surrounding structures.
Palpable Abdominal Mass: A palpable lump or mass in the abdomen may be felt during a physical examination.
Weight Loss and Fatigue: Advanced stages may lead to unintended weight loss and fatigue.
Paraneoplastic Syndromes: Some RCCs produce hormones or cytokines, leading to paraneoplastic syndromes, such as elevated erythropoietin levels causing polycythemia.
Pathology:
Histological Subtypes: Clear cell, papillary, chromophobe, and other rare subtypes exist. Clear cell is the most common and typically associated with worse prognosis.
Genetic and Molecular Alterations: Mutations in tumor suppressor genes (e.g., VHL, PBRM1, BAP1), chromosomal deletions, and alterations in cellular pathways contribute to RCC development.
Tumor Grading: Fuhrman grade and ISUP grading system assess tumor differentiation, with higher grades indicating a poorer prognosis.
Tumor Necrosis: Histologic coagulative tumor necrosis is an independent predictor of outcome.
Imaging:
CT Scan: High-resolution computed tomography (CT) imaging is the primary modality for RCC diagnosis and staging, providing detailed visualization of the tumor, surrounding structures, and potential metastases.
MRI: Magnetic resonance imaging (MRI) offers additional soft tissue contrast and is particularly useful for characterizing renal masses.
Ultrasound: Ultrasound may be used for initial assessment and is effective in detecting solid masses but may have limitations in characterizing complex lesions.
Nuclear Medicine: Positron emission tomography (PET) scans can be used for staging and detecting distant metastases.
Prognosis:
TNM Staging: The tumor, node, metastasis (TNM) staging system stratifies patients based on the extent of disease.
Anatomic Factors: Invasion into the renal vein or inferior vena cava, perinephric fat extension, and involvement of the urinary collecting system impact prognosis.
Histopathological Factors: Clear cell histology, higher tumor grade, and tumor necrosis are associated with a worse prognosis.
Molecular Markers: Various molecular markers, genetic alterations, and gene expression profiles can provide additional prognostic information.
Survival Rates: Prognosis varies widely, with early-stage disease having better survival rates compared to advanced stages. Advances in targeted therapies and immunotherapy have improved outcomes for some patients with advanced RCC.
Liver Tumors and Hepatocellular carcinoma supported by Hepatoblastoma. Most of the text are from Robbins Pathological basis of disease 9E, Goljan Review of pathology.
Euthanasia, derived from Greek words meaning "good death," is a complex and controversial ethical and legal issue revolving around the deliberate ending of a person's life to relieve suffering. It is often a topic of intense debate within medical, legal, religious, and ethical circles.
Types of Euthanasia:
Voluntary Euthanasia: This occurs when a competent person makes a voluntary and informed decision to end their life with the assistance of a medical professional or loved one.
Non-voluntary Euthanasia: In this scenario, the decision to end a person's life is made by someone other than the individual, typically when they are unable to make decisions for themselves due to being in a coma or having advanced dementia.
Involuntary Euthanasia: This is the termination of a person's life against their will or without their consent, often performed in situations where the person's suffering is deemed unbearable or where their quality of life is deemed too low by others.
Assisted Suicide: This involves providing a person with the means or information necessary to end their own life, such as prescribing lethal medication, while the individual ultimately carries out the act themselves.
Ethical Considerations:
Autonomy vs. Sanctity of Life: Supporters of euthanasia argue for individual autonomy and the right to die with dignity, while opponents often cite the sanctity of life and the potential for abuse or slippery slope arguments.
Quality of Life: Discussions often revolve around the subjective nature of suffering and the quality of life, with some arguing that euthanasia can alleviate unnecessary suffering, while others raise concerns about the potential devaluation of certain lives.
Medical Ethics: Euthanasia raises questions about the role of healthcare professionals in end-of-life care, the distinction between killing and allowing to die, and the obligations of physicians to relieve suffering while upholding ethical principles.
Legal Status:
The legality of euthanasia varies greatly around the world. Some countries, such as the Netherlands, Belgium, and Canada, have legalized certain forms of euthanasia under strict conditions, while others, including many U.S. states, maintain its illegality. In some regions, there are ongoing debates and court cases seeking to clarify or change existing laws.
Conclusion:
Euthanasia remains a deeply divisive and emotionally charged issue, touching on fundamental questions about life, death, autonomy, and suffering. As medical technology advances and societal attitudes evolve, discussions surrounding euthanasia are likely to persist, challenging individuals, communities, and policymakers to navigate the complexities of this sensitive topic with compassion and integrity.
Management of locally advanced ovarian, fallopian tube, and peritoneal tumors requires a comprehensive and multidisciplinary approach. Locally advanced tumors are those that have spread beyond the ovaries or fallopian tubes and may involve nearby structures, such as the peritoneum or adjacent organs. Here's a brief overview of the management strategies:
Surgery:
Debulking Surgery: The primary treatment for locally advanced tumors involves cytoreductive or debulking surgery. This aims to remove as much of the tumor as possible. Surgeons may perform a total hysterectomy, bilateral salpingo-oophorectomy, and removal of involved peritoneal tissues.
Lymphadenectomy: Lymph node dissection is often done to assess the extent of the disease spread and to remove involved lymph nodes.
Chemotherapy:
Neoadjuvant Chemotherapy: In some cases, chemotherapy may be administered before surgery to shrink the tumor, making surgery more effective.
Adjuvant Chemotherapy: Following surgery, chemotherapy is typically recommended to target any remaining cancer cells. Platinum-based chemotherapy regimens are commonly used.
Targeted Therapies:
PARP Inhibitors: Poly (ADP-ribose) polymerase inhibitors, such as olaparib and niraparib, have shown efficacy in treating ovarian and related cancers with specific genetic mutations, like BRCA mutations.
Immunotherapy:
Checkpoints Inhibitors: Immune checkpoint inhibitors, like pembrolizumab and nivolumab, may be considered in cases with specific molecular profiles.
Radiation Therapy:
External Beam Radiation: In some situations, radiation therapy may be used to target specific areas affected by the tumor.
Clinical Trials:
Participation in clinical trials may be an option for patients with locally advanced disease, offering access to innovative treatments and therapies.
Follow-up Care:
Regular monitoring and follow-up care are crucial to assess treatment effectiveness and detect any signs of recurrence.
Palliative Care:
Palliative care should be integrated into the management plan to address symptom control, improve quality of life, and provide support for both the patient and their family.
A personalized treatment plan should be developed based on the specific characteristics of the tumor, the patient's overall health, and individual factors. Regular communication among a multidisciplinary team, including surgeons, medical oncologists, radiation oncologists, and other specialists, is essential for optimizing the management of locally advanced ovarian, fallopian tube, and peritoneal tumors.
Metastatic breast cancer, specifically HER2-positive subtype, represents an advanced stage of breast cancer characterized by the presence of human epidermal growth factor receptor 2 (HER2) overexpression. HER2-positive breast cancer tends to be more aggressive, but advancements in treatment options have significantly improved outcomes.
Targeted therapies play a crucial role in managing metastatic HER2-positive breast cancer. Trastuzumab (Herceptin) and pertuzumab are monoclonal antibodies that specifically target the HER2 protein, inhibiting its activity and impeding cancer cell growth. These drugs are often used in combination with chemotherapy to enhance their effectiveness.
In addition to trastuzumab and pertuzumab, other HER2-targeted therapies such as ado-trastuzumab emtansine (Kadcyla) and lapatinib may be employed in certain cases. Ado-trastuzumab emtansine is an antibody-drug conjugate that delivers chemotherapy directly to HER2-positive cancer cells, minimizing damage to healthy cells. Lapatinib, on the other hand, is a small molecule inhibitor that blocks HER2 and other related receptors.
Given the chronic nature of metastatic breast cancer, treatment plans are often individualized based on the patient's overall health, specific characteristics of the cancer, and prior treatments. Hormone therapy may also be considered if the cancer is hormone receptor-positive. Clinical trials and ongoing research continue to explore novel treatment options, providing hope for further advancements in managing HER2-positive metastatic breast cancer. Patients are encouraged to work closely with their healthcare team to determine the most appropriate and effective treatment plan tailored to their unique circumstances.
Role of Neoadjuvant Chemotherapy (NACT) in Ovarian Cancer:
Objective: Administer systemic therapy before definitive surgery.
Goal: Reduce perioperative complications, enhance complete resection chances.
Patient Selection:
Offered to clinically apparent, unresectable ovarian cancer cases.
Considered for poor surgical candidates with medical comorbidities.
Diagnostic Laparoscopy: Used in stage III or IV cases to assess resectability.
Chemotherapy Choice: Prefer intravenous platinum-based regimen, e.g., carboplatin plus paclitaxel.
Assessment and Next Steps:
Serial evaluations during NACT, assessing treatment response after three cycles.
Surgical cytoreduction for optimal resection chances.
Consider Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for optimal surgical results if expertise available.
Medical therapy for disease progression or suboptimal response.
Following Surgery:
Recommend adjuvant platinum-based chemotherapy.
Prefer intravenous chemotherapy (carboplatin and paclitaxel for 3-6 cycles) over intraperitoneal therapy.
Non-clear cell renal cell carcinoma (RCC) encompasses diverse subtypes, each requiring tailored therapeutic approaches. Papillary RCC may benefit from immunotherapy or vascular endothelial growth factor receptor (VEGFR) inhibitors. Chromophobe RCC often sees mTOR inhibitors or VEGFR inhibitors as initial treatments. For collecting duct and renal medullary carcinomas, cytotoxic chemotherapy is recommended.
Translocation RCC may respond well to lenvatinib plus pembrolizumab, while unclassified RCC patients might consider immunotherapy-based regimens. Sarcomatoid features in non-clear cell RCC lean towards immunotherapy.
Clinical trials are encouraged due to limited high-quality data, emphasizing the need for personalized strategies based on histologic subtypes. Overall, these recommendations aim to optimize outcomes in the diverse landscape of non-clear cell RCC.
Osteoradionecrosis is a severe complication arising from head and neck radiotherapy. Mainly affecting the posterior mandible, it often manifests in molars and premolars. Common risk factors include high radiation doses, teeth extractions, and smoking. In the context of treatment, ORN can be categorized into four grades (1-4) based on severity.
Key Points:
Incidence: Occurs in approximately 7.5% of cases, with a median onset time of 8 months post-radiotherapy.
Risk Factors:
Higher incidence with elevated mean radiation doses to the mandible.
Smoking and pre-radiotherapy dental extractions significantly increase the risk.
Treatment Approaches:
Conservative management for early stages.
Surgical interventions include sequestrectomy (Stage 2) and, in severe cases, resection (Stage 3, involving mandibulectomy).
Hyperbaric oxygen therapy may aid in non-healing cases.
Prevention:
Precise dose planning tailored to individual patients crucial for minimizing risks.
Consideration of patient-specific factors, such as smoking and dental history, in treatment planning.
ORN underscores the importance of meticulous treatment planning and individualized approaches to minimize this debilitating complication.
Borderline ovarian malignancy, also known as borderline ovarian tumor or ovarian tumors of low malignant potential (LMP), is a distinct category of ovarian tumors that fall between benign and malignant tumors in terms of their behavior and potential for spreading.
Characteristics and Diagnosis:
Histological Features: Borderline ovarian tumors have certain cellular abnormalities that suggest malignancy but lack the invasive qualities seen in fully malignant tumors.
Age Group: They often occur in women of childbearing age, and their incidence tends to be highest in women in their 30s and 40s.
Clinical Presentation: Borderline ovarian tumors may be asymptomatic or present with nonspecific symptoms like abdominal pain, bloating, or changes in urinary habits.
Imaging and Biopsy: Diagnosis typically involves imaging studies, such as ultrasound, and a biopsy or surgical removal of the tumor for a pathological examination to confirm its borderline nature.
Treatment and Prognosis:
Surgical Approach: The primary treatment for borderline ovarian tumors is usually surgery, which involves removing the affected ovary or ovaries. The goal is to perform a comprehensive surgical staging to assess the extent of disease without removing both ovaries unless necessary.
Chemotherapy: Unlike malignant ovarian tumors, borderline tumors are less likely to spread beyond the ovaries. In cases where there is evidence of disease spread or in certain high-risk situations, chemotherapy may be considered.
Prognosis: The overall prognosis for women with borderline ovarian tumors is generally favorable. The majority of patients have an excellent long-term survival rate, especially if the tumor is confined to the ovaries at the time of diagnosis.
Follow-Up and Recurrence:
Regular Monitoring: Given the potential for recurrence, patients with borderline ovarian tumors often undergo regular follow-up examinations, including imaging studies and blood tests (such as CA-125), to monitor for any signs of disease recurrence.
Reproductive Considerations:
Fertility-Sparing Options: For women who wish to preserve fertility, there may be options for fertility-sparing surgery in carefully selected cases where the tumor is unilateral, well-staged, and the patient desires future childbearing.
Conclusion:
Borderline ovarian malignancy represents a unique category in ovarian tumors, requiring a multidisciplinary approach involving gynecologic oncologists, pathologists, and other healthcare professionals. While generally associated with a favorable prognosis, individual cases can vary, and personalized treatment plans are essential for optimal outcomes. Regular follow-up and clear communication between patients and healthcare providers play a crucial role in managing and monitoring borderline ovarian tumors.
Definition: Small cell lung carcinoma (SCLC) is a type of lung cancer that typically starts in the bronchi (large airways) and tends to grow and spread quickly. It accounts for approximately 10-15% of all lung cancers.
Characteristics: SCLC is characterized by small, oat-shaped cancer cells that rapidly divide and form large tumors. It is often associated with a history of smoking and has a strong correlation with tobacco exposure.
Aggressive nature: SCLC is considered highly aggressive, with a tendency to metastasize (spread) early to the lymph nodes and other distant parts of the body, such as the liver, bones, and brain. This rapid spread makes early detection and treatment crucial.
Limited and extensive stage: SCLC is classified into two stages: limited stage and extensive stage. Limited stage means the cancer is confined to one side of the chest and potentially adjacent lymph nodes, whereas extensive stage indicates that the cancer has spread beyond the chest to distant organs.
Treatment approach: The treatment of SCLC typically involves a combination of chemotherapy and radiation therapy. Surgery is generally not recommended for SCLC due to its aggressive nature and tendency to spread early. Chemotherapy, often in combination with immunotherapy, is the mainstay of treatment and can help shrink tumors and control the disease.
Prognosis: The prognosis for SCLC is generally poorer compared to non-small cell lung carcinoma (NSCLC) due to its more aggressive behavior and earlier metastasis. However, treatment advances and research efforts continue to improve outcomes for SCLC patients.
Supportive care: As with any cancer diagnosis, supportive care plays a critical role in managing SCLC. This includes addressing symptoms, managing pain, providing emotional support, and ensuring optimal quality of life for patients.
It's important to consult with healthcare professionals for an accurate diagnosis, personalized treatment plan, and ongoing monitoring for individuals suspected or diagnosed with small cell lung carcinoma.
Definition: Peritoneal mesothelioma is a rare cancer that develops in the lining of the abdomen, known as the peritoneum. It is primarily caused by exposure to asbestos fibers.
Symptoms: Common symptoms include abdominal pain, swelling, changes in bowel habits, unexplained weight loss, and fatigue. However, these symptoms can be nonspecific and resemble other gastrointestinal conditions, which can make diagnosis challenging.
Diagnosis: Diagnosis involves a combination of imaging tests, such as CT scans and MRIs, as well as biopsies to confirm the presence of peritoneal mesothelioma. These tests help determine the extent and stage of the disease.
Treatment options: The management of peritoneal mesothelioma often involves a multimodal approach, tailored to the individual case. Treatment options may include surgery, chemotherapy, and heated intraperitoneal chemotherapy (HIPEC).
Surgical interventions: Cytoreductive surgery aims to remove visible tumors from the abdomen, including affected organs and tissues. It is often performed in combination with HIPEC, a procedure where heated chemotherapy drugs are circulated in the abdominal cavity to target any remaining cancer cells.
Chemotherapy: Systemic chemotherapy, given intravenously or orally, may be used before or after surgery to help shrink tumors, kill cancer cells, and prevent their spread. In some cases, intraperitoneal chemotherapy (IPC) may be used instead of HIPEC.
Palliative care: Palliative care focuses on providing relief from symptoms and improving the quality of life for patients. It may involve pain management, nutritional support, and psychological support for both the patient and their loved ones.
Diagnosis: Prompt and accurate diagnosis is crucial. It involves imaging tests such as X-rays, CT scans, and MRIs, as well as biopsies to confirm the presence of pleural mesothelioma.
Treatment options: The management of pleural mesothelioma typically involves a multidisciplinary approach, which may include surgery, chemotherapy, and radiation therapy. The choice of treatment depends on the stage and extent of the disease, as well as the patient's overall health.
Surgical interventions: Surgical options may include pleurectomy/decortication (removal of the affected tissue lining the lungs) or extrapleural pneumonectomy (removal of the affected lung, lining, and nearby structures). These procedures aim to remove as much of the cancerous tissue as possible.
Chemotherapy: Chemotherapy drugs are often used to kill or slow the growth of cancer cells. They can be administered orally or through intravenous infusions. Sometimes, chemotherapy is given before surgery to shrink tumors and after surgery to target any remaining cancer cells.
Radiation therapy: This treatment involves the use of high-energy X-rays or other radiation sources to target and destroy cancer cells. It can be used before or after surgery, or as a standalone treatment to alleviate symptoms and manage the disease.
Palliative care: Palliative care focuses on improving the quality of life for patients by managing pain, reducing symptoms, and providing emotional and psychological support. It can be integrated into the treatment plan at any stage of the disease.
Systemic treatment in advanced hepatocellular carcinoma (HCC) refers to the use of medications or therapies that are administered throughout the body to target cancer cells beyond the liver. HCC is the most common type of liver cancer and often presents at an advanced stage, making systemic therapies crucial in managing the disease.
One of the main categories of systemic treatment for advanced HCC is targeted therapies. Targeted therapies are designed to selectively inhibit specific molecules or pathways involved in tumor growth, thereby blocking the signals that support cancer cell survival and proliferation. Sorafenib and lenvatinib are examples of targeted therapies that have been approved for the first-line treatment of advanced HCC. They target vascular endothelial growth factor (VEGF) receptors, which play a key role in promoting the growth of new blood vessels necessary for tumor growth. By inhibiting these receptors, these drugs can help slow down tumor growth and improve patient outcomes.
In addition to sorafenib and lenvatinib, other targeted therapies have shown promising results in the treatment of advanced HCC. Regorafenib, for instance, is a multi-kinase inhibitor that targets several pathways involved in tumor angiogenesis, cell proliferation, and survival. Cabozantinib is another multi-kinase inhibitor that has been approved as a second-line treatment option for patients who have progressed on or are intolerant to prior systemic therapy. These targeted therapies have demonstrated efficacy in improving overall survival and delaying disease progression in patients with advanced HCC.
Another significant advancement in systemic treatment for advanced HCC is the use of immune checkpoint inhibitors. Immunotherapy has revolutionized cancer treatment in recent years, including for HCC. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, work by blocking proteins that act as checkpoints on immune cells, such as programmed cell death protein 1 (PD-1) or its ligand (PD-L1). By doing so, these drugs help restore and enhance the immune system's ability to recognize and eliminate cancer cells. Checkpoint inhibitors have shown promising results, with some patients experiencing durable responses and improved overall survival.
Systemic treatment in advanced hepatocellular carcinoma (HCC) refers to the use of medications or therapies that are administered throughout the body to target cancer cells beyond the liver. HCC is the most common type of liver cancer and often presents at an advanced stage, making systemic therapies crucial in managing the disease.
One of the main categories of systemic treatment for advanced HCC is targeted therapies. Targeted therapies are designed to selectively inhibit specific molecules or pathways involved in tumor growth, thereby blocking the signals that support cancer cell survival and proliferation. Sorafenib and lenvatinib are examples of targeted therapies that have been approved for the first-line treatment of advanced HCC. They target vascular endothelial growth factor (VEGF) receptors, which play a key role in promoting the growth of new blood vessels necessary for tumor growth. By inhibiting these receptors, these drugs can help slow down tumor growth and improve patient outcomes.
In addition to sorafenib and lenvatinib, other targeted therapies have shown promising results in the treatment of advanced HCC. Regorafenib, for instance, is a multi-kinase inhibitor that targets several pathways involved in tumor angiogenesis, cell proliferation, and survival. Cabozantinib is another multi-kinase inhibitor that has been approved as a second-line treatment option for patients who have progressed on or are intolerant to prior systemic therapy. These targeted therapies have demonstrated efficacy in improving overall survival and delaying disease progression in patients with advanced HCC.
Another significant advancement in systemic treatment for advanced HCC is the use of immune checkpoint inhibitors. Immunotherapy has revolutionized cancer treatment in recent years, including for HCC. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, work by blocking proteins that act as checkpoints on immune cells, such as programmed cell death protein 1 (PD-1) or its ligand (PD-L1). By doing so, these drugs help restore and enhance the immune system's ability to recognize and eliminate cancer cells. Checkpoint inhibitors have shown promising results, with some patients experiencing durable responses and improved overall survival.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Hepatocellular Carcinoma (HCC), also known as liver cancer, is a primary malignancy originating
in the liver.
It is one of the most common and aggressive types of liver cancer and is associated with high
morbidity and mortality.
HCC typically arises in the context of chronic liver disease, such as cirrhosis or hepatitis B and C
infection.
Approximately 75 % of primary liver tumors are HCC, with cholangiocarcinoma comprising most
of the remaining cases
The use of antiviral therapy for patients with chronic HCV and an established diagnosis of HCC,
including data on reducing the risk of HCC recurrence .
Early detection and accurate staging of HCC are critical for effective management and improved
patient outcomes.
3. Cancer of the liver and intrahepatic bile ducts is the sixth most frequently diagnosed
malignancy worldwide.
With a five-year survival of approximately 21%, liver cancer is among the most lethal
gastrointestinal tumors
Estimated that 72 % of HCC cases occur in Asia, 10 % in Europe, 8 % in Africa, 5 % in North
America, and 5 % in Latin America
More frequently in men than in women, with a male to female ratio of approximately 3:1.
4. • common characteristic is injury to the liver parenchyma resulting in cirrhosis.
• Over 50 % of cases chronic HBV and 20 % of cases chronic HCV infection
• However, patients with chronic HBV infection are at risk for HCC even in the absence of
cirrhosis.
a. Cirrhosis
b. Viral hepatitis
c. Environmental toxins
d. Betel nut chewing
e. Iron overload in patients without genetic
susceptibility
f. Contaminated drinking water
g. Alcohol
h. Tobacco
i. Sugar-sweetened beverages
j. Nonalcoholic fatty liver disease
k. Diabetes mellitus
l. Obesity
m. Alpha-1 antitrypsin deficiency
n. Porphyria cutanea tarda (PCT)
PROTECTIVE FACTORS
• Vaccination for hepatitis B virus
(HBV) prevention
• Treatment for viral hepatitis
• Statins
• Aspirin and other nonsteroidal
anti-inflammatory drugs
• Metformin
• Coffee
• Physical activity
5. Cirrhosis :up to one-third of patients with cirrhosis will develop HCC during their lifetime, with an annual
incidence rate of 1 to 8%.
Hepatitis B virus —
Similarly, the annual incidence of HCC among those with HBV infection is higher in patients with cirrhosis
compared with no cirrhosis (3.2 vs 0.1 cases per 100 person-years).
• High viral load (ie, HBV DNA levels >106 copies /mL).
• HBeAg positivity (an indicator of a prolonged replication phase).
• HBsAg levels >1000 IU/mL in patients with HBeAg negative chronic HBV with low viral
load (ie, inactive chronic HBV)
• HBV genotype C
• Male sex (for patients who are HBsAg positive)
• Viral coinfection (HCV or hepatitis D virus, hepatitis E virus )
• HBsAg clearance – favorable prognosis, clearance of HBsAg did not eliminate the risk of
HCC .
• Young age of HBV acquisition or older age among those with chronic infection.
• Lifestyle factors –
• Alcohol or tobacco use.
• Blood group B (in males only).
• Family history of HCC.
Other factor
associated
with HCC
risk include
6. HCV infection is associated with an increased risk of HCC, primarily in patients with advanced hepatic fibrosis or cirrhosis.
The risk of developing HCC once cirrhosis has developed ranges from 1 to 4% per year.
In the United States, HCV accounts for approximately one-third of HCC cases. Successful treatment lowers but does not
eliminate HCC risk.
• Genotype 1b is associated with a higher risk of HCC compared to
genotypes 2a/c.
• Viral coinfection (HBV or HIV).
• Lifestyle factors like alcohol or tobacco use.
• Metabolic factors such as diabetes mellitus and obesity.
Additional risk factors for HCC in HCV-
infected individuals include:
HCC in the context of HCV is believed to arise due to rapid cellular turnover and the chronic inflammatory state induced by
the virus.
The imbalance in liver microenvironments and cytokines in HCV-infected livers leads to increased inflammation and cell
turnover, ultimately resulting in cirrhosis.
Poorly differentiated hepatocytes proliferate and develop into dysplastic nodules and HCC
8. 1.Jaundice:
2.Pruritus (Itching): bile salts in the bloodstream.
3.Spider Angiomas (Telangiectasia
4.Palmar Erythema
5.Leukonychia
6.Nail Changes
7.Cutaneous Lymphoma
8.Dermatomyositis
9.Pemphigus Foliaceus
9. • Extrahepatic metastases —
• Present at the time of diagnosis in approx. 10 to 15% of cases .
• Common in patients with advanced stage primary tumors (>5 cm, large vessel vascular
invasion.
• Extrahepatic recurrence after locoregional therapy in approximately 5 to 25% of patients
Metastatic HCC:
1.Lung Metastasis: cough, shortness of breath, chest pain
2.Bone Metastasis: Bone pain, particularly in the spine or hips.
3.Neurological Symptoms: headaches, confusion, difficulty speaking, or seizures.
4.Abdominal Discomfort: pain, discomfort, or digestive issues.
12. 1. Production by HCC: HCC cells can produce AFP, leading to elevated levels of this protein in the
bloodstream. AFP is often used as a tumor marker for HCC.
2. Tumor Screening and Diagnosis: AFP is a valuable tool for screening individuals at risk of HCC,
such as those with cirrhosis, chronic hepatitis B or C, or a family history of HCC
3. Monitoring and Surveillance: In patients already diagnosed with HCC, AFP is used for monitoring
the disease's progression and response to treatment. A rise in AFP levels over time can indicate
tumor growth or recurrence.
4. AFP Levels: The interpretation of AFP levels in the context of HCC is as follows:
1. Normal: Typically, AFP levels in healthy individuals are low (usually below 10 ng/mL).
2. Elevated but Non-specific: Elevated AFP alone is not specific to HCC and requires further
evaluation.
3. Significantly Elevated: A significant elevation of AFP, usually beyond 200 ng/mL, is more
strongly associated with HCC. However, not all HCC cases exhibit high AFP levels, and a
significant proportion of HCC cases have normal AFP levels.
4. AFP-L3%: Measuring the proportion of the specific form of AFP called AFP-L3% can improve
the specificity of AFP for HCC diagnosis. An AFP-L3% level of 10% or higher is often indicative
of HCC.
5. Combining AFP with Imaging: AFP is often used in conjunction with imaging studies such as
ultrasound, CT scans, or MRI for HCC diagnosis. Combining AFP with imaging results in a more
accurate assessment of the likelihood of HCC.
13. Aspect GALAD Score
Doylestown Algorithm (with
LMW Kininogen Modification)
Components Gender, Age, AFP-L3, AFP, DCP
Age, Gender, ALT, Alkaline
Phosphatase, AFP, LMW
Kininogen
Score Range Variable values
Variable values, modified with
inclusion of LMW Kininogen
Purpose Predicts HCC risk
Predicts HCC risk, improved
accuracy for low AFP values
Clinical Application
- Used for HCC risk assessment. -
Score values vary based on
individual factors.
- Used for HCC risk assessment. -
Modified version enhances
accuracy for patients with low
AFP values. - Score values vary
based on individual factors.
14. DIAGNOSTIC APPROACH
Patients at high risk for
HCC
Patients with chronic,
nonviral liver disease and
no cirrhosis
Patients without
chronic liver disease
Lesions <1
cm Lesions ≥1 cm
dynamic contrast-
enhanced CT or MRI of
the abdomen tailored for
liver lesion evaluation
monitored at short
intervals (eg, every three
to six months) for one to
two years
maging characteristics are
consistent with HCC and
the AFP is >400 ng/mL, a
biopsy may not be
necessary in all patients,
especially if the lesion
appears to be resectable.
tumor markers
(AFP, CA 19-9,
carcinoembryonic
antigen), and
imaging (a
contrast-
enhanced CT or
MRI of the
abdomen tailored
for liver lesion
evaluation)
biopsy can be
considered
15. HCC lesions show arterial hypervascularity and contrast "washout" in imaging.
HCC diagnosis involves multiphasic CT and MRI with contrast.
LI-RADS criteria apply to cirrhosis patients for CT or MRI diagnosis.
CEUS can solve indeterminate nodules but not recommended for full assessment.
CT and MRI are sensitive, with ultrasound being specific for HCC.
PET/CT predicts prognosis but lacks sensitivity for HCC detection.
MRI is more sensitive for HCC than CT, but specificity may not significantly differ.
Contrast MRI detects small lesions effectively (sensitivity 78%, specificity 92%).
Classical arterial enhancement in one imaging technique can diagnose small HCC.
NCCN Guidelines recommend CT or MRI for patients with HCC risk factors.
Gadolinium contrast is preferred for MRI.
16. 1.Imaging Technique: Triple-phase CT is a specialized imaging technique used for HCC
diagnosis and evaluation. It involves three distinct phases:
1. Non-contrast Phase: Initial scanning without contrast to assess baseline liver tissue and identify
lesions.
2. Arterial Phase: Contrast material is injected intravenously, and imaging is performed during the
arterial phase, capturing the early enhancement of the tumor.
3. Portal Venous Phase: Scanning is conducted during the portal venous phase, when the liver
parenchyma and most tumors reach peak enhancement.
2.Specificity in HCC Diagnosis: Triple-phase CT is highly specific for HCC diagnosis due
to several factors:
1. Arterial Phase: During this phase, HCC lesions typically show rapid and significant enhancement.
This is a key feature that distinguishes HCC from other liver lesions.
2. Washout Appearance: In the portal venous phase, HCC lesions demonstrate a "washout"
appearance, where the contrast agent is washed out of the tumor, making it less enhancing
compared to the surrounding liver tissue. This contrast washout is a hallmark of HCC.
3. Enhancement Pattern: The combination of arterial phase enhancement and portal venous phase
washout is a specific enhancement pattern for HCC, aiding in differentiation from other liver lesions.
3.Enhanced Accuracy: Triple-phase CT's ability to capture the dynamic enhancement
patterns of HCC greatly enhances its diagnostic accuracy and differentiation from benign
liver lesions.
4.Lesion Characterization: Besides diagnosis, triple-phase CT assists in characterizing
HCC lesions by assessing their size, number, and location, which is crucial for staging
and treatment planning.
5.Limitations: Despite its high specificity, triple-phase CT may not always detect early or
small HCC lesions.
17. Parameter Value
Sensitivity (All Lesions) 65%
Specificity (All Lesions) 96%
Sensitivity (Lesions <2
cm)
40%
Positive Predictive
Value (Lesions ≥2 cm in
Cirrhotic Patients)
92%
Study data shows : table 1:CT Scan ,2: Comparative
maging
Modality Sensitivity Specificity
Diagnostic
Accuracy
MRI 79% - 78%
CT 62% - 67%
CEUS (Any
Size)
78% 94% -
CEUS (≤3
cm)
77.5% 93% -
18. • Equipment: Requires a scanner with a magnet strength of ≥1.5 Tesla.
• Contrast Agent: Uses gadolinium-based contrast agents with precise injection
techniques and accurate timing for optimal results.
• Image Sets: Involves specific image sequences, including precontrast T1-weighted, T2-
weighted, and various post-contrast phases to characterize and differentiate HCC lesions.
• Superiority Over CT: Data suggests that MRI may outperform CT, especially for
diagnosing small HCC lesions (≤3 cm), with higher sensitivity and diagnostic accuracy.
• Special Considerations: Caution needed in patients with severe chronic kidney
impairment when using gadolinium contrast agents.
• Gadoxetate MRI: Utilizes gadoxetate disodium, a hepatobiliary-specific contrast agent,
for additional information through a hepatobiliary phase image set.
• Bilirubin Levels: Elevated bilirubin levels can affect the accuracy of MRI using
gadoxetate contrast, warranting caution in patients with bilirubin levels >3 mg/dL.
19. • Diagnostic Application: CEUS is used for HCC diagnosis, particularly in
lesions detected on non-contrast ultrasound.
• Limitations: CEUS cannot evaluate a patient as a liver transplantation
candidate and is generally limited to visualized lesions. To assess the
overall liver disease burden, additional imaging with CT or MRI is required.
• Continuous Imaging: CEUS involves continuous imaging for the first 60
seconds after contrast infusion, followed by intermittent imaging every 30
seconds for about four to five minutes. Comprehensive assessment of the
entire liver volume is not feasible with CEUS.
• Uncertainty in Results: Systematic reviews indicate some uncertainty
due to the risk of bias, study heterogeneity, and imprecision in results.
20. Should only be applied
Any of the following findings or risk factors:
• Cirrhosis (with exception)
• Chronic hepatitis B virus infection
• Lesion identified on a surveillance US
for HCC in a patient with cirrhosis
chronic hepatitis B virus infection, or
concurrent or prior diagnosis of HCC
Should not be applied
• No risk factors for HCC
• Age less than 18 years
• Cirrhosis related to congenital hepatic
fibrosis
• Cirrhosis secondary to a vascular
disorder Budd-Chiari syndrome, chronic
portal vein occlusion, cardiac
congestion, hereditary hemorrhagic
telangiectasia)
In vascular disorder, the altered hepatic blood flow results in formation of benign hypervascular
nodules that resemble and sometimes cannot be distinguished by imaging from HCC
LI-RADS patient criteria
21. LI-RADS Score Imaging Findings Likelihood of HCC Clinical Implications
LR-1 Definitely benign 0% No further workup, routine surveillance
LR-2 Probably benign 0% Most return to routine surveillance
LR-3 Intermediate risk 31% Repeat imaging every 3-6 months
LR-4 Probably HCC 64% Multidisciplinary discussion needed, biopsy
LR-5 Definitely HCC 95% Evaluation for treatment, no biopsy
LR-M
Probably/Definitely
malignant
33% Multidisciplinary discussion required, biopsy
LR-TIV Tumor in vein 54% Multidisciplinary discussion needed, biopsy
merit multidisciplinary discussion for individualized management, which may include follow-up or
alternative imaging, biopsy, or treatment as presumptive HCC (ie, resection) without biopsy
22. OPTN manages liver transplant waiting lists.
It employs imaging criteria to assess HCC patient eligibility for transplantation.
Imaging Diagnosis:
• OPTN criteria align with LI-RADS for HCC assessment.LR-5 (definite HCC) corresponds to
OPTN class 5.
Key Differences:
• OPTN covers paediatrics and non-cirrhosis causes.
• LI-RADS mainly focuses on cirrhotic adults.
• CEUS is LI-RADS-approved but excluded by OPTN.
• OPTN limits MRI agents with hepatobiliary excretion.
• LI-RADS allows more options.
• OPTN specifies size criteria for eligible HCC.
Transplant Eligibility : OPTN’s criteria ultimately determine transplant eligibility.
OPTN and LI-RADS:
• Understanding these differences ensures precise patient eligibility assessment.
• Improved coordination between OPTN and LI-RADS can optimize liver transplants for
HCC.
23. Patients Requiring Evaluation:
• Patients with LI-RADS LR-3, LR-4, and LR-M lesions may need further assessment to confirm HCC diagnosis.
Evaluation Options:
• Evaluation includes biopsy or follow-up imaging with the same or alternative methods.
• Biopsy is considered if it influences management decisions.
• For high-risk patients with LR-4 lesions, multidisciplinary discussion may allow presumptive HCC treatment.
Biopsy Considerations:
• Biopsy necessity is determined by clinical presentation and tumor marker levels.
• Individualized decision-making is recommended after multidisciplinary discussion.
• High alpha-fetoprotein levels (>400 ng/mL) and clinical factors might eliminate the need for biopsy.
• However, biopsy may still be required if it affects management (e.g., transplantation listing).
LR-3 Lesions:
• Most LR-3 lesions can be monitored through follow-up CT or MRI imaging.
• This monitoring continues until the lesion is definitively diagnosed as HCC, another malignancy, or a benign
condition.
LR-M Lesions:
• These lesions are complex, with about two-thirds being non-HCC malignancies.
• Biopsy often plays a critical role in determining malignancy type and guiding treatment decisions.
24. • Diagnosis in Low-Risk HCC Patients
• Specific Liver Conditions (e.g., cardiac
cirrhosis, congenital hepatic fibrosis)
• Elevated Tumor Markers (e.g., CA 19-
9, CEA) with suspicion of
cholangiocarcinoma (CCA) or mixed
HCC-CCA
• Confirming Metastatic Disease
• Histologic Grading and Molecular
Characterization
• Guiding Nonsurgical, Locoregional
Therapies (e.g., ablation)
• Liver Transplantation Evaluation
Biopsy is generally not
recommended for LR-1, LR-2, LR-
3, or LR-5 lesions.
25. • In small lesions (≤2 cm), the diagnostic yield can be as low as 70%,
and using core needles may enhance tissue collection.
• Risks of biopsy encompass immediate complications, tumor track
spread, and potential sampling errors leading to false negatives.
• Major complications include hemoperitoneum, hypotension,
pneumothorax, and biliary peritonitis, with a biopsy-related death
rate of 9 in 100,000 procedures.
• Needle track seeding risk with percutaneous biopsy is
approximately 2.7%.
26. Chest CT and Bone Scan in Hepatocellular Carcinoma
• Extrahepatic spread rate is low overall (except for tumors >5 cm)
• Routine chest CT and bone scan yield limited additional information
• Abnormal findings on chest CT and bone scan often overlap with liver imaging
• Staging chest CT and bone scans don't significantly impact management
• Routine chest CT recommended by OPTN for initial evaluation in transplant candidates
with HCC
Parameter Chest CT Bone Scan
Abnormal Findings 60% (229 out of 381) 53% (202 out of 381)
Patients with Documented
Metastatic Disease
30 (7.9% of 381) 8 (2.1% of 381)
Detection of the Same Lesions in
Chest CT or Chest Radiograph
19 patients (63.3% of
documented cases)
7 patients (87.5% of documented
cases)
Change in Staging
Only 3 patients shifted from B to C
(5% of BCLC stage B patients)
Data on staging shift not provided
in the context of bone scan
Additional Metastases Revealed
1.1% in T2 stage, 14% in T3a
stage, 5.6% in T3b stage
Data on additional metastases not
provided
Prospective cohort of 381 patients newly diagnosed with HCC at a Single Korean Institution
27. TNM
Staging:
•Use: TNM staging aids in
prognosis and treatment
planning.
•Disadvantage: It lacks
comprehensive
consideration of liver
function.
Okuda
System:
•Use: The Okuda system
provides a simple clinical
classification.
•Disadvantage: Its
simplicity may not
capture complex disease
presentations.
Cancer of
the Liver
Italian
Program
(CLIP)
Score:
•Use: CLIP predicts
survival using readily
available parameters.
•Disadvantage: Some
parameters may not be
universally accessible.
The
Barcelona
Staging
Classificatio
n:
•Use: BCLC guides
treatment decisions
based on multiple factors.
•Disadvantage: It
primarily serves for
treatment guidance.
Albumin-
Bilirubin
(ALBI)
Score:
•Use: ALBI assesses liver
function.
•Disadvantage: It doesn't
include tumor-specific
factors.
RETREAT
and MoRAL
Scores:
•Use: These scores predict
survival in TACE patients.
•Disadvantage: They
require further validation
and are tailored to TACE.
28.
29. Advantages
• Accurate tumor classification: Precise
prognosis
• Validated for resection and
transplantation: Treatment planning
• Incorporates size and vascular invasion:
Improved risk stratification
• Fibrosis score as a prognostic factor:
Consideration of liver function
Disadvantages
• Not accounting for cirrhosis: Limited in
liver disease cases
• Survival affected by underlying cirrhosis:
Inferior for tumors in cirrhotic livers
• Less useful for large tumors in cirrhotic
patients: Alternative systems may be
better
• TNM stage alone may not reflect
prognosis accurately: Need for
additional prognostic facto
30. Content:
• Tumor number
(single/multiple).
• Ascites
(absent/mild/severe).
• Total bilirubin level.
• Serum albumin level.
• Hepatic encephalopathy
(absent/present).
Advantages:
• Simple and easy to use.
• Reflects liver function.
• Helps predict prognosis.
• Guides treatment
planning.
Disadvantages:
• Less suitable for early-
stage HCC.
• May not account for
tumor-specific factors.
• Limited ability to finely
stratify risk.
• Most effective for
advanced disease.
31. Content:
• Child-Pugh class (A/B/C).
• Tumor morphology
(uninodular/multinodula
r).
• Alpha-fetoprotein (AFP)
level (<400 ng/mL or
≥400 ng/mL).
• Portal vein thrombosis
(absent/present).
Advantages:
• Incorporates liver
function (Child-Pugh
class).
• Considers tumor size
and AFP level.
• Provides a single
numerical score.
• Predicts survival and
helps guide treatment.
Limitations:
• Doesn't consider
microvascular invasion.
• Limited accuracy for
early-stage HCC.
• Complexity for some
patients.
• May require advanced
diagnostics.
32. Disadvantages of BCLC Staging:
• Challenges in assessing liver function beyond conventional Child-Pugh score.
• Ongoing debates on the accuracy and applicability of the BCLC system in surgical therapy.
33. Stage C: Advanced-Stage HCC
•Characteristics:
• Diffuse, infiltrative, or portal vein invasion.
• Preserved liver function.
•Management:
• Options include systemic therapies or participation
in clinical trials.
• Curative treatments are not applicable.
Stage D: End-Stage HCC
•Characteristics:
• Poor performance status (ECOG 3-4) or
decompensated liver dysfunction.
•Management:
• Focused on supportive care, as prognosis is
extremely poor.
Stage 0: Very Early-Stage HCC
•Characteristics:
• Single nodule <2 cm.
•Management:
• Curative therapies such as resection,
transplantation, or percutaneous ablation.
Stage A: Early-Stage HCC
•Characteristics:
• Single nodule or up to three nodules, all ≤3 cm.
• Well-preserved liver function.
•Management:
• Suitable for curative therapies like resection,
transplantation, or ablation.
Stage B: Intermediate-Stage HCC
•Characteristics:
• Multinodular tumors.
• Preserved liver function.
•Management:
• May be candidates for liver transplantation or local
therapies like chemoembolization.
• Not suitable for curative treatments.
34. • It calculated based on the patient's bilirubin and albumin levels, which are significant
factors affecting survival in HCC.
• The ALBI score provides a way to predict prognosis and refine prognostic estimates for
HCC patients undergoing various treatments.
• It categorizes patients into three grades (ALBI grade I, grade II, and grade III) based on
their score, with lower scores indicating better liver function and better
• Advantage:
• Simple liver function assessment tool.
• Predicts prognosis in HCC.
• Objectively assesses bilirubin and albumin levels.
• Enhances prognostic accuracy in various treatments.
• Reduces interobserver variation.
• Disadvantage:
• Limited use for patients with very poor liver function (Child-Pugh C).