The document provides an overview of the Egyptian HCC Guidelines presented by Mohamed A. Ezzel Arab MD. It summarizes the guidelines on primary, secondary, and tertiary prevention of HCC. It also outlines recommendations for screening, diagnosis, staging, treatment including surgical resection, locoregional therapies, transplantation, and systemic therapies. Post-treatment monitoring guidelines are also presented. The document aims to provide evidence-based guidelines tailored to factors in Egypt based on international guidelines and expert opinion.
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Here is a presentation about Pancreatic Cancer.
Steve Jobs and Ralph Steinman suffered from pancreatic cancer.
November : pancreatic cancer awareness month.
A few cases are included ,and these demonstrate different presentations of the same disease.
Pancreatic cancer is often indolent till late stages and is mostly advanced by the time it is diagnosed.
Surgical treatment is the mainstay of therapy . Chemotherapy can be tried. Intra operative radiation therapy is also being used in some centers. However the long term survival is low
Overview about evolution of the term Oligometastases,the paradigm and various states of oligometastases,treat options ,clinical trials and relevance in current clinical practice
Here is a presentation about Pancreatic Cancer.
Steve Jobs and Ralph Steinman suffered from pancreatic cancer.
November : pancreatic cancer awareness month.
A few cases are included ,and these demonstrate different presentations of the same disease.
Pancreatic cancer is often indolent till late stages and is mostly advanced by the time it is diagnosed.
Surgical treatment is the mainstay of therapy . Chemotherapy can be tried. Intra operative radiation therapy is also being used in some centers. However the long term survival is low
Presentation on New Advances in the Treatment of Liver Tumors (Laparoscopic Resections) by Dr. Kimberly Moore Dalal, Surgical Oncology & General Surgery, Peninsula Medical Center.
Mills-Peninsula Health Services Cancer Symposium - Kimberly Moore Dalal, MD, FACS
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Presentacion del Residente Jose Chavez Peche en las reuniones de los residentes de Cirugia General y Digestiva del Hospital Nacional Edgardo Rebagliati EsSALUD Lima Perú. Jefe del Departamento Iván Vojvodic
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
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
Microwave ablation versus hepatic resection in managment of HCC by dr Mohamme...Kafrelsheiekh University
Evaluation and comparison between Microwave Ablation and Hepatic Resection in management of Hepatocellular Carcinoma.
By evaluation of Patient pre intervention and post interventions
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Hcc egyptian guidelines overview Prof ezz elarab
1. Egyptian HCC Guidelines
Overview
Presented By
Mohamed A. Ezzel Arab MD
Head of the HCC & Intervention Unit
National Hepatology & Tropical Medicine Research Institute
Treasurer of the Egyptian Society of Liver Cancer
(ESLC)
2. INTRODUCTION
ESLC invited most of experts with different
specialties in HCC management all over the country, to discuss the new
guidelines taking into consideration basically the international guidelines
(level I evidence based), and in parallel considering as well the local
factors in Egypt, in addition to their own experience
(level III, expert opinion) in those points which could not be applicable
in Egypt, provided that it is based on reliable international publications.
Confirmation and collecting these points were done using live
voting system.
The final draft had been completely endorsed by the ESLC to be applied
for the Egyptian HCC patients.
3. HCC EGYPTIAN GUIDELINES 2011
Primary Prevention
• Prevention of chronic HBV and HCV infection by:
- Safe injection practices.
- Screening of donated blood for the presence of hepatitis viruses.
Secondary Prevention
- Passive immunization with hyperimmune –globulin has a role
in preventing HBV after acute exposure.
- Antiviral therapeutic agents.
- Tertiery Prevention HBV is a valuable step in the prevention of
Immunization against
hepatocellular carcinoma.
- Avoid Aflatoxin B1 exposure.
-Prevention of dietary iron overload by westernization of the
cooking habits and tools.
4. HCC EGYPTIAN GUIDELINES 2011
Secondary Prevention
• Venesection for cases with high iron overload.
Tertiery Prevention
• Prevention of progression of the cirrhosis to HCC is done by treating the
hepatitis B and C virus infections .
• Preventing HCC caused by alcoholic cirrhosis by avoiding alcohol
• Prevention of Non alcoholic steato-hepatitis.
5. HCC EGYPTIAN GUIDELINES 2011
Screening Early detection of cases with hepatic nodule or elevated AFP
Diagnosis Accurate diagnosis of HCC
Staging Treatment decision making, and determining prognosis
Treatment Selection of appropriate therapy
6. HCC EGYPTIAN GUIDELINES 2011
Screening
Screening should be preformed to all high risk groups:
All cirrhotic patients: Non-cirrhotic patients:
HBV HBV infection (carrier)
HCV (Metavir score 3 or 4)
NASH
Alcoholic
Haemochromatosis
Screening for HCC should be done for all high risk patients with
AFP and abdominal U/S with time interval every 4 months
7. HCC EGYPTIAN GUIDELINES 2011
Diagnosis
Diagnosis should be made as follow:
High risk patient with HFL and either serum AFP is ≥ 200 ng/ml,
or triphasic CT-scan abdomen shows typical criteria for HCC
then, it has to be diagnosed as HCC.
(NB: Radiological criteria of HCC is in the form of early
enhancement during arterial phase followed by rapid
washout of contrast in delayed phase)
8. HCC EGYPTIAN GUIDELINES 2011
Diagnosis
Senario (1)
High risk patient with HFL < 1cm, AFP < 200 ng/ml, then
follow up every 2 months by abdominal U/S and serum
AFP is recommended. If the lesion increases in size
then, reassess with triphasic CT-scan abdomen
Senario (2)
High risk patient with HFL ≥ 1cm, AFP has normal level or
< 200 ng/ml and triphasic CT-scan abdomen shows
atypical criteria for HCC then, a dynamic contrast MRI
(with magnet strength≥ 1.5 tesla) is recommended. If MRI
is not available or its result is not satisfactory then
targeted liver biopsy is recommended.
9. HCC EGYPTIAN GUIDELINES 2011
Diagnosis
Senario (3)
High risk patient with serum AFP ≥ 200 ng/ml and no HFL
could be detected neither by abdominal U/S nor trisphasic
CT-scan abdomen then, a dynamic MRI study (≥ 1.5 tesla)
is recommended.
10.
11. HCC EGYPTIAN GUIDELINES 2011
The recommended Workup for HCC patient at
time of diagnosis is:
- Full History (concerning the risk factor, occupation,
exposure to toxins, chemical …etc).
- Physical Examination.
- CBC.
- Bleeding profile (PT, INR and PTT).
- Liver function tests and LDH.
- Kidney function tests.
- AFP.
- Etiologies of liver cirrhosis: (HBsAg, HBcAb, HCV-Ab).
- ECG.
Triphasic spiral CT-scan abdomen or MRI ≥1.5 tesla
whenever indicated
12. HCC EGYPTIAN GUIDELINES 2011
Indications for HCC metastatic workup are:
• Clinical suspicion.
• Prior to transplant.
Screening for HCC metastasis is performed with:
• Chest/Pelvis CT with contrast.
• Bone scan on clinical suspicion or in symptomatic patients.
13. Staging of HCC
It should include the proper assessment of different views
covering; the patient clinical state, liver state, tumor size,
number, site, vascular invasion and extrahepatic disease.
Patient 1. Llovet JM. J Gastroenterol. 2005;40:225-235;
2. Marrero JA, et al. Clin Liver Dis. 2006;10:339-351;
3. Bruix J, et al. J Hepatol. 2001;35:421-430;
ECOG
PST
BCLC4
GRETCH5
Okuda6
Child-
Pugh CUPI7 TNM
CLIP8
JIS9
Liver Tumor
14. BCLC Staging System
HCC
Early Stage Intermediate Stage Advanced Stage End Stage
Surgical Treatment TACE Sorafenib
Local Ablation
(30%)
(50%-60%) (10%)
Potentially Curative
Randomized Trials BSC
Treatments 5-y
Median Survival If Untreated: 6-16 mo Survival <3 mo
Survival: 40%-70%
TACE = transarterial chemoembolization; BSC = best supportive care.
Llovet JM, et al. J Natl Cancer Inst. 2008;100:698-711.
15. HCC EGYPTIAN GUIDELINES 2011
Surgical Resection:
Patient who is fit for surgical resection should fulfill the
following conditions:
• Child Pugh score < 6 (Child A).
• Good performance status.
• Site is anatomically accessible(cases with subcapsular HCC
are good candidates for surgical resection while deep
lesions should be assessed first for the possibility of ablative
therapies).
• Serum bilirubin < 1.5 mg/dl.
• Localized HCC.
• No vascular invasion.
• Absence of extrahepatic spread (EHS).
• Absence of portal hypertension.
16. HCC EGYPTIAN GUIDELINES 2011
N.B: Criteria predicting portal hypertension are:
•Platelets count < 100,000 /mm3.
•Splenomegaly.
•Upper GIT endoscopy showing either esophageal varices or
signs of portal hypertensive gastropathy.
•Hepatic Venous Wedge Pressure (HVWP > 10 mmHg).
Large HCC lesion is not a contraindication for liver resection
provided an adequate residual volume of the cirrhotic liver after
proper metastatic workup.
N.B: operative theatres for liver surgery should be fully equipped
with all facilities and equipments required especially operative
ultrasound machine and capability of operative ablative therapy.
18. HCC EGYPTIAN GUIDELINES 2011
Liver transplantation will be beneficial for
recurrent HCC within Milan criteria after liver resection with
the following criteria:
•No micro-vascular invasion.
•Well differentiated HCC.
•Acceptable AFP < 1000 ng/ml.
20. HCC EGYPTIAN GUIDELINES 2011
In bridging or downstaging of HCC either by surgical
resection or locoregional therapy, liver transplantation
could be done if:
serum AFP is < 1000 ng/ml.
Adequate radiological response (Partial and complete
responders) according to modified RECIST criteria after
locoregional therapy.
Absence of disease progression during time period of 3
months.
21. HCC EGYPTIAN GUIDELINES 2011
Local recurrence of HCC after liver transplantation may be
treated with surgery if it is resectable
or with loco-regional therapy if it is unresectable.
While Sorafenib is the only available systemic therapy
indicated in distant recurrent HCC.
22. HCC EGYPTIAN GUIDELINES 2011
Locoregional Therapy:
HCC ≤ 4 cm, away from main bile ducts or intestinal loops,
without vascular invasion or extrahepatic spread in Child-
Pugh A or B patients neither candidate for surgery nor
ready for liver transplantation, are candidates for
Radiofrequency (RFA) or Microwave ablation.
HCC ≤ 4 cm close to a great vessel, without vascular
invasion or extrahepatic spread in Child-Pugh A or B
patients neither candidate for surgery nor ready for liver
transplantation, are candidates for Microwave ablation.
23. HCC EGYPTIAN GUIDELINES 2011
RFA and Microwave ablation are contraindicated in lesions
located in close contact with main bile ducts or intestinal
loops. So, the best clue for these patients with Child Pugh
Class A or B, neither fit for resection nor transplantation, is
Percutanous Ethanol Injection (PEI) in lesions < 3 cm or
combined Transarterial Chemoembolization (TACE) + PEI
for lesions 3 – 6 cm.
Also intra operative RFA could be an alternative for patient
who is fit for surgery with single HCC ≤ 4cm close to
intestinal loops.
24. HCC EGYPTIAN GUIDELINES 2011
HCC measuring 4 – < 6 cm, away from main bile
ducts or intestinal loops without vascular invasion or
extra-hepatic spread in Child A or B patient neither
candidate for surgery nor ready for transplantation, are
candidates for combined therapy of Heat ablation
(with RFA or Microwave ablation) + TACE.
HCC measuring ≥ 6 cm or multifocal lesions, without
vascular invasion or extra-hepatic spread in Child A and
early B and not candidate for surgical management, could
be treated with TACE.
Addition of Sorafenib is optional, to act against the rising
serum level of VEGF which occur especially during the
first week after embolization.
25. HCC EGYPTIAN GUIDELINES 2011
Ablation therapy could be performed as a potentially
curative modality for up to 3 lesions, however, cases
with more than 3 lesions are not an absolute
contraindication for ablation and should be discussed
on a case by case basis.
26. HCC EGYPTIAN GUIDELINES 2011
Single or multifocal HCC with portal vein invasion
in Child Pugh Class A or early B patient are candidates for
Sorafenib.
Furthermore, in respect to the rising promising data
coming to support the use of Selective Internal
Radiotherapy (SIRT) with Y-90 in advanced HCC especially
in case of portal vein thrombosis.
Radioembolization with Y-90 could be recommended as a
second line of treatment for those patients in the following
situations:
- Progressive disease inspite of full dose Sorafenib.
- Patient who can’t tolerate the adverse events of
Sorafenib.
27. HCC EGYPTIAN GUIDELINES 2011
Systemic treatment:
Sorafenib is the standard systemic therapy indicated for
treatment of HCC in the following conditions:
• Extrahepatic spread (such as lymph node, lung or suprarenal
metastasis).
• Vascular invasion (such as malignant portal vein or hepatic vein
invasion).
• In patients with post-transarterial chemoembolization (TACE)
progressive disease.
HCC patient who is candidate for Sorafenib should have
Child A liver cirrhosis or early B (score≤7), good
performance status, and serum bilirubin ≤ 2 mg/dl.
The standard daily oral dose of Sorafenib is 800 mg/day
(divided into two doses per day) one hour before meals or
two hours after meals.
28. HCC EGYPTIAN GUIDELINES 2011
Systemic treatment:
Clinical follow up of patients on Sorafenib should be performed
twice monthly after beginning of treatment then monthly on a
regular basis. While assessment of radiological response with
modified RECIST criteria is accepted with triphasic spiral CT-
scan or MRI (≥ 1.5 tesla) every three months.
Addition of external beam radiotherapy is amenable in case of
bone metastasis together with Sorafenib
Finally, ESLC is aware of the plethora of targeted therapies
that are in progress in phase II and III clinical trials.
Therefore in case of Sorafenib failure in patients who are still
maintaining child score A and good performance status, they
could be included into clinical trials.
29. HCC EGYPTIAN GUIDELINES 2011
Best Supportive Care:
It is the only line of treatment indicated for end stage HCC
which is defined by; poor performance score or child C liver
cirrhosis who are not eligible for transplantation.
Best supportive care should cover the following states:
• Treatment of portal hypertension.
• Nutritional management.
• Pain management.
• Psychological management.
• Control of ascites.
30. HCC EGYPTIAN GUIDELINES 2011
Post-therapeutic monitoring for HCC patients:
•Clinical:
Reassessment of the patient’s general condition and his Performance
status is mandatory.
•Serological:
•AFP (if elevated at baseline).
•CBC.
•LFTs (especially S. bilirubin).
•KFTs (especially S. uric acid).
•PT and INR
•Radiological:
It is recommended to perform tri-phasic CT-scan abdomen one
month after initial treatment, then every 3 months during the first
year after therapy. Then every 6 months if the patient does not
develop recurrence or disease progression ,meanwhile he should
enter in the screening program by abdominal U/S and serum AFP / 4
months ,aiming early detection of new HCC.