Hepatocellular carcinoma premanagement
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This document discusses liver cancers. It covers the anatomy of the liver, epidemiology, etiology, prognostic factors, workup, and staging of liver cancers. Some key points include: - Liver cancer is the 5th most common cancer in men worldwide and the second leading cause of cancer death. Incidence is highest in East Asia and lowest in Northern Europe. - Major risk factors for liver cancer include hepatitis B and C infections, alcohol use, and metabolic diseases like hemochromatosis. - Staging involves radiological imaging like CT scans and tumor markers like AFP. Biopsies may also be used for pathological examination. - Prognostic factors include tumor size, number, vascular invasion,
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A supercool powerpoint about thyroid cancer that is very hard to understand unless I am speaking to you and filling in the blanks so check out my blog and look for a related post:
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This document discusses the management of complicated papillary thyroid carcinoma through two patient case studies. It provides details on the patients' histories, examination findings, investigations, diagnoses, surgical procedures, post-operative management, and literature review on papillary thyroid carcinoma classification, risk factors, staging, treatment options including surgery, radioactive iodine therapy, and TSH suppression.
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- RCC accounts for 2-3% of all cancers and 90% of renal malignancies. Risk factors include tobacco, obesity, hypertension, and family history.
- Clear cell RCC is the most common type, accounting for 70-80% of cases. Other types include papillary and chromophobe RCC.
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1) Inadequate dietary intake due to loss of appetite, early satiety, dietary restrictions, and frequent procedures which leads to accelerated starvation and protein loss.
2) Intestinal changes allow bacterial translocation in advanced liver cirrhosis, exposing the body to toxins and increasing inflammation.
3) Hepatic dysfunction results in impaired nutrient processing and increased protein breakdown to produce glucose via gluconeogenesis for energy. This further exacerbates muscle wasting.
Managing sarcopenia is important as it negatively impacts survival and quality of life in cirrhotic patients.
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- 1. LIVER CANCERS Dr. MANISH DUTT
- 2. • ANATOMY • EPIDEMIOLOGY • ETIOLOGY • PATHOLOGY • PROGNOSTIC FACTORS • WORKUP • STAGING
- 3. anatomy
- 5. Clinical significance Each segment can be resected without damaging those remaining resections must proceed along the vessels Dual blood supply: Portal vein: 3/4 Hepatic artery:1/4 Venous outflow: Hepatic veins: left, right and middle Drains into IVC
- 8. EPIDEMIOLOGY • 782,000 new cases worldwide 2012 • fifth most common cancer in men, 7.5% of the total) and the ninth in women (3.4%) • high incidence in Eastern and South-Eastern Asia (ASRs 31.9 and 22.2 respectively) • lowest rates in Northern Europe (4.6) and South-Central Asia (3.70 • second most common cause of death from cancer 746,000 deaths in 2012 (9.1% of the total) • prognosis very poor (overall ratio of mortality to incidence of 0.95
- 10. INDIAN STATS • men 0.9-7.5 per 100,000 • women 0.2 -2.2 per 100,000 • male:female ratio for HCC in India is 4:1 • age of presentation 40 to 70 years • highest AAIR was reported from Sikkim(7.5)and Mizoram(6.4) • 4–8% of the cancers were due to HCC • annual incidence rate of 1.6% (Paul et al) in cirrhotics • age standardized mortality rate for men is 6.8 ,women 5.1/100,000. • incidence of HCC in cirrhotics in India is 1.6% per year • 70–97% of patients with HCC at the time of diagnosis had underlying cirrhosis of liver • incidence of HCC is increasing in India
- 11. ETIOLOGY • Viral hepatitis- HBV 1. 98 fold greater risk 2. Asymptomatic HbsAg+ - 12 times RR 3. MECHANISM-indirect/direct 4. 70% HBV related HCC- with cirrhosis 5. Risk of HCC in hepB cirrhotic 0.5% • HCV- 1. Chronic infection(60-80%) 2. 20 fold more and advanced cirrhosis 3. Risk of HCC in hepC cirrhotic 5% Mi-R-155 accumulation
- 12. Etiology contd. • Alcohol- carcinogenic, acetaldehyde, oxidative stress • NASH(24%) • METABOLIC DISEASES-haemochromatosis, Wilson, alpha1 AT def. • Chemical carcinogens- aflatoxin • Anabolic steroids, estrogens • Pesticides, insecticides • Obesity, DM • Cumulative tobacco use • Male, old age, specific promotor mutations, higher viremia levels
- 13. STAGING
- 14. PROGNOSTIC FACTORS • large size, • multiple tumors • vascular invasion • lymph node spread • Macroscopic or microscopic vascular invasions • severity of underlying liver disease- CHILD PUGH, CLIP, V- CLIP, (JIS), BCLC
- 15. DIAGNOSTIC W/U • Labs: CBC, LFTs, chemistries, coagulation panel, serum AFP(10–15% false negative), Hepatitis B/C panels. • Abdominal CT scan (special contrast protocol). • FNAC can be performed but is not always needed.
- 16. W/U Contd. Radiological/non invasive • Lesions>2cm- • arterial hyperenhancement on two different imaging modalities, or on one imaging modality alongside with a serum AFP of 400 ng/dL • both arterial hyperenhancement and venous washout in a single imaging modality concomitant with an AFP >200 ng/mL • sensitivity and specificity of 64.9% and 62.8% pathological • Core biopsies- liver/portal vein • stromal invasion • sensitivity and specificity of 89.1% and 100%