This document provides information on hepatocellular carcinoma (HCC) including its anatomy, etiology, pathogenesis, clinical presentation, diagnosis, staging, and management. HCC most commonly develops in cirrhotic livers as a result of risk factors like hepatitis or alcohol abuse. Imaging like ultrasound and CT are used to diagnose and stage HCC lesions. Treatment depends on the extent of disease and liver function, and may include resection, ablation, transplantation, or sorafenib for advanced disease. Managing HCC requires a multidisciplinary approach due to the risk of recurrence from residual disease in the liver.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
European hernia society guidelines: Adult Inguinal Hernia (Post operative car...Jibran Mohsin
This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
A basic approach towards carcinoma of prostate , symptoms, investigations , diagnosis, staging, treatment and follow up along with recent advances in surgeries, vaccines and immunotherapy.
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
European hernia society guidelines: Adult Inguinal Hernia (Post operative car...Jibran Mohsin
This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
A basic approach towards carcinoma of prostate , symptoms, investigations , diagnosis, staging, treatment and follow up along with recent advances in surgeries, vaccines and immunotherapy.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth, nodule, or tumor.
Growths in the liver can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
Benign tumors:
-- are rarely a threat to life
-- can be removed and usually don't grow back
-- don't invade the tissues around them
-- don't spread to other parts of the body
Malignant growths:
-- may be a threat to life
-- sometimes can be removed but can grow back
-- can invade and damage nearby tissues and organs (such as the stomach or intestine)
-- can spread to other parts of the body
Most primary liver cancers begin in hepatocytes (liver cells). This type of cancer is called hepatocellular carcinoma or malignant hepatoma.
Liver cancer cells can spread by breaking away from the original tumor. They mainly spread by entering blood vessels, but liver cancer cells can also be found in lymph nodes. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
IMMUNOHISTOCHEMICAL ALTERATIONS IN HEPATOCELLULAR CARCINOMA PATIENTS TREATED ...Jing Zang
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Doxorubicin (Dox) is an anthracycline antibiotic used as a single chemotherapeutic agent for HCC. The present work was conducted to study the immunohistochemical alterations in HCC patients treated with Dox. Thirty cases (24 males and 6 female) with a confirmed diagnosis of hepatocellular carcinoma (HCC) were used. They were divided into 3 groups, group 1. Ten specimens of HCC were taken before Dox treatments, group 2.Ten specimens HCC patients were taken one week after Dox treatment and group 3.Ten specimens of HCC patients were taken two weeks after Dox treatment. Hepatic biopsies were obtained from the three groups and prepared for histological, immunohistochemical (p53, Bcl-2 and CD34) and molecular studies. Histological examination of the specimen of HCC patients, before and after Dox treatment, showed trabecular appeareance, cytoplasmic vacuolation of the hepatocytes, fatty degeneration and necrosis. Cirrhosis appeared in 40% of the patients before treatment and 40% and 30% after one week and 2 weeks of treatment, respectively. Imunohistochemical results revealed an increase in expression of p53, CD34 and Bcl-2 in HCC patients. Overexpression of p53, decrease of Bcl-2 and mild degree of expression of CD34 was recorded in patients treated with Dox. Significant increase in DNA fragmentation was recorded in HCC patients treated by Dox in comparison with untreated HCC.
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.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- 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
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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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Liver tumors
1. HEPATOCELLULAR
CARCINOMA & IT’S
MANAGEMENT
DR.ASHIRWAD K
PG 2ND YEAR
DR.C K DURGA UNIT
DR RML HOSPITAL DELHI
2. ANATOMY OF LIVER
• LIVER IS THE LARGEST ORGAN IN BODY WEIGHING ABOUT 1.5 KGS .
• IT HAS DUAL BLOOD SUPPLY WITH 80% OF IT BEING FROM PORTAL VEIN AND 20%
FROM HEPATIC ARTERY.
• THE RIGHT HEPATIC AETRERY SUPPLIES THE MAJORITY OF LIVER PARENCHYMA AND
IS THE LARGEST OF TWO.
• MAJOR VENOUS DRAINAGE IS BY 3 MAJOR HEPATIC VEINS THAT JOIN IVC BELOW THE
DIAPHRAGM
• THE LIVER IS HELD IN POSITION IN RUQ BY PERITONEAL REFLECTIONS WHICH ARE
TRIANGULAR LIGAMENTS AND FALCIFORM LIGAMENT.
4. ANATOMY CONT…
A)COUINAUD CLASSIFICATION:
1. EIGHT SEGMENTS
2.EACH SEGMENT IS A FUNCTIONAL UNIT WITH ITS OWN BRANCH OF HEPATIC
ARTERY,
PORTAL VEIN AND BILE DUCT AND DRAINED BY A BRANCH OF HEPATIC
VEIN.
B)CANTLIE’S LINE DIVIDES LIVER INTO FUNCTIONAL RIGHT AND LEFT UNIT.
C)HEPATIC LOBULES- FUNCTIONAL UNIT OF LIVER SEGMENTS.
5.
6. INTRODUCTION
• HEPATOCELLULAR CARCINOMA (HCC) IS THE SIXTH MOST COMMON
MALIGNANCY IN THE WORLD AND THIRD COMMONEST CAUSE OF DEATH FROM
CANCER.
• INCIDENCE – 5 PER 100000 POPULATION.
• MALE>FEMALE (2:1 TO 4:1)
• BECAUSE OF THE TIME NECESSARY FOR CANCER TO DEVELOP IN INFECTED
PATIENTS AND THE INCREASED RISK IN OLDER PATIENTS, THE NUMBER OF
PATIENTS WITH HCC HAS RISEN RAPIDLY .
7. ETIOLOGY
MAJOR RISK FACTORS FOR HEPATOCELLULAR CARCINOMA
• INFECTION: HEPATITIS B, HEPATITIS C INFECTION.
• TOXIN/DRUG: ALCOHOLIC CIRRHOSIS, ALFATOXINS ,ANABOLIC STEROIDS .
• GENETIC: HEMOCHROMATOSIS, Α1-ANTITRYPSIN DEFICIENCY.
• IMMUNOLOGIC: AUTOIMMUNE CHRONIC ACTIVE HEPATITIS, PRIMARY BILIARY
CIRRHOSIS.
• OTHER: OBESITY ,NONALCOHOLIC STEATOHEPATITIS, CIRRHOSIS (OTHER
CAUSES AND IDIOPATHIC)
• THE INCIDENCE OF HEPATOCELLULAR CARCINOMA RELATED TO RISK FACTORS
OTHER THAN VIRAL HEPATITIS, AFLATOXIN, AND STEATOHEPATITIS IS
RELATIVELY SMALL. AND IT IS PROBABLY TRUE THAT ANY PATIENT WITH
CIRRHOSIS FROM ANY ETIOLOGY IS AT RISK FOR HEPATOCELLULAR CARCINOMA.
IN CHILDREN, THE VIRAL ETIOLOGIES ARE THE MOST COMMON CAUSES OF HCC.
8. PATHOGENESIS
• A) CIRRHOSIS :
1. MORE THAN 90% OF PATIENTS WHO DEVELOP HCC HAVE EVIDENCE OF
FIBROSIS IN THE LIVER.
2. RISK OF DEVELOPING HEPATOCELLULAR CARCINOMA ONCE CIRRHOSIS IS
ESTABLISHED IS ABOUT 3% TO 5% PER YEAR.
3. BECAUSE THE RISK OF LIVER CANCER IS GENERALIZED TO THE ENTIRE ORGAN,
THE CARCINOGENIC POTENTIAL IS TERMED A “FIELD EFFECT.” THIS “FIELD
EFFECT” IS RESPONSIBLE FOR THE HIGH RATE OF RECURRENCE AFTER
RESECTION OF HCC BECAUSE OF THE REMAINING UNRESECTED LIVER BEING
AT RISK.
4. THE RECURRENCES AFTER RESECTION ARE MOST COMMONLY SECOND
PRIMARY LESIONS RATHER THAN RECURRENCE OF THE RESECTED LESION.
9. PATHOGENESIS CONT…..
B)ARTERIAL ANGIOGENESIS :
1. HCC GETS ITS BLOOD SUPPLY FROM THE HEPATIC ARTERY. THUS ON
COMPUTED TOMOGRAPHY (CT), THE HCC LESION APPEARS HYPERDENSE
DURING THE ARTERIAL PHASE.
2. ON ANGIOGRAPHIC IMAGING, THE VESSELS HAVE AN UNUSUAL AND
IRREGULAR PATTERN IN BOTH SIZE AND BRANCH PATTERN, WHICH IS
DIFFERENT THAN NORMAL HEPATIC ARTERIAL SUPPLY. THIS ABNORMAL
ARTERIAL PERFUSION ALLOWS FOR TREATMENT OF HCC VIA EMBOLIZATION
OF THE FEEDING ARTERY(IES).
10. PATHOGENESIS CONT…..
C) PORTAL VEIN INVASION
1. ANOTHER CHARACTERISTIC OF HCC IS ITS PROPENSITY TO INVADE THE
PORTAL VEIN.
2. TUMORS MEASURING MORE THAN 2 CM HAVE AN INCREASED RISK OF PORTAL
VEIN INVASION.
3. IT IS LIKELY THAT PORTAL VENOUS INVASION IS EITHER A MECHANISM FOR A
DIFFUSION OF THE TUMOR ELSEWHERE IN THE LIVER AND THE BODY AND/OR
THAT THE PHENOTYPES OF THE CELLS THAT CAN INVADE THE PORTAL VEIN
ARE CELLS THAT CAN DISSEMINATE AND IMPLANT IN OTHER ORGANS SUCH
AS THE LUNG OR BONE.
11. CLINICAL PRESENTATION
A) BECAUSE OF THE KNOWN RISK FACTORS FOR HCC, THERE IS USUALLY A
HISTORY OF VIRAL HEPATITIS, ALCOHOL OR DRUG ABUSE, OBESITY AND/OR
DIABETES, OR PAST HISTORY OF HCC.
B) AS AN INCIDENTAL FINDING DURING ULTRASOUND ABDOMEN.
C) THE FINDING OF SMALL ASYMPTOMATIC LIVER LESIONS DURING THE
RADIOLOGIC EVALUATION FOR LIVER TRANSPLANTATION IS ANOTHER
COMMON PRESENTATION.
12. PHYSICAL EXAMINATION
-JAUNDICE, ASCITES, CACHEXIA, SPLENOMEGALY, HEPATOMEGALY, OR IT MAY BE
NORMAL.
-WITH SUBTLE STIGMATA OF LIVER DISEASE, SUCH AS SPIDER ANGIOMATA OR
PALMAR ERYTHEMA.
13. LABORATORY INVESTIGATIONS
1. ABNORMAL LIVER FUNCTION TESTS AND ENZYMES.
2. VIRAL SEROLOGY
3. CIRRHOTICS MAY HAVE THROMBOCYTOPENIA, WHICH IS A MARKER OF PORTAL
HYPERTENSION.
4. Α-FETOPROTEIN (AFP): A LEVEL >400 NG/ML IS DIAGNOSTIC WHEN THERE IS A
LIVER MASS >2 CM PRESENT. IN LESIONS <2 CM THE LEVELS MAY BE NORMAL.
5. DES-CARBOXYPROTHROMBIN (DCP):SPECIFIC IN DIFFERENTIATING BENIGN FROM
MALIGNANT LESIONS, AND IS ELEVATED IN ABOUT 40% OF PATIENTS WITH HCC
LESIONS LESS THAN 2 CM.
14. IMAGING MODALITIES
A) USG:
1.PRIMARY USE FOR ULTRASONOGRAPHY IS IN SCREENING POPULATIONS FOR
HCC.
2.SENSITIVITY IS 65-85% AND SPECIFICITY IS > 90%.
3. SURVEILLANCE OF HIGH-RISK INDIVIDUALS WITH ULTRASOUND AND AFP EVERY
6 MONTHS REDUCES HCC-RELATED MORTALITY BY CLOSE TO 40%.
4.LESION <1CM- FOLLOW UP.
5.LESION 1-2CM/>2CM – CONFIRM WITH ANOTHER IMAGING MODALITY.
6.CANNOT DIFFERENTIATE B/W BENIGN & MALIGNANT LESIONS BUT USING
CONTRAST AGENTS WITH MICROBUBBLES CAN HELP DIFFERENTIATING B/W THE
LIVER MASSES.
15. B.COMPUTED TOMOGRAPHY
1.ACCURATELY DIAGNOSE & STAGE THE EXTENT OF DISEASE.
2. SENSITIVITY OF MDCT IS ABOUT 86%, WHICH DROPS TO ABOUT 60% WITH
LESIONS <2 CM IN SIZE.
3. INVASIVE COMBINATION TECHNIQUES SUCH AS INTRAARTERIAL CT
ANGIOGRAMS AND CT ARTERIAL PORTOGRAPHY HAVE SHOWN A SENSITIVITY AND
SPECIFICITY OF UP TO 93% AND 97%, RESPECTIVELY.
4.LIPIODOL (IONIZED POPPY SEED OIL)- HETEROGENEOUS UPTAKE OF LIPIODOL ON
FOLLOWUP CT WITH RESIDUAL TUMOR ENHANCEMENT IS SUGGESTIVE OF
PRESENCE OF VIABLE TUMOR.
16. C . MRI
1. HIGH SIGNAL INTENSITY ON T2-WEIGHTED SEQUENCES WITH STRONG EARLY
ARTERIAL ENHANCEMENT AND DELAYED WASHOUT.
2. EARLY MALIGNANT GROWTH WITHIN DYSPLASTIC NODULES -“NODULE
WITHIN A NODULE” APPEARANCE.
3. CONTRAST AGENTS - GADOLINIUM CHELATES, SUPERPARAMAGNETIC IRON
OXIDE, AND HEPATOCYTE-DIRECTED AGENTS (MANGAFODIPIR TRISODIUM).
17. STAGING SYSTEMS
STAGING HELPS PLAN MANAGEMENT AND PREDICT PROGNOSIS AND OUTCOME,
WHICH ARE:
1.BCLC
2.TNM
3.OKUDA
4.CLIP
18. MANAGAEMENT
- AS WITH MOST CANCERS, TREATMENT DECISIONS IN PATIENTS WITH HCC NEED TO
BE BASED ON THE OVERALL HEALTH STATUS OF THE PATIENT, THE EXTENT OF THE
DISEASE, AND THE DATA REGARDING THE RESULTS OF ANY PARTICULAR
TREATMENT.
- HCC FREQUENTLY ARISES IN A CIRRHOTIC LIVER. DECOMPENSATION OR THE RISK OF
DECOMPENSATION BECAUSE OF THE CHOSEN THERAPY OF THE CIRRHOSIS CAN LIMIT
POTENTIAL THERAPIES.
- BECAUSE OF FIELD EFFECT THE RISK OF DEVELOPING A SECOND PRIMARY AFTER
RESECTION FOR HCC IS ABOUT 35% AT 1 YEAR, 40% TO 50% OVER 3 YEARS, AND AS
HIGH AS 70% AT 5 YEARS.
- UNFORTUNATELY, 80% OF PATIENTS WILL PRESENT AT A STAGE TOO ADVANCED FOR
SURGICAL RESECTION OR TRANSPLANTATION.
21. CONT…
D.RESECTION
-ASSESSMENT OF HEAPTIC FUNCTION AND RESERVE
1)ICG- AT 15 MINS IF RETENTION >20% - 1/6TH OF LIVER RESECTION
AT 15 MINS IF RETENTION >30%- RFA OR LIMITED RESECTION IS
APPROPRIATE.
2)CTP- A- 50% RESECTION
B-25% RESECTION
C- NO RESECTION
3)PORTAL VENOUS PRESSURE ASSESED BY HVWP AND ABNORMAL BILIRUBIN
LEVELS.
4)PORTAL VEIN EMBOLISATION.
5)INTRA OPERATIVE USG WITH PRE-OP TUMOR VASCULATURE PATTERN
22. CONT….
THE APPROPRIATE TECHNIQUE DEPENDS ON THE LOCATION OF THE TUMOR, THE
DEGREE OF CIRRHOSIS, AND THE EXPERIENCE OF THE SURGEON. THE PRINCIPLES
ARE THE PREVENTION OF BLOOD LOSS AND THE PRESERVATION OF AS MUCH
FUNCTIONAL LIVER AS POSSIBLE. IT DOES APPEAR THAT MARGINS GREATER THAN
5 TO 10 MM ARE ADEQUATE.