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HCC Pathophysio

The pathophysiology of hepatocellular carcinoma has not been definitively elucidated and is

clearly a multifactorial event. In 1981, after Beasley linked HBV infection to hepatocellular

carcinoma development, the cause of hepatocellular carcinoma was thought to have been

identified.[7]

However, subsequent studies failed to identify HBV infection as a majorindependent risk factor, and it became apparent that most cases of hepatocellular carcinoma

developed in patients with underlying cirrhotic liver disease of various etiologies, including

patients with negative markers for HBV infection and who were found to have HBV DNA

integrated in the hepatocyte genome.

Inflammation, necrosis, fibrosis, and ongoing regeneration characterize the cirrhotic liver and

contribute to hepatocellular carcinoma development. In patients with HBV, in whom

hepatocellular carcinoma can develop in livers that are not frankly cirrhotic, underlying fibrosis

is usually present, with the suggestion of regeneration. By contrast, in patients with HCV,

hepatocellular carcinoma invariably presents, more or less, in the setting of cirrhosis. This

difference may relate to the fact that HBV is a DNA virus that integrates in the host genome andproduces HBV X protein that may play a key regulatory role in hepatocellular carcinoma

development;[8]

an RNA virus replicates in the cytoplasm and does not integrate in the host

DNA.

The disease processes, which result in malignant transformation, include a variety of pathways,

many of which may be modified by external and environmental factors and eventually lead to

genetic changes that delay apoptosis and increase cellular proliferation.

The chart below provides an overview of the pathways and the modifiers that lead to

hepatocellular carcinoma.

Transcatheter arterial chemoembolization / Transarterial Chemoembolization (TACE) is a

minimally invasive medical procedure to restrict a tumor'sblood supply.

TACE has been used extensively to delay the progression ofhepatocellular carcinoma(HCC), a

type of liver cancer. With continuing TACE, thelife spanfor a patient with unresectable HCC

could reasonably be extended for 12 years, although the exact benefit would depend heavily on

the patient's medical condition (seeChild-Pugh score).

Procedure

TACE is aninterventional radiologyprocedure. The procedure involves gainingpercutaneous

access to thehepatic artery, usually by puncturing the common femoral artery in the right groin

and passing acatheterthrough the abdominalaorta, through theceliac trunkand common hepatic

artery, into the proper hepatic artery (which supplies the liver).

http://en.wikipedia.org/wiki/Blood_supplyhttp://en.wikipedia.org/wiki/Blood_supplyhttp://en.wikipedia.org/wiki/Blood_supplyhttp://en.wikipedia.org/wiki/Hepatocellular_carcinomahttp://en.wikipedia.org/wiki/Hepatocellular_carcinomahttp://en.wikipedia.org/wiki/Hepatocellular_carcinomahttp://en.wikipedia.org/wiki/Life_expectancyhttp://en.wikipedia.org/wiki/Life_expectancyhttp://en.wikipedia.org/wiki/Life_expectancyhttp://en.wikipedia.org/wiki/Child-Pugh_scorehttp://en.wikipedia.org/wiki/Child-Pugh_scorehttp://en.wikipedia.org/wiki/Child-Pugh_scorehttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Celiac_trunkhttp://en.wikipedia.org/wiki/Celiac_trunkhttp://en.wikipedia.org/wiki/Celiac_trunkhttp://en.wikipedia.org/wiki/Celiac_trunkhttp://en.wikipedia.org/wiki/Aortahttp://en.wikipedia.org/wiki/Catheterhttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Percutaneoushttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Child-Pugh_scorehttp://en.wikipedia.org/wiki/Life_expectancyhttp://en.wikipedia.org/wiki/Hepatocellular_carcinomahttp://en.wikipedia.org/wiki/Blood_supply

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Theinterventional radiologistthen performs anarteriogramto identify the branches of the

hepatic artery supplying the tumor(s) and threads smaller catheters into these branches. This

position is called a superselective position. This is done to maximize the amount of the

chemotherapeutic dose that is directed to the tumor and minimise the amount of the

chemotherapeutic agent that could damage the normal liver tissue.

When a blood vessel supplying tumor has been selected, alternating aliquots of the chemotherapy

dose and of embolic particles, or particles containing the chemotherapy agent, are injected

through the catheter. The total chemotherapeutic dose may be given in one vessel's distribution,

or it may be divided among several vessels supplying the tumor(s).

http://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Interventional_radiologyhttp://en.wikipedia.org/wiki/Angiogramhttp://en.wikipedia.org/wiki/Angiogramhttp://en.wikipedia.org/wiki/Angiogramhttp://en.wikipedia.org/wiki/Angiogramhttp://en.wikipedia.org/wiki/Interventional_radiology