hepatocellular carcinoma diagnosis, treatment, prognosis + quiz vinko bubic mentor: a. Žmegač...
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Hepatocellular carcinoma
Diagnosis, Treatment, Prognosis + Quiz
Vinko BubicMentor: A. Žmegač Horvat
Diagnosis
Physical examination - enlarged, tender liver
Elevated serum alpha fetoprotein (normally : 40mg/l)
Elevated liver enzymes (ALT, AST, Alpha-1 antitrypsin, serum bilirubin, urine bilirubin...)
Diagnosis
CT
CT
Computed tomography - medical imaging method employing tomography (imaging by sections or sectioning)
Large series of two-dimensional X-ray images taken around a single axis of rotation, computer integration
Iodine dye through vein for better visualisation (allergy)
MRI
Magnetic resonance imaging The body - mainly composed of water molecules Electromagnetic field causes protons to absorb
some of its energy Scanner detects release of proton energy (tumor
tissue releases different frequency) Greater contrast than CT
Modern 3T MRI
Biopsy
Definitive diagnosis of hepatocellular carcinoma
Hyperchromatic, clear cells with large red cytoplasm
Treatment
Liver transplatation (cadaver liver or live donor lobe)
Surgical resection (best prognosis for long-term survival, but possible in only
10-15% of cases)
Treatment
Percutaneus ethanol injection - small (< 3 cm) solitary tumors
Transcatheter arterial chemoembolization (TACE) - more than 3 cm and less than 4 cm in diameter
Sealed source radiotherapy (brachytherapy) - radioactive source is placed inside or next to area requiring treatment
Prior to ethanol ablation After
Transcatheter arterial chemoembolization
Other techniques
Radiofrequency ablation (RFA) High intensity focused ultrasound (HIFU) Chemotherapy (antiestrogen + tamoxifen) Cryosurgery - destruction of abnormal
tissue using sub-zero temperatures
HIFU
Cryosurgery
Iceball
HCC complications
Gastrointestinal bleeding Cachexy Portal hypertension -> esophageal bleeding Liver failure Metastasis (lymph nodes around pancreas,
aorta, lungs, adrenal glands, bones) Rupture of tumor -> abdominal bleeding
Prognosis
Usually poor outcome Only 10 - 20% of hepatocellular
carcinomas can be removed completely If not, disease usually deadly within 3 to 6
months
Quiz:
The definitive HCC diagnosis isconfirmed by: a) spider nevus by inspection b) auscultation c) biopsy and microscopy d) MRI e) esophageal reflux
Ethanol: a) dehydrates cells b) hydrates cells and cracks them c) activates IL-8 d) causes apoptosis e) nothing from above
In cryotherapy, tumor is frozen by: a) flucloxacillin b) Iodine c) liquid nitrogen d) surgeon’s eye e) cocaine
What did you eat today?
This maybe?
Thanks ! ! !
References:
http://www.cancer.gov/cancertopics/types/liver/ http://www.mayoclinic.com/health/liver-cancer/D
S00399 Medicinski leksikon, Leksikografski zavod
“Miroslav Krleža”, Zagreb 1992. PATOLOGIJA, urednici Damjanov, Jukic, Nola,
izdanje 2007.