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.