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Hepatocellular carcinoma

Hepatocellular carcinoma. Diagnosis, Treatment, Prognosis + Quiz. Vinko Bubic Mentor: A. Žmegač Horvat. Diagnosis. Physical examination - enlarged, tender liver Elevated s erum alpha fetoprotein (normally : 40mg/l)

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Hepatocellular carcinoma

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  1. Hepatocellular carcinoma Diagnosis, Treatment, Prognosis + Quiz Vinko Bubic Mentor: A. Žmegač Horvat

  2. 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...)

  3. Diagnosis • CT

  4. 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)

  5. MRI • Magnetic resonance imaging • The body - mainly composed of water molecules • Electromagnetic fieldcauses protons to absorb some of its energy • Scanner detects release of proton energy (tumor tissue releases different frequency) • Greater contrast than CT

  6. Modern 3T MRI

  7. Biopsy • Definitive diagnosis of hepatocellular carcinoma

  8. Hyperchromatic, clear cells with large red cytoplasm

  9. 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)

  10. 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

  11. Prior to ethanol ablation After

  12. Transcatheter arterial chemoembolization

  13. Other techniques • Radiofrequency ablation (RFA) • High intensity focused ultrasound (HIFU) • Chemotherapy (antiestrogen + tamoxifen) • Cryosurgery - destruction of abnormal tissue using sub-zero temperatures

  14. HIFU

  15. Cryosurgery Iceball

  16. 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

  17. Prognosis • Usually poor outcome • Only 10 - 20% of hepatocellular carcinomas can be removed completely • If not, disease usually deadly within 3 to 6 months

  18. Quiz: The definitive HCC diagnosis is confirmed by: • a) spider nevus by inspection • b) auscultation • c) biopsy and microscopy • d) MRI • e) esophageal reflux

  19. Ethanol: • a) dehydrates cells • b) hydrates cells and cracks them • c) activates IL-8 • d) causes apoptosis • e) nothing from above

  20. In cryotherapy, tumor is frozen by: • a) flucloxacillin • b) Iodine • c) liquid nitrogen • d) surgeon’s eye • e) cocaine

  21. What did you eat today? This maybe? 

  22. Thanks ! ! !

  23. References: • http://www.cancer.gov/cancertopics/types/liver/ • http://www.mayoclinic.com/health/liver-cancer/DS00399 • Medicinski leksikon, Leksikografski zavod “Miroslav Krleža”, Zagreb 1992. • PATOLOGIJA, urednici Damjanov, Jukic, Nola, izdanje 2007.

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