Hepatocellular tumors

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  • Hepatocellular carcinoma (HCC) used to be regarded as a rare disease. The increasing numbers of chronic hepatitis C virus carriers in the United States and subsequent increased incidence of HCC seen in most large medical centers means that it is no longer an uncommon disease for most gastroenterologists or oncologists to encounter. During the times when liver resection or systemic chemotherapy were the only real therapeutic modalities available, the outcomes were generally dismal, especially because most patients presented with advanced-stage tumors.

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  • The prognosis for individuals with liver cancer is frequently poor. Cancers include those which have metastasized to the liver from elsewhere, reflecting advanced stage disease where cure is rarely possible. Similarly, primary liver cancer frequently complicates chronic liver disease, which further limits therapeutic options. Despite these dismal facts, there are signs that change is imminent. Not only have imaging modalities and surgical techniques improved, but preventive strategies and medical therapies show promise.

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  • Harrison's Internal Medicine Chapter 88. Tumors of the Liver and Biliary Tree Hepatocellular Carcinoma Incidence Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The annual global incidence is about 1 million cases, with a male to female ratio of about 4:1. The incidence rate equals the death rate. In the United States, 19,160 new cases and 16,780 deaths were noted in 2007. The death rate in males in low-incidence countries such as the United States is 1.

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  • Chapter 088. Hepatocellular Carcinoma (Part 6) Hepatocellular Carcinoma: Treatment Most HCC patients have two liver diseases, cirrhosis and HCC, each of which is an independent cause of death. The presence of cirrhosis usually places constraints on resection surgery, ablative therapies, and chemotherapy. Thus patient assessment and treatment planning have to take the severity of the nonmalignant liver disease into account. The clinical management choices for HCC can be complex (Fig. 88-1). The natural history of HCC is highly variable.

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  • Carcinoma of the Ampulla of Vater This tumor arises within 2 cm of the distal end of the common bile duct, and is mainly (90%) an adenocarcinoma. Locoregional lymph nodes are commonly involved (50%), and the liver is the most frequent site for metastases. The commonest clinical presentation is jaundice, and many patients also have pruritus, weight loss, and epigastric pain. Initial evaluation is performed with an abdominal ultrasound to assess vascular involvement, biliary dilatation, and liver lesions. This is followed by a CT scan, or MRI and especially MRCP.

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  • Clinical Features Symptoms in HCC patients include abdominal pain, weight loss, weakness, abdominal fullness and swelling, jaundice, and nausea (Table 88-3). Presenting signs and symptoms differ somewhat between high- and low-incidence areas. The most common symptom is abdominal pain in high-risk areas, especially in South African blacks; by contrast, only 40–50% of Chinese and Japanese patients present with abdominal pain. Abdominal swelling may occur as a consequence of ascites due to the underlying chronic liver disease or may be due to a rapidly expanding tumor.

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  • Chapter 088. Hepatocellular Carcinoma (Part 7) Local Injection Therapy Numerous agents have been used for local injection into tumors, most commonly, ethanol (PEI). The relatively soft HCC within the hard background of cirrhotic liver allows for injection of large volumes of ethanol into the tumor without diffusion into the hepatic parenchyma or leakage out of the liver. PEI causes direct destruction of cancer cells, but it is not selective for cancer cells and will destroy normal cells in the vicinity. It usually requires multiple injections (average of three), in contrast to one for RFA.

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  • Physical Signs Hepatomegaly is the most common physical sign, occurring in 50–90% of patients. Abdominal bruits are noted in 6–25%, and ascites occurs in 30–60% of patients. Ascites should be examined by cytology. Splenomegaly is mainly due to portal hypertension. Weight loss and muscle wasting are common, particularly with rapidly growing or large tumors. Fever is found in 10–50% of patients, from unclear cause. The signs of chronic liver disease may be present, including jaundice, dilated abdominal veins, palmar erythema, gynecomastia, testicular atrophy, and peripheral edema.

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  • MicroRNAs are a class of small noncoding RNAs that function as key reg-ulators of gene expression at the post-transcriptional level. Recently, micr-oRNA-373 (miR-373) has been found to function as an oncogene in testicular germ cell tumors.

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  • Urokinase-type plasminogen activator (uPA) and c-met play a major role in cancer invasion and metastasis. Evidence has suggested that uPA and c-met overexpression may be coordinated in human hepatocellular carci-noma (HCC). In the present study, to understand whether the expression of these genes might be coregulated by specific microRNAs (miRs) in human cells, we predicted thatHomo sapiensmicroRNA-23b could recog-nize two sites in the 3¢-UTR of uPA and four sites in the c-met 3¢-UTR by the algorithm pictar. ...

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  • Longmire, called it a "hostile" organ because it welcomes malignant cells and sepsis so warmly, bleeds so copiously, and is often the ?rst organ to be injured in blunt abdominal trauma. To balance these negative factors, the liver has two great attributes: its ability to regenerate after massive loss of substance, and its ability, in many cases, to forgive insult. This book covers a wide spectrum of topics including, history of liver surgery, surgical anatomy of the liver, techniques of liver resection, benign and malignant liver tumors, portal hypertension, and liver trauma.

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  • In summary, the DLEU2/miR-15a/16-1 tumor suppressor locus plays a role in regulating the expansion of the mature B-cell pool, by preventing the entry into G0/G1-S transition. The impairment of this cell cycle control in MDR-deleted cells may allow them to proliferate after BCR stimulation by foreign or self antigens. In these conditions, a model for the pathogenesis of CLL with 13q14 deletion based on the presumptive cellular origin of the tumor cell precursor can be proposed.

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  • Tumor-Induced Hypoglycemia Caused by Excess Production of IGF-II (See also Chap. 339) Mesenchymal tumors, hemangiopericytomas, hepatocellular tumors, adrenal carcinomas, and a variety of other large tumors have been reported to produce excessive amounts of insulin-like growth factor type II (IGF-II) precursor, which binds weakly to insulin receptors and strongly to IGF-I receptors, leading to insulin-like actions. The gene encoding IGF-II resides on a chromosome 11p15 locus that is normally imprinted (that is, expression is exclusively from a single parental allele).

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Serum levels of soluble Fas, soluble tumor necrosis factor-receptor II, interleukin-2 receptor and interleukin-8 as early predictors of hepatocellular carcinoma in Egyptian patients with hepatitis C virus genotype-4...

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi

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  • Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium...

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  • The third part of the book is dedicated to analysis of role of DNA methylation in cancer. According to the American Cancer Association, nearly 13% of all deaths worldwide are cancer related. Aberrant DNA methylation patterns is likely to play a causative role in cancer initiation and development. The first chapter is dedicated to investigation of DNA methylation role in the development of hepatocellular carcinoma associated with tyrosinemia.

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  • Because of the asymptomatic process of carcinogenesis, the early detection of cancers such as hepatocellular carcinoma (HCC) is very challenging. Tumor-prone transgenic mouse models of oncogenesis can provide a stable and powerful tool for the analysis of cancer initiation, and are therefore promising for the discovery of early putative biomarkers of HCC.

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