Liver carcinoma

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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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  • Liver Metabolism and Fatty Liver Disease addresses the current understanding of the development of nonalcoholic fatty liver disease as well as the clinical aspects of the disease by examining the current knowledge surrounding metabolism in the liver. The book discusses various topics including the involvement of oxidative stress, metabolic effects, and inflammation as well as the effect of nutrition on the development and progression of the disease.

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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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  • Fibrolamellar HCC (FL-HCC) This rarer variant of HCC has a different biology than adult-type HCC. None of the known HCC causative factors seem important here. It is typically a disease of younger adults, often teenagers and predominantly females. It is AFP negative, but patients typically have elevated blood neurotensin levels, normal liver function tests, and no cirrhosis. Radiology is similar for HCC, except that characteristic adult-type portal vein invasion is less common.

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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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  • Management of Disseminated CUP Patients who present with liver, brain, and adrenal metastatic disease usually have a poor prognosis. Beside primary peritoneal carcinoma, carcinomatosis presenting as CUP in other settings is not uncommon. Gastric, appendicular, colon, pancreas, and cholangiocarcinoma are all possible primaries, and imaging, endoscopy, and pathologic data help in the evaluation. Traditionally, platinum-based combination chemotherapy regimens have been used to treat patients with CUP.

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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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  • Table 88-6 Some Novel Medical Treatments for Hepatocellular Carcinoma EGF receptor antibody Erlotinib, Gefitinib Kinase antagonists, Sorafenib Vitamin K IL-2 131 I – ethiodol (Lipiodol) 131 I – Ferritin 90 Yttrium microspheres 166 Holmium Three-dimensional conformal radiation Proton beam high-dose radiotherapy Anti-angiogenesis strategies, Bevacizumab Note: EGF, epidermal growth factor; IL, interleukin. Summary Most Common Modes of Patient Presentation 1.

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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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  • Approach to the Patient: Hepatocellular Carcinoma History and Physical The history is important in evaluating putative predisposing factors, including a history of hepatitis or jaundice, blood transfusion, or use of intravenous drugs. A family history of HCC or hepatitis should be sought, and a detailed social history taken to include job descriptions for industrial exposure to possible carcinogenic drugs as well as contraceptive hormones.

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  • Ung thư gan nguyên phát là ung thư xuất phát từ các tế bào biểu mô của nhu mô gan bao gồm : +Ung thư biểu mô tế bào gan (Hepatocellular carcinoma, HCC), +Ung thư biểu mô tế bào ống mật trong gan (Cholangiocarcinoma), +Ung thư mạch máu trong gan (Angiosarcoma hoặc hemangiosarcoma), +Ung thư gan ở trẻ em dưới 4 tuổi (Hepatoblastoma). -Ung thư gan thứ phát là ung thư từ nơi khác di căn đến gan, như từ : ung thư đường tiêu hoá, ung thư vú, ung thư phổi, ung thư tử cung, …...

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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P32 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P35 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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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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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P6 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P15 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P24 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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  • Hepatocellular Carcinoma: Targeted Therapy and Multidisciplinary P30 provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options.

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