Hepatocellular Carcinoma

Hepatocellular carcinoma (hepatoma) develop usually in patients with liver cirrhosis and are common in areas where a high prevalence of chronic hepatitis B there and / or c. The symptoms and complaints are not specific in general. The diagnosis is derived from the alpha-fetoprotein (AFP) levels, imaging and sometimes a liver biopsy. Screening with 6-monthly AFP and ultraschallsonographischen controls is recommended for all high-risk patients. The prognosis is poor if the cancer is advanced, but small tumors that are confined to the liver, there are effective palliative (ablative Verfaheren, Chemoemboliasation, sorafenib) and potentially curative (surgical resection, liver transplantation) treatment options.

Hepatocellular carcinoma is the most common form of primary liver cancer, with an estimated 23,000 new cases and over 14,000 deaths in 2012 in the US. However, it is more common outside the United States, especially in East Asia and in sub-Saharan Africa; The incidence is essentially proportional to the geographical prevalence of chronic hepatitis B virus (HBV) infection (1).

Hepatocellular carcinoma (hepatoma) develop usually in patients with liver cirrhosis and are common in areas where a high prevalence of chronic hepatitis B there and / or c. The symptoms and complaints are not specific in general. The diagnosis is derived from the alpha-fetoprotein (AFP) levels, imaging and sometimes a liver biopsy. Screening with 6-monthly AFP and ultraschallsonographischen controls is recommended for all high-risk patients. The prognosis is poor if the cancer is advanced, but small tumors that are confined to the liver, there are effective palliative (ablative Verfaheren, Chemoemboliasation, sorafenib) and potentially curative (surgical resection, liver transplantation) treatment options. Hepatocellular carcinoma is the most common form of primary liver cancer, with an estimated 23,000 new cases and over 14,000 deaths in 2012 in the US. However, it is more common outside the United States, especially in East Asia and in sub-Saharan Africa; The incidence is essentially proportional to the geographical prevalence of chronic hepatitis B virus (HBV) infection (1). Etiology Hepatocellular carcinoma is usually a complication of liver cirrhosis. The presence of HBV increases the risk of hepatocellular carcinoma by> 100 fold. HBV infection can induce malignant transformation in the absence of chronic hepatitis or cirrhosis. Each cirrhosis can cause hepatocellular carcinoma. cirrhosis of the liver as a result of chronic hepatitis C virus (HCV) infection, hemochromatosis, which shall not be:-alcoholic steatohepatitis (NASH) and the alcoholic cirrhosis are quantitatively particularly important in addition to the hepatitis B. Patients with cirrhosis as a result of other diseases also have an increased risk. Environmental carcinogens may play a role, such. As is the intake of alpha-toxin-contaminated food is viewed as an additional risk factor for the high incidence of hepatocellular carcinoma in the subtropics. Symptoms and complaints most frequently appear previously stable patients with cirrhosis, with abdominal pain, weight loss, mass in the right upper quadrant and unexplained deterioration in general health status. Fever may occur. In some patients the first manifestation of hepatocellular carcinoma bloody ascites, shock or peritonitis caused by blood flow to the tumor. Rarely is also a bruit over the liver. Sometimes systemic metabolic complications such as hypoglycemia, erythrocytosis, hypercalcemia and hyperlipidemia occur. These complications may become clinically apparent. Diagnostic alpha-fetoprotein (AFP) measurement Imaging (contrast-enhanced computer tomography, ultrasound, or MRI), the clinical suspicion of a hepatocellular carcinoma exists when an enlarged liver is an unresolved decompensation of a chronic liver disease is palpable developed an imaging study, conducted for other reasons is, especially when the patient has cirrhosis of the liver, a mass in the right upper quadrant of the abdomen shows through screening programs, however, numerous hepatocellular carcinomas are discovered before the onset of symptoms. Basis of diagnosis are based contrast agent imaging techniques and optionally the biopsy. AFP is mainly used to follow the course. In adults AFP signaled a dedifferentiation of hepatocytes, which suggests most of hepatocellular carcinoma; 40 to 65% of patients with cancer have high AFP levels (> 400 ug / l). High values ??are otherwise rare; Exception is the teratocarcinoma of the testis, a much rarer tumor. Lower AFP levels are less specific and can occur in hepatocellular regeneration (for. Example, hepatitis). Other blood tests, such as AFP-L3 (an AFP isoform) and gamma Carboxyprothrombin are investigated as a marker for early detection of hepatocellular carcinoma. Depending on the initially applied imaging techniques can be a contrast-enhanced computed tomography, ultrasound or MRI of the local preferences and options. A Leberarteriographie can sometimes continue for unclear cases and also serve to analyze the vascular anomaly ablation or a planned surgical procedure. When imaging techniques provide characteristic findings and liver cirrhosis is present, the diagnosis is considered unique. In unclear cases, the definitive confirmation of the diagnosis an ultrasound or CT-guided liver biopsy is required. Staging If hepatocellular carcinoma is diagnosed, the spread diagnosis usually includes a chest computed tomography without contrast agent and a presentation of the portal vein (if not already done) to exclude by MRI, ultrasound or computed tomography with contrast thrombosis. For the staging of liver carcinoma various systems can be used, none is used universally. One is the TNM system, based on the following (see Table: staging hepatocellular carcinoma *): T: number of primary tumors, size and spread of the cancer to adjacent organs N: propagation and infection of nearby lymph nodes M: metastases in other organs Numerals (0 to 4) as T, N and M indicate the increasing severity. Staging hepatocellular carcinoma * Stadium Name Description 1 T1, N0, M0 single tumor (any size) without invasion of blood vessels II T2, N0, M0 single tumor (any size) with invasion of blood vessels or multiple tumors, all of <5 cm IIIA T3a, N0, M0 Several tumors with at least one> 5 cm IIIB T3b, N0, M0 One or more tumors of any size with invasion of a main branch of the portal vein or hepatic vein IIIC T4, N0, M0 tumor or tumors of any size with invasion of adjacent organs except the gallbladder or with perforation of the visceral peritoneum IVA Each T, N1 , M0 tumors or tumors of any size with spread to nearby (regional) lymph nodes IVB Jed it T, any N, M1 tumor or tumors of all sizes with distant metastases * Adapted from the American Joint Committee on Cancer (AJCC) AJCC Cancer Staging Manual, ed. “7. New York, Springer, 2010. Other scoring systems are the Okuda and the Barcelona Clinic Liver Cancer staging systems. Besides the size of the tumor, local extension and metastases, these systems integrate information on the severity of liver disease. With the TNM system better prognosis for patients can probably be made in which a tumor resection (and possibly a transplant) was than with other systems, while the Barcelona system for patients who do not have surgery makes better predictions possible (More For information, see staging system in hepatocellular carcinoma) .Screening A growing number of hepatocellular carcinomas are detected by screening programs. The screening in patients with cirrhosis is meaningful. A common screening method is an ultrasound every 6 months. Some experts advise B infection and for screening in patients with long-standing hepatitis, even if no cirrhosis is recognizable. Therapy transplant in a few small tumors and the treatment of hepatocellular carcinoma depends on its level from (1). For individual tumors <5 cm or ? 3 tumors which are all ? 3 cm and which are limited to the liver (Milan CRITERIA), has a liver transplant an equally good prognosis, such as liver transplantation, which is not performed due to a cancer diagnosis. Alternatively, a surgical resection may be performed; However, recurrences are common. Ablative treatments (. For example, trans-arterial chemoembolization [TACE] Embolization with yttrium 90 microspheres [selective internal radiation therapy or SIRT], radiofrequency ablation) are effective palliative approaches that slow tumor growth; they are also used as "bridging" in patients who are waiting for a liver transplant. If the tumor is large (> 5 cm), multifocal, is entered into the portal vein or has metastasized (ie stage III or higher), the prognosis is less favorable (eg., 5-year survival rates of about 5% or fewer). Radiation therapy is usually ineffective. Sorafenib appears to improve somewhat in advanced disease survival. Treatment Note Bruix J, M Reig, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 50 (4): 835-853, 2016. doi: 10.1053 / j.gastro.2015.12.041. Prevention Prophylactic vaccination against HBV results in measurable reduction in the incidence of hepatocellular carcinoma, v. a. in endemic areas. The prevention of the development of liver cirrhosis any cause (for. Example, on the treatment of chronic hepatitis C, the early diagnosis of hemochromatosis, or the treatment of alcohol addiction) also has a significant effect. Important points Hepatocellular carcinomas are usually a complication of cirrhosis of the liver and mostly occur in areas of the world where a high prevalence of hepatitis B prevails. The diagnosis should be considered when an enlarged liver is found on physical examination or imaging or when a chronic liver disease unexpectedly deteriorated. The diagnosis of hepatocellular carcinoma based on the AFP-mirrors and the findings in the imaging procedure; the spread diagnosis is performed by a thoracic computed tomography without contrast, a representation of the portal vein and possibly scintigraphy. A transplant should be gezogenw with few and small tumors into consideration. For prevention include the hepatitis B vaccination and treatment of diseases that cause liver cirrhosis.

Health Life Media Team

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