Ebook Pocket oncology (2/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Pocket oncology (2/E): Part 2
Ebook Pocket oncology (2/E): Part 2
Hepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Ebook Pocket oncology (2/E): Part 2 cause of worldwide CA mortality (598,000/y)» >80% cases of HCC occur in sub-Saharan Africa, eastern & southeastern Asia, & parts of Oceania including Papua New Guinea» 9th leading cause of CA mortality in US Recent T in the incidence of HOC (8.4/100,000) & HCC-related mortality in USRisk Factors» V Ebook Pocket oncology (2/E): Part 2iral hepatitis: HBV & HCV are the leading RFs for HOC & accounts for 75% cases worldwide; HCV infxn is predominant in Europe, North America, & Japan,Ebook Pocket oncology (2/E): Part 2
HBV in Asia & Africa (Gastroenterology 2012:142:1264)» While HCV is now the leading cause of HOC in the US, NASH is expected to become a risk factor oHepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Ebook Pocket oncology (2/E): Part 2 in US), environmental exposure to aflatoxin from Aspergillus fungus, tobacco, autoimmune hepatitis» Metabolic disorders: Metabolic syn, DM, NASH, hereditary hemochromatosis (mts in HFE gene) & other rare metabolic disordersScreening and Prevention» Screening w/ ultrasonography & AFP testing every 6 Ebook Pocket oncology (2/E): Part 2-12 mos recommended for pts w/ HBV & HCV who are at risk for HCC•Additional imaging (at least 3-phase contrast-enhanced CT or MRI) in setting of risinEbook Pocket oncology (2/E): Part 2
g serum AFP or identification of liver mass on US» A marked advance was made w/ the approval of new effective anti-HCV Rx (sofosbuvir, ledipasvir) w/ Hepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Ebook Pocket oncology (2/E): Part 2ng cohorts born after 1960 (JCO 2016:34:1787)Pathophysiology» Hepatocarcinogenesis begins w/ an acute or chronic insult to hepatocytes - induces liver remodeling that results in liver cirrhosis or fibrosis - stepwise accumulation of genetic & molecular aberrations; up to 20% of HCC cases develop in Ebook Pocket oncology (2/E): Part 2pts w/o cirrhosis» HBV-induced hepatocarcinogenesis may occur through direct viral DNA insertion•Histopathologic markers of HCC: granular HepPar-1 staEbook Pocket oncology (2/E): Part 2
ining, positive AFP» Dysplastic nodules evolve into HCC w/ loss of IGF-2 receptor oncogene & tumor suppressors p53, PTEN, & pl6Clinical ManifestationsHepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Ebook Pocket oncology (2/E): Part 2tomegaly, ascites, jaundice, encephalopathy & other signs of adv cirrhosis•Lab findings: reflects level of liver dysfunction. Ĩ Total bill., low albumin, & elevated INR in the setting of adv cirrhosis» Paraneoplastic syn are rareDiagnostic Workup•Includes imaging, pathologic confirmation of HCC, tum Ebook Pocket oncology (2/E): Part 2or markers, & LFTs•Imaging: At least 3-phase contrast-enhanced CT scan (arterial, portal venous, & parenchymal phase), tumor enhances in arterial phasEbook Pocket oncology (2/E): Part 2
e & becomes hypoattenuating in portal venous phase, or gadolinium-enhanced or contrast-enhanced MRI. US primarily used as screening modality. PET/CT nHepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Ebook Pocket oncology (2/E): Part 2e. Bx should be strongly considered in pts in whom dx is in question, & in pts w/o cirrhosis. However, bx confirmation may not be required for early curable stages, when surgery or transplant are considered, or when certain radiological criteria are met in the setting of screening detected tumors•La Ebook Pocket oncology (2/E): Part 2bs: Hepatitis B & c serologies; Serum AFP not sensitive norspecific» Classification systems for assessment of hepatic dysfunction: Child-Pugh classifiEbook Pocket oncology (2/E): Part 2
cationThe Child-Pugh Scoring System for Liver CirrhosisPointsParameter123Hepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leading Hepatocellular Carcinoma __________(HCC)___________IMANEELDIKA • GHASSAN ABOU-ALFAEpidemiology•6th most common CA worldwide (626,000/y) & 2nd leadingGọi ngay
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