医学课件：肝细胞癌(英文版)

1、Hepatocellular carcinomaEpidemiology HCC is the seventh most common cancer worldwide, and the third leading cause of cancer-related deaths.More than 600,000 new cases worldwide annually (50% in China)Over 80% of HCCs occur in developing countriessub-Saharan Africa, southeast Asia, and east Asia Inci

2、dence decreased in developing countries and increased in developed countriesYang JD, et al. Nature Rev 2010Global variation in incidence of HCCYang JD, et al. Nature Rev 2010Etiology Hepatitis B: 50% HCC attributed to HBV worldwideAround 100 times higher for incidence of HCC in carriers than non car

3、riersHepatitis C: leading cause of HCC in Western countries and JapanAflatoxin B: synergistic factor with HBV in China and sub-Saharan AfricaAlcoholic liver disease: second most common risk factor for HCC after HCV in USANonalcoholic steatohepatitis (NASH): an emerging risk factor in developed count

4、riesPrevention Vaccination of HBVReduced HCC incidence after universal vaccination of newborn babiesLamivudine treatment reduced incidence of HCC in hepatitis B or resultant cirrhosisPrevention of HCV transmissionNo vaccination for HCVInfection control measures in high risk practices (screening bloo

5、d donors, use of disposable needles, thorough sterilization of surgical instruments)Interferon and ribavirin for hepatitis CPathology of HCCDifferentiationEdmondson grade: I, II, III, IVPortal vein invasionMicro vessel, macro vessel (portal vein, hepatic vein, Inferior vena cava)MetastasisDistant me

6、tastasis: lung, lymph nodule, bone, adrenal gland, brain)Tumor markersAlpha-fetoprotein (AFP)HCC: 60%70% with elevated AFPOthers:Active Hepatitis, liver cirrhosisLiver metastasis: Gastric cancer, pancreatic cancer, kidney cancer, embryonic tumorsdes-carboxy prothrombin (DCP)Imagines UltrasonographyD

7、ynamic computed tomography (CT)Magnetic resonance imagine (MRI)AngiographySurveillance of HCCIndividuals high risk for HCCHepatitismen over 40 years, women over 50 yearsPatients with persistently or intermittently elevated alanine transaminase (ALT)levelsLiver cirrhosisHepatitis B or C relatedAlcoho

8、lic liver diseaseHemochromatosisPrimary biliary cirrhosisHow to carry out the screeningUltrasonography in combination with serum HCC marker, alpha-fetoprotein (AFP), every 6 monthsDiagnosisAmerican Association for the study of liver Diseases (AASLD)Lesion 1.0cm, with HCC features (enhancement in art

9、ery phase and washout in venous phase) on one of Dynamic imagines (CT or MRI)Biopsy Diagnosis of HCCBruix J and Sherman M, Hepatology 2011Diagnosis of HCCLiver cirrhosisCT/MRIOr biopsyStaging systemsBarcelona Clinic liver Cancer (BCLC)Cancer of the liver Italian Program (CLIP)TNM (tumor, node and me

10、tastasis)OkudaJapanese Integrated staging score (JIS) systemsBCLC stageBruix J and Llovet JM, Lancet 2009Differential diagnosisLiver metastasisColorectal, pancreatic, breast, lung;Intrahepatic cholangiocarcinoma AngiomaLiver cystsLiver Abscess TreatmentSurgical treatmentSurgical resectionliver trans

11、plantationTransarterial chemoembolizaionLocal ablationPercutaneous ethanol injection (PEI)Radiofrequency ablation (RFA)RadiationSyctemic therapyChemotherapy, immunotherapy, molecular target therapySorafenib Sorafenib in advanced HCCMedian sur 6.5m vs 4.2mP=0.014Median time to progress 2.8m vs 1.4mP=

12、0.0005Cheng AL et al. Lancet Oncol 2009Prognosis Tumor stageSize, nodules, portal vein involvement, metastasisBiomarkersLiver functionChild-PughECOG performanceThanks UltrasonographyMRIT1WT2WArtery phaseVenous phaseCTNon enhancement, Enhancement in artery phase wash out in venous phaseangiographyPan

13、creatic cancer metastasis to the liverIntrahepatic cholangiocarcinomaangiomaLiver cystSurgical resection n 5-y OS transplantation 468 75.7% surgical resection samll liver cancer 5059 57.0%large liver cancer 4860 30.3%Long-term survival of HCC treated with surgical resection and transplantation (1958-2009)Transarterial chemoembolizationPercutaneous ethanol injectionRad