肝癌病理课件.ppt

1、Risk Factors 2. Screening for HCC 3. Diagnosis 4. Evaluation 5. Management,1. Risk Factors,Hepatitis B,C Alcohol Non-alcohol steatohepatitis(NASH) Primary biliary cirrhosis Environment exposure to aflatoxin Auto-immune hepatitis Inherited errors of metabolism Genetic hemochromatosis Porphyria cutane

2、a tarda Alpha1-antitrypsin deficiency Wilsons disease,2.Screening for HCC,Symptoms jaundice, anorexia, weight loss, malaise, upper abdominal pain Physical signs hepatomegaly, ascites Paraneoplastic syndromes hypercholesterolemia, erythrocytosis hypoglycemia,3.Diagnosis,Imaging,Biopsy,Serum biomarker

3、s,Hepatitis panel Assessment of the presence of comorbidity Imaging studies to detect the presence of metastatic disease Evaluation of hepatic function Portal hypertention,4.Evaluation,Staging (AJCC) TNM staging system Okuda system BCLC CLIP JIS,CLIP classification,Parameter Score ChildPugh A0 B1 C2

4、 Tumour morphology Uninodular and extension 400 ng/ml 1 Macrovascular invasion No 0 Yes 1,Definition of the BCLC staging for HCC,Surgery partial hepatectomy liver transplantation Local regional therapy ablation: RFA PEI embolization: bland embolization(TAE) chemoembolization(TACE) radioembolization RT:conformal or stereotactic therapy Systemic therapy Best supportive care,Management,Levels of bilirubin ,ALT, AST, ALP,LDH,albumin,protein Cr, BUN PT,INR,Child-pugh score