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Hepatocellular carcinoma

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Hepatocellular carcinoma Diagnosis, Treatment, Prognosis + Quiz Vinko Bubic Mentor: A. mega Horvat Diagnosis Physical examination - enlarged, tender liver ... – PowerPoint PPT presentation

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Title: Hepatocellular carcinoma


1
Hepatocellular carcinoma
  • Diagnosis, Treatment, Prognosis Quiz

Vinko Bubic Mentor A. Žmegac Horvat
2
Diagnosis
  • Physical examination - enlarged, tender liver
  • Elevated serum alpha fetoprotein (normally
    40mg/l)
  • Elevated liver enzymes (ALT, AST, Alpha-1
    antitrypsin, serum bilirubin, urine bilirubin...)

3
Diagnosis
  • CT

4
CT
  • Computed tomography - medical imaging method
    employing tomography (imaging by sections or
    sectioning)
  • Large series of two-dimensional X-ray images
    taken around a single axis of rotation, computer
    integration
  • Iodine dye through vein for better visualisation
    (allergy)

5
(No Transcript)
6
MRI
  • Magnetic resonance imaging
  • The body - mainly composed of water molecules
  • Electromagnetic field causes protons to absorb
    some of its energy
  • Scanner detects release of proton energy (tumor
    tissue releases different frequency)
  • Greater contrast than CT

7
Modern 3T MRI
8
Biopsy
  • Definitive diagnosis of hepatocellular carcinoma

9
Hyperchromatic, clear cells with large red
cytoplasm
10
Treatment
  • Liver transplatation (cadaver liver or live donor
    lobe)
  • Surgical resection (best prognosis for long-term
    survival, but possible in only
  • 10-15 of cases)

11
Treatment
  • Percutaneus ethanol injection - small (lt 3 cm)
    solitary tumors
  • Transcatheter arterial chemoembolization (TACE) -
    more than 3 cm and less than 4 cm in diameter
  • Sealed source radiotherapy (brachytherapy) -
    radioactive source is placed inside or next to
    area requiring treatment

12
Prior to ethanol ablation
After
13
Transcatheter arterial chemoembolization
14
Other techniques
  • Radiofrequency ablation (RFA)
  • High intensity focused ultrasound (HIFU)
  • Chemotherapy (antiestrogen tamoxifen)
  • Cryosurgery - destruction of abnormal tissue
    using sub-zero temperatures

15
HIFU
16
Cryosurgery
Iceball
17
HCC complications
  • Gastrointestinal bleeding
  • Cachexy
  • Portal hypertension -gt esophageal bleeding
  • Liver failure
  • Metastasis (lymph nodes around pancreas, aorta,
    lungs, adrenal glands, bones)
  • Rupture of tumor -gt abdominal bleeding

18
Prognosis
  • Usually poor outcome
  • Only 10 - 20 of hepatocellular carcinomas can be
    removed completely
  • If not, disease usually deadly within 3 to 6
    months

19
Quiz
  • The definitive HCC diagnosis is
  • confirmed by
  • a) spider nevus by inspection
  • b) auscultation
  • c) biopsy and microscopy
  • d) MRI
  • e) esophageal reflux

20
  • Ethanol
  • a) dehydrates cells
  • b) hydrates cells and cracks them
  • c) activates IL-8
  • d) causes apoptosis
  • e) nothing from above

21
  • In cryotherapy, tumor is frozen by
  • a) flucloxacillin
  • b) Iodine
  • c) liquid nitrogen
  • d) surgeons eye
  • e) cocaine

22
What did you eat today?
This maybe? ???
23
Thanks ! ! !
24
References
  • http//www.cancer.gov/cancertopics/types/liver/
  • http//www.mayoclinic.com/health/liver-cancer/DS00
    399
  • Medicinski leksikon, Leksikografski zavod
    Miroslav Krleža, Zagreb 1992.
  • PATOLOGIJA, urednici Damjanov, Jukic, Nola,
    izdanje 2007.
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