Surgery - Hepatocellular carcinoma
Introduction primary hepatic parenchymal cancer. Etiology 1–6% of cases of cirrhosis are caused by chronic liver injury. The greatest risk is from hemochromatosis and hepatitis B and C. Aflatoxin-containing grains (from fungus- or biological weapon-contaminated crops). Epidemiology One million people die from the fourth most frequent cancer in the world each year. less frequent than cancers that metastasize to the liver. incidence in areas (such as the southern Mediterranean and the Far East) where hepatitis B and C are endemic. History Malaise, weight loss, and appetite loss are signs of a previous cancer. History of liver cirrhosis: The only signs that are frequently present are jaundice and abdominal fullness. Examination Symptoms of cancer lymphadenopathy and cachexia. Hepatomegaly: Smooth, nodule, or both. A deep palpation could cause pain. Ascites and jaundice. Over the liver, bruit could be audible. Investigations Blood: hepatitis serology, coagulation, a-fetoprotein, FBC, ESR, and LFT. Imaging: A lesion within a cirrhotic liver may be detected by abdominal ultrasonography. The gold standard for staging is an MRI or CT scan. Angiogram: Should transarterial embolization be contemplated. Histology: Cytology may be consulted when ascites are aspirated. Staging: CT scans of the abdomen, pelvis, and chest. Think about bone scan. Management Medical: Tyrosine kinase inhibitors, such as sorafenib, are more recent medications that may have a greater response than chemotherapy or transarterial chemoembolization. Surgical: If the condition is limited to one lobe, liver resection is recommended. The possibility of liver transplantation exists. The Milan criteria for transplantation are one tumor less than 5 cm or three tumors less than 3 cm. Yttrium-90 microspheres are one type of radioembolization used in radiotherapy. Ablation: Effective in reducing tumors that are resistant to excision. The methods include cryoablation, radiofrequency, and percutaneous ethanol injection. Complications blockage of the biliary tree, abrupt liver failure, hemoperitoneum and hepatic rupture, reactive pleural effusion, and distant metastases. Prognosis Very poor. Only 5% of patients can be surgically cured, and the majority of patients pass away within a year after diagnosis.
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