LIVER TUMORS PROFF. S.FLORET
NEOPLASM OF LIVER PRIMARY 1)BENIGN 2)MALIGNANT METASTATIC/SECONDARY LIVER
Primary Liver Cancer the Second Killer among tumors high morbidity and mortality(20.40/100,000) etiology pathology clinical features diagnosis * treatment
TYPES Hepatocellular carcinoma Fibrolamellar carcinoma Cholangiocarcinoma Hepatoblastoma
Etiology 1. viral hepatitis In China hepatitis B virus cirrhosis primary liver cancer heapatitis B surface antigen& core antibody found in 70 to 80%. In Japan hepatitis C virus In Russia hepatitis D virus 2. liver cirrhosis substratum of primary liver cancer In china post necrotic cirrhosis In western world alcoholic cirrhosis 20 to 40% haemochromatosis macronodular cirrhosis
3. aflatoxin fungus aspergillus flavus 4. other chemical carcinogens nitrosamine thorotrast(angiosarcoma) vinyl chloride (angiosarcoma) cigarette smoking
5.ENVIRONMENTAL FACTORS: clonarchis cholangiocarcinoma 6.SEX HORMONE prolonged use of sex hormones liver cell adenoma& HCC
Pathology gross classification massive multinodular diffused microscopic classification hepatocellular carcinoma( HCC ) cholangiocellular carcinoma mixed type
HEPATOCELLULAR CARCINOMA Trabecular pattern with area of hemorrage & necrosis Giant cell are characteristics.
FIBROLAMELLAR CARCINOMA Abundant fibrous stroma arranged in thin parallel bands around tumor cells. Hepatocytes are deeply eosinophilic.
CHOLANGIOCARCINOMA Adenomatous tumor in schirrous background. Mucous formation seen. But bile never seen.
HEPATOBLASTOMA Small fetal hepatocytes arranged in sheets.
Clinical presentation General symptom: liver cell failure metastatic Local symptom
insidious 1. pain site: right upper quadrant or epigastric area character: dull, aching pain ruptured & bleeding dramatic increase or sudden onset of pain
2. systematic and digestive symptoms fatigue weight loss fever (37.5 38 ) anorexia nausea vomiting diarrhea 3. hepatomegaly non tender and hard 4. metastatic symptoms
Diagnosis * When typical symptoms are found, the diagnosis is not difficult but too LATE in most cases. EARLY diagnosis monitor the high risk population
High risk population 1. age>35ys 2. HBsAg (+) 3. cirrhosis (+) 4. active hepatitis>5 years 5. family history of liver cancer Theoretically, by examining AFP & ultrasound every 6 months, all 3cm liver cancers can be tested out in general check up.
Diagnostic methods qualitative diagnosis : AFP (α fetoprotein ) 定 性 诊 断 AFP heteroplasmon location diagnosis : ultrasound 定 位 诊 断 CT MRI selective arteriography 动 脉 照 影
AFP positive rate 70% diagnostic criteria of radio immune method 1. AFP 400ug/L lastingly 2. exclude pregnancy active liver diseases embryonic tumors AFP heteroplasmon positive rate 90%
Ultrasound non invasive sensitivity 84% test out the lesion 2cm depend on the skill of operator
CT positive rate 90% test out lesions 1cm
MRI similar with CT Advantages: biplanar images differentiate hemangioma 血 管 瘤
Selective arteriography best location diagnosis method for the lesions 2cm sensitivity 90% disadvantages: invasive and expensive
Diagnostic procedures AFP(+) image(+) liver cancer (+) AFP( ) image(+) test AFP heteroplasmon AFP heteroplasmon(+) liver cancer(+) AFP heteroplasmon( ) differential diagnosis AFP(+) image( ) liver cancer(±) close follow up
Treatment Surgery 1. Surgical resection Indication : good general condition localized tumor( half liver) no severe cirrhosis good compensatory function no invasion of 1st, 2nd hilum and inferior vana cava no severe injuries of other organs.
NOTE : In hepatectomy, 30% good liver tissue or 50% cirrhotic liver tissue must be remained at least. 2. Other surgery treatment for special cases ligation of hepatic artery embolism of hepatic artery microwave treatment re resection for recurrence
Chemotherapy General chemotherapy Intubation chemotherapy Chemotherapy embolism Radiotherapy Anhydrous alcohol injection Immunotherapy Chinese medicine therapy