Laparoscopic Management of Hepatocellular Carcinoma
Hesham Mohamed Hashem Ali Badawy;
Abstract
Epidemiology and etiology:
The geographic distribution of HCC closely mirrors that of viral hepatitis. Because it is associated strongly with chronic Liver Disease. Its incidence increase with age and more common in than in female
Main causes are:
• Infections: hepatitis B or C viruses.
• Cirrhosis: alcohol induced, autoimmune or primary biliary cirrhosis.
• Environmental: aflatoxins, thorotrast or N-nitrosylated compounds.
• Metabolic: Hemochromatosis, Alpha1-antitrypsin deficiency, Wilson's disease or Familial cholestatic cirrhosis.
Pathologic features of HCC:
HCC has been graded as well differentiated, moderately differentiated, and poorly differentiated. No firm correlation of grade to prognosis has been established.
HCC can be classified into hanging type which is attached to the normal liver by a small vascular stalk, pushing type which is usually demarcated and encapsulated by a fibrous capsule or the infilterative type which has a greater degree of invasion and vascular infilteration.
Fibrolamellar variant is a type of HCC. It is generally well demarcated ,often encapsulated and having a central fibrotic area. It occurs without underlying cirrhosis.
Diagnosis:
Diagnosis of HCC can be carried out through:
Clinically:
Non specific symptom like abdominal pain, weakness and weight loss.
Fetoprotein: It is useful in screening of high risk groups and in diagnosis in patients with hepatic focal lesion. AFP is elevated in only 50% to 70% of cases. In the presence of a space-occupying hepatic lesion and such an elevated AFP level, the diagnosis of HCC is virtually sure. There is other types of tumor marker specific in diagnosis of HCC.
Ultrasonography:
US is the most commonly used imaging modality for detecting HCC. It has the advantage of being widely available, less costly than other methods, and relatively noninvasive. However, it is also the most operator-dependent imaging modalityBut not all cases of HCC can be detected early with US.
Computed tomography:
CT has the advantage of producing high-resolution cross-sectional images and is less operator-dependent in both acquisition and interpretation of the images.
Computed tomography plays an important role in both confirming diagnosis and determining the extent of disease. CT is extremely useful in the assessment of hepatic anatomy, resectability, and surgical planning in the case of resectable disease especially by triphasic type
The geographic distribution of HCC closely mirrors that of viral hepatitis. Because it is associated strongly with chronic Liver Disease. Its incidence increase with age and more common in than in female
Main causes are:
• Infections: hepatitis B or C viruses.
• Cirrhosis: alcohol induced, autoimmune or primary biliary cirrhosis.
• Environmental: aflatoxins, thorotrast or N-nitrosylated compounds.
• Metabolic: Hemochromatosis, Alpha1-antitrypsin deficiency, Wilson's disease or Familial cholestatic cirrhosis.
Pathologic features of HCC:
HCC has been graded as well differentiated, moderately differentiated, and poorly differentiated. No firm correlation of grade to prognosis has been established.
HCC can be classified into hanging type which is attached to the normal liver by a small vascular stalk, pushing type which is usually demarcated and encapsulated by a fibrous capsule or the infilterative type which has a greater degree of invasion and vascular infilteration.
Fibrolamellar variant is a type of HCC. It is generally well demarcated ,often encapsulated and having a central fibrotic area. It occurs without underlying cirrhosis.
Diagnosis:
Diagnosis of HCC can be carried out through:
Clinically:
Non specific symptom like abdominal pain, weakness and weight loss.
Fetoprotein: It is useful in screening of high risk groups and in diagnosis in patients with hepatic focal lesion. AFP is elevated in only 50% to 70% of cases. In the presence of a space-occupying hepatic lesion and such an elevated AFP level, the diagnosis of HCC is virtually sure. There is other types of tumor marker specific in diagnosis of HCC.
Ultrasonography:
US is the most commonly used imaging modality for detecting HCC. It has the advantage of being widely available, less costly than other methods, and relatively noninvasive. However, it is also the most operator-dependent imaging modalityBut not all cases of HCC can be detected early with US.
Computed tomography:
CT has the advantage of producing high-resolution cross-sectional images and is less operator-dependent in both acquisition and interpretation of the images.
Computed tomography plays an important role in both confirming diagnosis and determining the extent of disease. CT is extremely useful in the assessment of hepatic anatomy, resectability, and surgical planning in the case of resectable disease especially by triphasic type
Other data
| Title | Laparoscopic Management of Hepatocellular Carcinoma | Other Titles | وسائل علاج سرطان الكبد بالمنظار | Authors | Hesham Mohamed Hashem Ali Badawy | Issue Date | 2014 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.