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Hepatocellular Carcinoma Imaging & Treatment

Hepatocellular Carcinoma Imaging & Treatment. Ali N Khan FRCS, FRCP, FRCR. Hepatocellular carcinoma is the most common liver malignancy. It has considerable variability in incidence worldwide. 80% of HCC arise on the background of cirrhosis. Non-cirrhotics catching up. Presentation.

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Hepatocellular Carcinoma Imaging & Treatment

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  1. Hepatocellular Carcinoma Imaging & Treatment Ali N Khan FRCS, FRCP, FRCR INCTR 2004

  2. Hepatocellular carcinoma is the most common liver malignancy It has considerable variability in incidence worldwide. 80% of HCC arise on the background of cirrhosis. Non-cirrhotics catching up INCTR 2004

  3. Presentation • Most discovered on cross sectional imaging: US • Cirrhosis surveillance • Small numbers have non-specific symptoms INCTR 2004

  4. Atypical presentations INCTR 2004

  5. Obstructive jaundice INCTR 2004

  6. PUO INCTR 2004

  7. Adrenal mass? INCTR 2004

  8. Imaging Options: • No one imaging has been shown to be superior • US • CT • MRI • Angiography • NM INCTR 2004

  9. Liver Biopsy: Think first, then don’t do it! Converts loco-regional disease into systemic • Do only if inoperable • Do only if markers negative • Never biopsy hepatomas or haemangiomas • Biopsy FNH & adenomas useless • If operable: laparoscopy & IOUS • If operable the liver remnant is most important INCTR 2004

  10. EASL monothematic conference Non-invasive diagnostic criteria for HCC in Cirrhosis: • Lesions > than 2 cm with arterialisation as shown by two coincident imaging techniques Or • Focal lesion > 2 cm associated with alpha FP > 400 ng ml-1 INCTR 2004 Bruix J, et al J Hepatol 2001

  11. Options • Surgery 30% operable, NMGH experience only 3% operable (143 patients) • Multicentric disease • Systemic chemotherapy not effective INCTR 2004

  12. So what is the alternative? INCTR 2004

  13. Ablative procedures • Chemoembolization/Drug eluting bead embolisation • Alcohol ablation • Cryosurgery • Radio-frequency ablation • Laser ablation • Microwave ablation INCTR 2004

  14. The detection rate by MRI 63%, by US 67%, by CT 50%, by DSA 74%, and by Lipiodol-CT 93%. INCTR 2004

  15. Poppy seed oil used as vehicle to deliver chemotherapeutic agents

  16. Chemotherapeutic agents: • Doxorubicin • Mitomycin • Cisplatin • Epirubicin • 5-FU INCTR 2004

  17. PVA

  18. ChemoembolizationRational • Dual blood supply • Lipiodol concentrated by HCC • Selective placement of a catheter • Embolisation with an emulsion of anticancer drug & Lipiodol • Sealing the embolisation with particulate material

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