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Liver Cancer

Liver Cancer. . Liver Cancer. . Liver Cancer. Primary Liver Cancer Secondary Liver Cancer. Hepatic neuroendocrine metastasis. . Liver Cancer. Primary Liver Cancer Secondary Liver Cancer. Hepatic neuroendocrine metastasis. . Primary Liver Cancer. Incidence and mortality.

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Liver Cancer

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  1. Liver Cancer

  2. Liver Cancer

  3. Liver Cancer Primary Liver Cancer Secondary Liver Cancer Hepatic neuroendocrine metastasis 

  4. Liver Cancer Primary Liver Cancer Secondary Liver Cancer Hepatic neuroendocrine metastasis 

  5. Primary Liver Cancer Incidence and mortality Worldwide primary liver cancer is considered the fifth most significant cancer in terms of number of cases (437,000 or 5.4% of new cancer cases) It is the fourth most significant in terms of mortality (427,000 deaths or 8.2% of the total) The small difference in incidence and mortality reflects the extremely poor prognosis of primary liver cancer D.Parkin et al, CA Cancer J.Clin 1999: 49(1) 33-64 

  6. Primary Liver Cancer Types of primary liver cancer: • hepatocellular carcinoma (HCC) • cholangiocarcinoma • haemangioendothelioma • haemangioblastoma • angiosarcoma • primary sarcoma HCC is the most common primary malignancy of the liver (85%) 

  7. Primary Liver Cancer HCC - Risk factors: • hepatitis virus infections (HBV, HCV) • drugs (mostly alcohol and tobacco) • mycotoxins or phytotoxins • liver diseases • metabolic diseases • chemical agents and inorganic substances • medication • ionizing radiation 

  8. Primary Liver Cancer HCC - Symptoms: HCC develops without subjective complaints and is therefore usually detected (too) late! Complains - if any - are very varied: • pain in the upper abdomen • bloating, flatulence • anorexia, nausea • weight loss • fatigue, weakness • stool irregularities 

  9. Primary Liver Cancer HCC - Clinical findings: • fever • subicterus • ascites • latent encephalopathy • arterial murmur • tenderness upon pressure • palpable tumour • perihepatic friction 

  10. Primary Liver Cancer HCC - Diagnosis: • laboratory findings (incl. alpha-fetoprotein=AFP) • sonography • computer tomography • percutaneous fine-needle biopsy (FNB) • laparoscopy 

  11. Primary Liver Cancer HCC - Diagnosis – Computer Tomography (CT): 

  12. Primary Liver Cancer HCC - Diagnosis - Laparoscopy: 

  13. Primary Liver Cancer HCC - Prognosis: The prognosis is determined by the tumour mass and its speed of growth at the time of diagnosis. Signs of poor prognosis are: • considerable size of tumour (>5cm) • infiltrative growth • multilocular growth • metastatic spread 

  14. Primary Liver Cancer HCC - Prognosis: The natural course of disease shows an average survival rate of 5 months (2-8 months). Some 3% of patients survive for 5 years 

  15. Liver Cancer TNM staging of primary liver cancer: T0 Disease free T1 <2cm, no vascular invasion T2 <2cm, vascular invasion or: >2cm, no vascular invasion T3 >2cm with vascular invasion or: multiple lesions T4 multiple lobes, macrovascular invasion N0 no regional lymph node involvement N1 regional lymph node involvement M0 no metastasis M1 metastasis 

  16. Primary Liver Cancer HCC – Staging: stage 1: 0 points, stage 2: 1-2 points, stage 3: 3-4 points K.Okuda et al., 1993 

  17. Primary Liver Cancer HCC - Complications: • acute liver failure • portal hypertension The cause of death is anorexia with tumour cachexia, accompanied by signs of circulatory and renal failure. Occasionally there is intraperitoneal hemorrhage and a tumour rupture with formation of hemorrhagic ascites 

  18. Liver Cancer Primary Liver Cancer Secondary Liver Cancer Hepatic neuroendocrine metastasis 

  19. Secondary Liver Cancer Many Patients with cancer will develop hepatic metastases Liver metastases develops via the portal vein, via the hepatic artery or via lymphatic permeation. In many cases there will be widespread dissemination and liver involvement will not be a separate medical problem 

  20. Secondary Liver Cancer If the metastases are widespread the expectation of life is only 2-3 months Metastatic carcinoid tumours may be very slow growing, and in this disease hepatic metastases are compatible with survival of 3-5 years 

  21. Secondary Liver Cancer Blood circulation 

  22. Secondary Liver Cancer Most common ‘feeding’ primary tumours breast lung melanoma colorectal Only portal hepatic metastases have a low probability of extrahepatic disease 

  23. Secondary Liver Cancer Hepatic colorectal metastasis Approximately 160,000 new cases of colorectal cancer (CRC) are diagnosed each year in the United States Approximately 62,000 deaths are expected due to colorectal cancer (CRC) in 2006 (US) 

  24. Secondary Liver Cancer Hepatic colorectal metastasis 50% of patients in whom the primary tumour drains into the portal vein will develop hepatic metastases! 50 50 

  25. Secondary Liver Cancer metastases cancer umbilicus 

  26. Secondary Liver Cancer

  27. At the time of diagnosis most patients have multiple nodes in both lobes Secondary Liver Cancer Number of nodes / lobes affected A solitary node is found in some 10% of patients at the time of diagnosis In 15-20% of cases only one lobe is effected 

  28. Secondary Liver Cancer Symptoms: • increasing malaise • feeling of weakness • febrile attacks • upper abdominal pain • anorexia • weight loss But: Metastases are characteristically asymptomatic. 

  29. Secondary Liver Cancer Clinical findings: • hepatomegaly (liver growth) • hardening of the liver • occasional palpability of tumour nodes • occasional ascites • occasional thrombosis of the portal vein • occasional swelling of the lymph nodes 

  30. Secondary Liver Cancer Diagnosis: • biochemistry: rise in γ-GT is characteristic • tumour markers • sonography • computer tomography (CT) • MRI • explorative laparoscopy • fine needle biopsy (FNB) 

  31. Secondary Liver Cancer Laboratory findings: 

  32. Secondary Liver Cancer Prognosis (CRC-Metastasis): The natural course of disease shows an average survival rate of 3-10 months In almost all cases the patients die because of their metastatic liver disease The 5-year survival rate is 2% to 8% 

  33. Liver Cancer Primary Liver Cancer Secondary Liver Cancer Hepatic neuroendocrine metastasis 

  34. Secondary Liver Cancer Hepatic neuroendocrine metastasis: Neuroendocrine tumours (NET) are rare tumours arising from cells within the gastrointestinal mucosa and pancreatic islet that normally secret regulatory hormones Up to 93% of patients with neuroendocrine tumours develop liver metastasis. A mean survival up to 8.1 years has been reported 

  35. Liver Cancer Primary Liver Cancer Secondary Liver Cancer Hepatic neuroendocrine metastasis 

  36. Liver Cancer What is most important to remember? HCC – Incidence and Prognosis CRC – Liver Metastasis NET 

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