“Hepatocellular Carcinoma” (HCC)

By

Faiza Asghar

Cancer Mutation Un - controlled cellular growth

Tumor!!

BenignTumors Malignant

Cancer in Progress…

Liver Cancer

Benign Malignant

Primarye.g.

Secondary

Cholangiocarcinoma

Hepatocellular carcinoma Angiosarcoma

Etymology Chronic, primary liver cancer.

Starts in hepatocytes.

Metastatic; spreads through blood stream and lymphatic system.

More frequent in men especially, in cirrhotic patients.

Statistics Common in Asia, China, Japan, U.S., Africa, Latin

America, and Eastern European countries.

6th most common cancer in the world.

5th most common disease in men.

8th most common disease in women.

HCC rate in Pak. is2.69%/Yr.

Etiology

Disease MechanismMutation inactivation of tumor repressor genes and

cell cycle regulators activation of oncogenic pathways.

Two steps:1. Activation of specific pathways triggering

proliferation of cancer e.g. EGFR, IGF, MAP kinase, Wnt, mTOR etc.

2. Activation of generic mechanisms involved in all types of cancers e.g. VEGFR, Insensitivity of apoptosis, Inactivation of cell cycle check points, Preserving unlimited replicative potential.

Mol. Biology involved…

α1 -antitrypsin deficiency.

Lower expression of p27kip1 protein.

Integration of viral proteins (HBV, HCV).

Telomerase is active in 90% of human HCC. It appears to be necessary for the immortal proliferation capacity of HCCs.

Research still going on…

Symptoms

1.Weight loss.2.High level of AFP & ALP.3. 4. 5.

Anorexia HepatomegalyJaundice

Continued… 6.

8.9.

7.

Abdominal Fluid

(Ascites)

Nausea

Abdominal Pain

Fatigue

Diagnosis

Full physical exam. Ultrasonography. M.R.I.C.T scans etc.

M.R.I

CT Scan

Continued…Biopsy.L.F.T. A.F.P serology.

BiopsyL.F.T

Clinical Treatment Tumor ablation.i. RFAii. Ethanol injectioniii. Cryotherapy etc.

TACE. Partial hepactomy. Endoscopic palliation. Liver transplant.

Cryotherapy

Chemo-embolizatio

n

RFA

Prevention

Vaccination against HBV & HCV.

Regular screening.Balanced diet.Regular exercise.No alcohol.No food storage!

BioTech Services... Ongoing Research for Molecularly targetted drugs. e.g. Sorafenib,

Nexavar. DNA microarray to determine recurrence %age in

future. Telomerase inhibition to impair proliferation or using it

as an anticancer agent. Development of new markers to improve screening

for early lesions. Antibody treatment against HCC surface markers

have been reported to lower recurrence rates after liver transplantation.

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