24- Hepatobiliary Explains Flashcards
What is the global ranking of hepatocellular carcinoma as a cause of cancer deaths?
Hepatocellular carcinoma is the second leading cause of cancer deaths globally.
What is the survival rate for hepatocellular carcinoma?
Unfortunately, the incidence of hepatocellular carcinoma approximates the death rate, resulting in few long-term survivors.
How many cases of hepatocellular carcinoma are reported annually?
Up to 750,000 cases of hepatocellular carcinoma are reported annually.
Who is at the highest risk for developing hepatocellular carcinoma?
Hepatocellular carcinoma occurs most commonly in individuals with chronic hepatitis and established liver cirrhosis.
What is a recognized risk factor for hepatocellular carcinoma in an otherwise healthy liver?
The presence of adenomas in an otherwise healthy liver is a recognized risk factor for hepatocellular carcinoma.
How should individuals with chronic hepatitis and liver cirrhosis be screened for hepatocellular carcinoma?
Individuals with chronic hepatitis and liver cirrhosis should be closely screened for the development of hepatocellular carcinoma with serum AFP testing and liver ultrasound every 6-12 months.
What are the diagnostic criteria for hepatocellular carcinoma?
Rising AFP levels and a liver ultrasound showing a nodule greater than 1cm in diameter make hepatocellular carcinoma much more likely, and further evaluation with MRI scanning is recommended.
What is the Barcelona Clinic Liver Classification used for?
The Barcelona Clinic Liver Classification system is used to categorize the extent of the disease, guide treatment decisions, and predict prognosis for hepatocellular carcinoma.
What are the key factors to consider when determining the ideal treatment for hepatocellular carcinoma?
When determining the ideal treatment modality for hepatocellular carcinoma, the key factors to consider are disease extent, functional state of the liver, and overall patient condition.
What is the aim in diagnosing hepatocellular carcinoma?
The aim is to avoid unnecessary percutaneous biopsy. Radiologically, on CT, the classical feature of hepatocellular carcinoma is a suspicious lesion that is highlighted during the arterial phase with washout during the venous phase, reflecting the hypervascularity of the lesions.
What are the features and treatment options for Stage 0 hepatocellular carcinoma?
Features: Single lesion (less than 2cm), normal portal pressures. Treatment: Resection (40-70% survival).
What are the features and treatment options for Stage A hepatocellular carcinoma?
Features: Single nodule greater than 3cm or multiple nodules (no more than 3), Child Pugh A/B. Treatment: Radiofrequency ablation if associated disease, transplantation if no associated disease (up to 70% survival in some cases).
What are the features and treatment options for Stage B hepatocellular carcinoma?
Features: Multiple nodules, Child Pugh A/B. Treatment: Transarterial chemoembolization (usually with doxorubicin) (26% survival at 3 years).
What are the features and treatment options for Stage C hepatocellular carcinoma?
Features: Advanced tumors, invasion of portal vein, Child Pugh A/B. Treatment: Sorafenib (usually survive 10.7 months).
What are the features and treatment options for Stage D hepatocellular carcinoma?
Features: Child Pugh stage C, advanced tumors. Treatment: Best supportive care (less than 6 months survival).
What are the recommended treatment options for hepatocellular carcinoma in selected patients?
In selected patients, the best outcomes are achieved with surgical resection or transplantation (when surgical resection is not possible). Anatomical resections with minimum 2cm margins provide the best outcomes.
What is the role of adjuvant chemotherapy in hepatocellular carcinoma treatment?
At present, there is no evidence to recommend treatment with adjuvant chemotherapy.
What is sorafenib and what is its role in hepatocellular carcinoma treatment?
Sorafenib is an oral multi-tyrosine kinase inhibitor. It is the only drug currently demonstrated to extend survival in individuals with advanced hepatocellular cancer. It improves median survival from 7 months to 10 months.
What is the prevalence of gallstones in women and men?
Up to 24% of women and 12% of men may have gallstones.
What percentage of patients who undergo surgery for gallstones will have stones in the common bile duct?
12% of patients who undergo surgery for gallstones will have stones in the common bile duct.
What is the most common composition of gallstones?
The majority of gallstones are of mixed composition (50%), with pure cholesterol stones accounting for 20% of cases.
How does the etiology of common bile duct stones differ between the Western and Eastern parts of the world?
In the West, most common bile duct stones result from migration. In the East, a higher proportion of stones arise de novo in the common bile duct.
What are the classical symptoms of gallstones?
The classical symptoms of gallstones include colicky right upper quadrant pain that occurs after eating.
When are the symptoms of gallstones usually the worst?
The symptoms are usually worst following a fatty meal when cholecystokinin levels are highest and gallbladder contraction is maximal.