Hepatocellular carcinoma
This liver cancer is often
associated with acute hepatitis C, which turned into chronic hepatitis, itself
followed by cirrhosis.
The time to onset of cirrhosis after
the initial infection with hepatitis C is approximately 20 years and the
occurrence of hepatocellular carcinoma 30 years.
This cancer most often develops in a
macro become dysplastic nodule regeneration (see dysplasia)
The occurrence of breast cancer is
more common in these parameters
Age over 50 years
seniority of cirrhosis
male
presence of esophageal varices
prothrombin time decreased
alpha-fetoprotein increased
presence of antibodies to hepatitis
C virus
Drinking more than 50 grams per day.
SYMPTOMS
Often discovered incidentally during
a routine ultrasound examination in a patient with cirrhosis patient, but
sometimes related to:
- A decline in general health
- Abdominal pain
- Ascites
- Gastrointestinal bleeding
- Compressive jaundice biliary
DIAGNOSIS
It will be confirmed by imaging
quality.
Especially when the discovery of a
lesion with a diameter of over 20 mm with arterial vascularization.
Hyper above 400 ng / ml
alpha-fetoprotein.
Biopsy may be necessary in case of a
nodule size of less than 15 to 20 mm.
Ultrasound examination at three and
six month intervals recording an increase in nodule can confirm the diagnosis
sometimes avoiding biopsy.
Nevertheless, this confirmatory
diagnosis is sometimes difficult to ascertain.
Repeat examinations becoming
indispensable.
TREATMENT
A curative treatment is possible in
about 10% of cases.
Liver transplantation is the best
solution.
By restriction of indications,
excluding patients with more than three tumors larger than three centimeters or
more of a single tumor five centimeters, as well as patients with portal
thrombosis (clot in the vein door) prognosis has improved considerably.
The recurrence rate is less than 15%
and the overall five-year survival is around 70%.
These criteria still need to be
checked because some patients carrying more bulky tumor were grafted had a
satisfactory long-term survival.
The variables to be disease-free
survival.
The cause of hepatocellular
carcinoma:
- The presence of cirrhosis.
- The rate of alpha-feto-protein.
- The rate of gamma-GT.
- The number of cancerous nodules.
The maximum diameter of the largest
nodule.
uni or bipolar location (one lobe of
the liver with s or more).
The histological differentiation of
the tumor.
Studies are continuing to refine the
indications and contraindications.
Surgical resection may be considered
in case of lack of graft, but the operative mortality remains relatively high
and frequent recurrences.
Finally, it is sometimes possible to
consider percutaneous destruction by alcohol or RFID (see this term).
After curative treatment is
meticulous monitoring (ultrasound, MRI, serum alpha-fetoprotein).
Trials are underway to try to reduce
the frequency of relapses (alpha interferon, intra-arterial radioactive lipiodol,
or polyprénoïque acid).
If this advanced carcinoma, it may
be permissible to consider treatment with tamoxifen, androgens, adriamycin, and
cisplatin has.
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