Hepatocellular Carcinoma HCC By Faiza Asghar Cancer Mutation

“Hepatocellular Carcinoma” (HCC) By Faiza Asghar

Cancer Mutation Un - controlled cellular growth Tumor!! Benign Tumors Malignant

Cancer in Progress…

Liver Cancer Benign Cholangio carcinoma Malignant Primary e. g. Secondary 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. 6 th most common cancer in the world. 5 th most common disease in men. 8 th most common disease in women. HCC rate in Pak. is 2. 69%/Yr.

Etiology

Disease Mechanism Mutation 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, m. TOR 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… α 1 -antitrypsin deficiency. Lower expression of p 27 kip 1 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. Anorexia Hepatomegaly 5. Jaundice

Continued… 8. 9. 6. Abdominal Pain Fatigue 7. Nausea Abdominal Fluid (Ascites)

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

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

Clinical Treatment i. iii. Tumor ablation. RFA Ethanol injection Cryotherapy etc. TACE. Partial hepactomy. Endoscopic palliation. Liver transplant.

Cryotherap y Chemoembolization RFA

Prevention Vaccination against HBV & HCV. Regular screening. Balanced diet. Regular exercise. No alcohol. No food storage!

Bio. Tech Services. . . Ongoing Research for R 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.