LIVER MALIGNANCY power point presentation

PPT on Liver malignancy

1. LIVER MALIGNANCY

2. 6-7% OF ALL MALIGNANCIES 3RD MOST COMMON CAUSE OF CANCER RELATED DEATH 90% OF THE LIVER TUMORS ARE PRIMARY HEPATOCELLULAR CARCINOMA. HCC- Malignant neoplasm of the liver that arise from parenchymal cells. M: F -2.5 INCIDENCE

3. PRIMARY HEPATOCELLULAR CARCINOMAL FIBROLAMELLAR HCC - RARE CHOLANGIO CARCINOMA- ductular cells ANGIO SARCOMA LYMPHOMAS SECONDARY CARCINOIDS GIST COLO RECTAL METASTASIS METASTASIS FROM OTHER ORGANS – RENAL, BREAST, GASTRIC, LUNG

4. INDICATIONS FOR LIVER BIOSPY Absence of cirrhosis. Radiological criteria are not meeting the requirements for the diagnostic criteria for HCC. STAINS: Glypican 3,Glutamine synthetase ,Heat shock protein70

5. TREATMENT STRATEGIES: SURGICAL TREATMENT RADIOFREQUENCY ABLATION CHEMOEMBOLISATION LIVER TRANSPLANTATION SYSTEMIC TREATMENT

6. TACE - injection of Doxorubicin or cisplatin via hepatic artery. complications: liver abscess liver failure systemic embolisation.

7. SYSTEMIC THERAPHY MOLECULAR TARGETED THERAPHY: SORAFENIB DURATION- 6 MONTHS 800MG/DAY Multikinase inhibitor of VEGFR levantinib regorafenib

8. immune checkpoint inhibitors:

9. VEGFR ANTIBODIES BEVACIZUMAB Advanced HCC- Atezolizumab +Bevacizumb combination.

10. INTRA HEPATIC CHOLANGIO CARCINOMA 5-30% OF PRIMARY TUMOUR 0.5 -2/100000 – WEST CLONORCHIS SINENSIS THREE SUBTYPES INFILTRATING PERIDUCTAL MASS FORMING INTRA DUCTAL

11. PROGNOSIS VASCULAR INVASION, NODAL STATUS, LOCAL EXTENSION,MULTIPLICITY, PERIDUCTAL INFILTRATION DIAGNOSIS USG, MRCP ERCP – BRUSH BIOPSY PET-CT TREATEMENT MOSTLY PALLIATIVE RESECTION IF POSSIBLE

12. Indication Disease free liver with clear surgical margin. Post operative 25% of FLR Treatment options Sequential, delayed resection - Standard Simultaneous resection strategy Liver first approach Follow up – Yearly PET CT for 5 years COLORECTAL METASTASIS

13. CONSERVATIVE PALLIATIVE RESECTION OTHER METS

14. MC PRIMARY – HCC RISK FACTORS – INFECTION/ CIRRHOSIS STAGING – BCLC PREVENTION IS BETTER MANAGEMENT – TRIPLE PHASE CT ABDOMEN & MRI RESECTION ON ANATOMICAL SEGMENTS LIVER TRANSPLANTATION OTHER MODALITIES TACER SORAFENIB RFA SUMMARY

15. THANK YOU