SOL Liver Management, a comprehensive medical lecture.pptx

SOL Liver Management

1. SOL Liver Management

2. Space Occupying Lesions in Liver These are abnormal growths that occur in liver. They maybe benign or malignant. They may be simple cyst, solid mass or heterogeneous mass.

3. Sign and Symptoms Asymptomatic Abdominal pain Fatigue Feeling full after eating food Loss of appetite Jaundice Abdominal mass

4. Diagnosis History and clinical exam Abdominal imaging such as U/s, CT or MRI, nuclear scan. Tumor markers such as AFP Biopsy FNAC, Needle biopsy, laparoscopic assissted biopsy, open biopsy

5. Treatment Treatment of liver lesions depends on: Nature of the lesions: Whether it is benign or malignant The size of lesions and its pressure effect, Condition of the liver whether healthy or diseased. Liver function Tumor multicentricity

6. Treatment of benign liver lesions If the lesion is small and benign and don’t cause symptoms , no treatment is needed. Eg. Haemingioma Benign inflammatory lesion or abscess need appropriate treatment eg ID or excision Hydatid cyst and benign liver cysts also need appropriate treatment If the lesions is large, cause symptoms or it is malignant, it always need treatment There are several options for treatment.

7. Ablation Ablation destroy the liver lesions with heat or chemicals. This works best in small lesions. Radiofrequency ablation, using single electrode inserted into the tumor under radiological guidance. It takes more time to preform but may case complete tumor necrosis. The approaches are more attractive, particularly in patients in whom surgery is inappropriate

8. Percutaneous therapy Percutaneous ethanol inject into tumor under U/S guidance for tumors of 3cm or smaller Its efficacy rate / cure rate is 80%

9. Hepatic resection This is treatment of choice for non-cirrhotic patients. Tumor is surgically removed. The 5 year survival in this group is about 50%. Few patients with small tumors and good liver function are suitable for resection.

10. Liver Transplantation This usually done on cirrhotic liver and removing the risk of a second, de novo tumor in high risk patients. The 5 year survival rate following transplantation is 75% for patients with single tumor less than 5cm or three tumors smaller than 3cm. Unfortunately, in hepatitis C may recover in transplanted liver and can results in recurrent cirrhosis giving rise to de novo HCC risk.

11. Trans arterial chemo-embolization Hepatic artery embolization with Gelfoam and doxorubicin is more effective with survival rate of 60% in cirrhotic patients. Survival benefit is lost at 4 years. TACE is contraindicated in decompensated cirrhosis and multifocal HCC. PACE is now most frequent used as first interventional while the tumor is being assessed and definitive management planned is being developed.

12. Chemotherapy The response rate to chemotherapy with drugs is only 30%. Sorafenib improve survival of few months in cirrhotic patients. The drug is multikinase inhibitor with activity against RAF, vascular endothelial growth factor (VEGF) and platelet derived growth factor(PDGF). It is the first systemic therapy to prolong survival in HCC.

13. Suppurative care In terminal stage of HCC best supportive care is given. Survival rate become less than 3 months.