a12. Hepatoma (HCC)
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Transcript of a12. Hepatoma (HCC)
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ANATOMI HATI
T.D. 2 LOBUS : KANAN & KIRI.
LOBUS KIRI SEG. LATERAL .SEG. MEDIAL .
BATAS LIG . FALSIFORMIS.
LOBUS KANAN SEG. ANTERIOR .SEG. POSTERIOR.
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This is the external surface of a normal liver.
The color is brown and the surface is smooth.
A normal liver is about 1200 to 1600 grams.
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Surgical Treatment of HCC Budi Irwan 5
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METABOLISME GARAM EMPEDU,PIGMENEMPEDU
METABOLISME KARBOHIDRAT
PEMBENTUKAN UREA,PENYIMPANAN
PROTEIN(ASAMAMINO),METABOLISME
LEMAK,KETOGENESIS SINTESIS
KOLESTEROL,DAN PENIMBUNAN LEMAK
PENIMBUNAN VITAMIN DAN MINERAL METABOLISME STEROID
DETOKSIFIKASI
GUDANG DARAH DAN FILTRASI
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KHS (KARSINOMA
HEPATOSELULAR),HEPATOMA PRIMER DR
SEL HEPATOSIT
KARSINOMA
KOLANGIOSELULAR,HEPATOMA PRIMER
YANG BERASAL DARI EPITEL SALURAN
EMPEDU INTRAHEPATIK KARSINOMA CAMPURA HEPATOSELULAR
DAN KOLANGIOSELULAR
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TIPE MASSIF,PD SATU LOBUS DAN HANYA
SATU NODUL SAJA
TIPE NODULER,PALING SERING
DIJUMPAI,HATI MEMBESAR,NODUL YG
BANYAK (IRREGULER)
TIPE DIFFUS,UMUMNYA SEL HATI MASIH
DALAM BATAS NORMAL TETAPI TERISI OLEHSEL KARSINOMA YG DIFFUS
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TUMOR HATI PRIMER ( HEPATO CELLULAR
CARCINOMA ) AS, JARANG DISTRIBUSI DENGAN ANGKA KEJADIAN
TERTINGGI DI ASIA TIMUR,SUB SAHARA
AFRIKA DAN MELANESIA,
JARANG DITEMUKAN PADA USIA MUDA
INSIDENS MENINGKAT PADA USIS TUA
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Hepatocellular carcinoma (HCC) a primarymalignancy of the liver, hepatocellularorigin HCC is a major cause of death from cancerin Eastern Asia and sub-Saharan Africa HCC causes 662,000 deaths per year,about half of them in China. Males >> females Age of 30 to 50.
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HBV
70-90% of chronic cases in cirrhosis Treatment decrease risk
HCV 1-3% of HCV develop HCC
Treatment decrease risk Co-infection Aflatoxins (Aspergillus fumigatus)
4 fold increased risk HCC
Alcohol >50-70g/day Synergist with HCV and HBV
Nonalcoholic Steatohepatitis?
El-Serag, H.B. and K.L. Rudolph, Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology, 2007. 132(7): p. 2557-76.Brunetto M.R., O.F., Koehler M., et al., Effect of interferon-alpha on progression of cirrhosis to hepatocellular carcinoma: a retrospective cohort study.
International Interferon-alpha Hepatocellular Carcinoma Study Group. Lancet, 1998. 351(9115): p. 1535-9.
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Obesity
Diabetes Mellitus
Hemochromatosis Alpha-1 antitrypsin deficiency
Autoimmune hepatitis
15-50% of HCC in the US have noestablished risk factors
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15/43Thorgeirsson, S.S. and J.W. Grisham, Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet, 2002. 31(
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HCC with cholangiolar features, moderately
differentiated
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Hepatic Fibrosis
Cirrhosis Liver Cancer
Healthy Liver
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Hepatic Fibrosis
Cirrhosis Liver Cancer
Healthy Liver
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KANKER HATI
20% infeksi kronis 80%Infeksi HCV: kronis
berakhir dengan sirosis
25% sirosis berakhir
dengan kanker hatiatau gagal hati
Kelompok Risiko Tinggi HCV:
Pengguna Narkoba Suntik
Penerima Transfusi
Pasien terpapar alat medis
yang tak steril
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Here is another example of macronodular cirrhosis. Viral hepatitis (B or
C) is the most common cause for macronodular cirrhosis. Wilson's
disease and alpha-1-antitrypsin deficiency also can produce a
macronodular cirrhosis.
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METASTASE TUMOR HATI DIAFRAGMA PERI PORTAL LIMPH NODE
PARU - PARU
TULANG
ADRENAL
OTAK
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D/ SUBKLINIS HEPATOMA,STAD.DINI,TANPA
GEJALA DAN TANDA FISIK YG JELAS
D/NON INVASIF
D/PATOLOGIS
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1. Clinis2. Imaging3. Blood level of alphafetoprotein4. Needle biopsy
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RIWAYAT ALKOHOL ATAU SIROSIS
RASA SAKIT ATAU TIDAK ENAK
TERABA MASSA
BERAT BADAN MENURUN
ASITES
JAUNDICE
ANOREKSIA,PERUT GEMBUNG
LETIH,BERAT BADAN MENURUN,
PERDARAHAN
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DIAGNOSA
AFP MENINGGI 50 90 % . TUMOR KECIL BISA NORMAL / SDKT . AFP JUGA BISA ME PADA SIROSIS HATI .
TIDAK BERMAKNA.
MONITOR KEBERHASILAN RESEKSI
KURATIF.AFP
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PARA NEOPLASTIC COMPLIKASI :HIPOGLISEMIA
HIPERKALSEMIA
ERITROSITOSIS
HIPERTROFI PULMONARI
OSTEOARTROPATI
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CT Scan MRI Preferred USG Nuclear Medicine Angiography Less usefull Plain film
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BIOPSI
USG . STAGING .
STAGING SYSTEM HCC ( AJCC )
KLASIFIKASI TNM
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TNM SISTEM,OKUDA,MORPHOLOGY,MET,VI
OKUDA SISTEM, BILLIRUBIN,ALB,ASC
CLIP (CANCER OF THE LIVER ITALIAN
PROGRAM),CHILD PUGH
JIS SCORE (JAPAN INTEGRATED STAGING)
BCLC(BARCELONA CLINIC LIVER CANCER)
,CHILD PUGH,PH,BILLIRUBIN
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STAGE GROUP
- STAGE I T 1 N0 M0
- STAGE II T2 N0 M0
- STAGE III T3 N0 M0
T 1-3 N1 M0
- STAGE IVa T4 Any N M0
- STAGE IVb Any T Any N M1
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PENATALAKSANAAN :
TERAPI DEFINITIF
OPERASI
HANYA 10 30 % MASIH OPERABLE HANYA 50 70 % YANG CURATIVE
KRITERIA NON OPERATIF :
ADA PENYAKIT EKTRA HEPATIK
GANGGUAN FUNGSI HATI BERAT MASA TUMOR YANG MASIF
V. PORTA ATAU V. CAVA SUDAH TERLIBAT
KONTRA INDIKASI RELATIF
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HEMANGIOMA
ABSESS HEPAR
TUMOR METASTASE
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TERAPI OPERASI
RESEKSI
TRANSPLANTASI HATI
TERAPI NON OPERATIP
RFA (RADIO FREKWENSI ABALATIO) INJ.ETANOL MRNI (95%),INTRA TUMOR
PERKUTANTAS
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KEMOEMBOLISASI ARTERI HEPATIK
PERKUTANERAPI OPERASI
KEMOTERAPI SISTEMIK
RADIOTERAPI
TAMOXIPEN
INJ.ASAM ASETAT PERKUTAN
SORAFENIF (95%)
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Treatment modality
1. Livertransplantation
2. Hepatic resection3. Thermal ablation
(Radiofrequency,microwave,la
ser)
4. Cryotherapy
Limitations
1.Donor avaibility, Three orfewer lesions, none > 3 cm ,
Solitary lesion < 5 cm2.Minimal or no cirrhosis, threeor fewer lesions
3.Three or fewer lesions, each