Hepatocellular Carcinoma
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
There is a dilemma when patients present with large hepatocellular carcinoma and liver cirrhosis. However, liver resection is the most suitable treatment for patients with single hepatocellular carcinoma, even if the tumor size is over 10 cm in diameter. Makuuchi proposed that normal serum bilirubin levels and a normal indocyanine green retention rate at 15 minutes (ICG R-15) are required for major hepatectomy by his criteria. However, abnormal ICG-R15 is often noted in patients with hepatocellular carcinoma and liver cirrhosis. This chapter shows an attractive and practical procedure which could predict future remnant liver function. The allowable liver resection volume could be predicted by Takasaki’s log table with ICG-R15. ICG-R15 and liver volumetry on three-dimensional computed tomography are keys for success when planning major liver surgery, even if the liver is cirrhotic.
Hepatocellular Carcinoma
Pat Price, Karol Sikora in Treatment of Cancer, 2020
This chapter discusses the etiological factors and the clinicopathological features of Hepatocellular Carcinoma (HCC) and describes therapeutic options, grouped broadly into surgery, loco-regional treatments, and systemic therapies. Knowledge of risk factors for HCC development provides opportunities for interventional strategies that may reduce incidence and to identify high-risk populations who may be suitable for screening programs. HCC is increasingly diagnosed pre-symptomatically by screening patients with cirrhosis using serial ultrasound examinations and/or estimations of alpha-fetoprotein. Symptomatic HCC is usually rapidly fatal and untreated patients typically die within 12 months of the onset of symptoms. Prognostic models for HCC are therefore complex and should take into account tumor stage, degree of liver impairment, patient fitness, and treatment efficacy. Endocrine manipulation has been studied in advanced HCC based on reports of estrogen receptor expression in some HCCs. HCC possesses characteristics that render it a good target for immunotherapy.
Hepatocellular Carcinoma
Victor A. Bernstam in Pocket Guide to GENE LEVEL DIAGNOSTICS in Clinical Practice, 2019
The earliest morphological events produced in the liver of rats in the course of chemically induced carcinogenesis are the appearance of enzyme-altered foci and altered hepatic foci, marked by enzyme elevations. In hepatoblastomas, malignant hepatic tumors of childhood, the pattern of chromosomal aberrations is similar to that observed in pediatric embryonal rhabdomyosarcomas, suggesting a certain parallelism in the genetic pathways. The potential mechanisms of hepatocarcinogenesis related to hepatitis B virus (HBV) infection range from the predisposition to malignancy associated with cirrhosis to integration of HBV deoxyribonucleic acid leading to dramatic changes in hepatocyte gene expression. The larger the tumor, the lower the percentage of diploid cells detected in Hepatocellular Carcinoma (HCC). The relative risk of developing HCC in carriers has been estimated to be over 200-fold compared to noncarrier control populations. Loss of heterozygosity has frequently been observed on chromosome 4, 11p, 13q, and 17q.
Effects of microwave ablation on T-cell subsets and cytokines of patients with hepatocellular carcinoma
Published in Minimally Invasive Therapy & Allied Technologies, 2017
Haiwen Zhang, Xiaowei Hou, Hongjian Cai, Xingjun Zhuang
Objectives: To investigate the effects of microwave ablation on T-lymphocyte subsets and cytokines in patients with hepatocellular carcinoma. Material and methods: Peripheral blood was collected from 45 patients with hepatocellular carcinoma treated by microwave ablation before treatment, one week and one month after treatment. T cells (CD3+, CD4+ and CD8+ cells), CD4+ CD25+ Tregs, and CD16+ CD56+ NK cells were analyzed by flow cytometry. Levels of cytokines (IL-2, IFN-γ, TNF-α, IL-12, IL-4, IL-6, IL-8, and IL-10) were determined by a Luminex 200 analyzer. Results: Compared with before treatment, CD3+ cells, CD4+ cells and IL-12 increased significantly at one month after the microwave ablation treatment, while IL-4, IL-10 decreased significantly. Conclusions: Microwave ablation could relieve the suppression of immune function caused by tumors, promote the deviation of Th2/Th1, and improve immune dysfunction in patients with hepatocellular carcinoma.
Combined approach to hepatocellular carcinoma: a new treatment concept for nonresectable disease
Published in Expert Review of Anticancer Therapy, 2008
Bruno M Strebel, Jean-François Dufour
Depending on tumor burden, hepatic function and patients’ performance status, hepatocellular carcinoma is treated by surgery, local procedures, systemic therapy or palliation. The majority of patients are diagnosed at a stage where local therapy is the treatment of choice. Recently, the multikinase inhibitor sorafenib was found to improve the survival of patients with advanced hepatocellular carcinoma and conserved liver function. In this manuscript, we summarize the experimental evidence supporting the combination of a systemic targeted therapy with a local therapy. We also discuss the pros and cons of different schedules of combining such treatments. We conclude that there is enough of a theoretical argument to design clinical trials testing this strategy.
MEK 1/2 inhibitors in the treatment of hepatocellular carcinoma
Published in Expert Review of Gastroenterology & Hepatology, 2015
Antonio Facciorusso, Raffaele Licinio, Brian I Carr, Alfredo Di Leo, Michele Barone
Sorafenib is the only approved systemic treatment for advanced hepatocellular carcinoma patients and all the recently published randomized controlled trials on new systemic drugs have been unsuccessful. This is likely due to a lack of understanding of tumor progression, molecular drivers, and liver toxicity, as well as flaws in trial design. An important signaling pathway in hepatocarcinogenesis is the MEK cascade involved in various cellular responses, including adaptation and survival. A key role in this cascade is played by MEK, of which MEK 1/2 represent the prototypes and an interesting target for new oncological drugs. This review analyzes recent developments and future perspectives on the role of MEK inhibitors in hepatocellular carcinoma treatment.