tailieunhanh - Ebook Pocket oncology (2/E): Part 2

Part 2 book “Pocket oncology” has contents: Gastrointestinal malignancies, endocrine malignancies, gynecologic malignancies, breast cancer, neurologic oncology, cancer of unknown primary, plasma cell disorders, myeloproliferative disorders, leukemias and myelodysplastic syndromes, stem cell transplantation, and other contents. | Hepatocellular Carcinoma (HCC) IMANE EL DIKA • GHASSAN ABOU-ALFA Epidemiology 6th most common CA worldwide (626,000/y) & 2nd leading cause of worldwide CA mortality (598,000/y) >80% cases of HCC occur in sub-Saharan Africa, eastern & southeastern Asia, & parts of Oceania including Papua New Guinea 9th leading cause of CA mortality in US Recent ↑ in the incidence of HCC () & HCC-related mortality in US Risk Factors Viral hepatitis: HBV & HCV are the leading RFs for HCC & accounts for 75% cases worldwide; HCV infxn is predominant in Europe, North America, & Japan, HBV in Asia & Africa (Gastroenterology 2012:142:1264) While HCV is now the leading cause of HCC in the US, NASH is expected to become a risk factor of increasing importance in the next decade (Gastrointest Cancer Res 2008;2:64) Acquired RFs: Excessive EtOH → alcoholic cirrhosis (1/3 of cases of HCC in US), environmental exposure to aflatoxin from Aspergillus fungus, tobacco, autoimmune hepatitis Metabolic disorders: Metabolic syn, DM, NASH, hereditary hemochromatosis (mts in HFE gene) & other rare metabolic disorders Screening and Prevention Screening w/ ultrasonography & AFP testing every 6–12 mos recommended for pts w/ HBV & HCV who are at risk for HCC Additional imaging (at least 3-phase contrast-enhanced CT or MRI) in setting of rising serum AFP or identification of liver mass on US A marked advance was made w/ the approval of new effective antiHCV Rx (sofosbuvir, ledipasvir) w/ cure rates exceeding 90%, & expected decrease in HCC risk With the universal application of HBV vaccination, decrease in HCC incidence is expected among cohorts born after 1960 (JCO 2016;34:1787) Pathophysiology Hepatocarcinogenesis begins w/ an acute or chronic insult to hepatocytes → induces liver remodeling that results in liver cirrhosis or fibrosis → stepwise accumulation of genetic & molecular aberrations; up to 20% of HCC cases develop in pts w/o cirrhosis HBV-induced hepatocarcinogenesis may occur through .