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Transcript of AngioDynamics, Inc. Copyright © 2010. All rights reserved.
AngioDynamics, Inc.
www.angiodynamics.comCopyright © 2010. All rights reserved.
Goal and Objectives
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
Colon AnatomyColon Anatomy
Liver AnatomyLiver Anatomy
Hepatocellular Carcinoma Hepatocellular Carcinoma
Metastatic Colorectal CancerMetastatic Colorectal Cancer
TreatmentsTreatments
Anatomy Anatomy
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
Goal and Objectives
Basic InformationBasic Information
Fundamental CausesFundamental Causes
SymptomsSymptoms
PrognosisPrognosis
Hepatocellular Carcinoma Hepatocellular Carcinoma
Metastatic Colorectal CancerMetastatic Colorectal Cancer
TreatmentsTreatments
Anatomy Anatomy
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
The goal of this course is to provide you with a basic understanding of hepatocellular carcinoma (HCC) and
metastatic colorectal cancer (MCRC).
Goal and Objectives
Treatment OptionsTreatment Options
Determining TreatmentDetermining Treatment
Transarterial Chemoembolization Transarterial Chemoembolization
Surgery Surgery
Chemotherapy Chemotherapy
Palliative CarePalliative Care
Tissue AblationTissue Ablation
Hepatocellular Carcinoma Hepatocellular Carcinoma
Metastatic Colorectal CancerMetastatic Colorectal Cancer
TreatmentsTreatments
Anatomy Anatomy
Navigation
• Colon Anatomy• Liver Anatomy
Colon Anatomy
Colon Anatomy Colon Anatomy Colon AnatomyColon Anatomy
Colon Blood SupplyColon Blood Supply
Colon WallsColon Walls
Colon Anatomy
The colon is 150 cm long and divided into the:The colon is 150 cm long and divided into the:
Transverse Colon
Ascending Colon
Cecum
DescendingColon
Sigmoid Colon
Colon Anatomy
Ascending Colon
Ileocecal Valve
Cecum
Colon Blood Supply
Superior Mesenteric Artery
InferiorMesenteric Artery
Splenic Flexure
Ileocecal Valve
Colon Walls
Serosa
Muscularis Propia
Submucosa
Mucosa
Liver Anatomy
Liver Anatomy Liver Anatomy Liver AnatomyLiver Anatomy
Dual Blood SupplyDual Blood Supply
Blood FlowBlood Flow
Biliary TreeBiliary Tree
Liver FunctionsLiver Functions
Common Liver DisordersCommon Liver Disorders
Hepatitis B and Hepatitis CHepatitis B and Hepatitis C
Liver Anatomy
Falciform ligament
Pinkish brown organ in the right upper quadrant of the abdomen
Pinkish brown organ in the right upper quadrant of the abdomen
Largest internal organLargest internal organ
Largest gland; weighs 3 – 4 lbs.Largest gland; weighs 3 – 4 lbs.
Divided into right and left lobes by the falciform ligament
Divided into right and left lobes by the falciform ligament
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Blood Flow
Kupffer cellsKupffer cells
Remove pathogensRemove pathogens
MacrophagesMacrophages
Venous bloodVenous blood
Filters through the endothelial lining to the
hepatocytes
Filters through the endothelial lining to the
hepatocytes
Breaks down and metabolizes toxins
Breaks down and metabolizes toxins
Blood returned to heart from the hepatic vein into the
inferior vena cava
Blood returned to heart from the hepatic vein into the
inferior vena cava
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Liver Functions
Breaks down drugs
Stores and mobilizes
energy
Produces vitamins
Filters blood to eliminate bacteria and toxins
Produces and stores
Iron
Aids digestion by producing bile
Controls blood sugar and regulates fat storage
Regulates blood clotting by
manufacturing blood proteins
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Differences Between Hepatitis B and C
Hepatitis B Hepatitis C
Virus Virus
Acute or chronic condition Chronic condition
Spreads through:– Blood– Semen – Vaginal fluids– Body fluids– Mother to newborn
Blood borne spread:– Hemodialysis patients– Hemophiliacs– IV drug abuse – Blood transfusion prior to 1990– Mother to newborn
25% of children infected die from liver cancer (or failure) as adults
Responsible for 50-76% of all liver cancers, which occur 30-40 years after infection
Vaccination available since 1982– 95% effective– Recommended for all
No vaccine available
The Colon:Is 150 cm longDivided into five
sectionsIncludes the
ileocecal valveIncludes superior
and inferior mesenteric arteries
Has a wall with four layers
The Colon:Is 150 cm longDivided into five
sectionsIncludes the
ileocecal valveIncludes superior
and inferior mesenteric arteries
Has a wall with four layers
Summary
The liver:Is the largest
internal organ and gland
Receives blood from two sources
Filters pathogens out of the blood
Secretes bile via the biliary tree
Has a number of common disorders
The liver:Is the largest
internal organ and gland
Receives blood from two sources
Filters pathogens out of the blood
Secretes bile via the biliary tree
Has a number of common disorders
• Basic Information• Fundamental Causes• Symptoms• Prognosis
HCC Basic Information
Basic Information Basic Information
HCC PreventionHCC Prevention
HCC StatisticsHCC Statistics
HCC DefinedHCC Defined
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HCC Prevention
Hepatitis Prevention Hepatitis Prevention Cirrhosis Prevention Cirrhosis Prevention
Hepatitis B VaccinationHepatitis B Vaccination
Screening donated blood for hepatitis viruses
Screening donated blood for hepatitis viruses
Proper hygieneProper hygiene
Avoiding alcohol abuseAvoiding alcohol abuse
Preventing viral hepatitisPreventing viral hepatitis
Goals Goals
No vaccine exists for Hepatitis CNo vaccine exists for Hepatitis C
HCC Prevention
Hepatitis B or CHepatitis B or C
Non-alcoholic Fatty Liver Disease (NAFLD)
Non-alcoholic Fatty Liver Disease (NAFLD)
Primary Biliary CirrhosisPrimary Biliary Cirrhosis
HemochromatosisHemochromatosis
CirrhosisCirrhosis
Screen high risk patients Screen high risk patients
Reduce obesity and Type II diabetesReduce obesity and Type II diabetes
HCC Defined
InflammationInflammation
NecrosisNecrosis
FibrosisFibrosis
RegenerationRegeneration
Occurs in patients with chronic liver disease and cirrhosis
Occurs in patients with chronic liver disease and cirrhosis
Defined byDefined by
Cancer starts during adulthoodCancer starts during adulthood
Hepatic stem cell thought to be cell origin
Hepatic stem cell thought to be cell origin
HCC Symptoms
Symptoms Symptoms
HCC PresentationHCC Presentation
HCC Growth PatternsHCC Growth Patterns
HCC Clinical PresentationHCC Clinical Presentation
Angiogram showing hypervascular lesions
HCC Growth Patterns
MultifocalMultifocal
Solitary massSolitary mass
DiffuseDiffuse
InfiltrativeInfiltrative
Hypervascular with neovascularity and
arteriovenous shunting
Hypervascular with neovascularity and
arteriovenous shunting
HCC Presentation
Weight lossWeight loss
Right upper quadrant painRight upper quadrant pain
Lump under the ribsLump under the ribs
Weakness or fatigueWeakness or fatigue
JaundiceJaundice
BruisingBruising
BleedingBleeding
HCC Presentation
CT scan of liver and abdomen
Early screening of cirrhosis patients using
Early screening of cirrhosis patients using
3-phase CT scan3-phase CT scan
Measurement of a tumor marker (alpha-fetoprotein
level)
Measurement of a tumor marker (alpha-fetoprotein
level)
HCC Prognosis
Prognosis Prognosis
StagingStaging
Diagnostic MethodsDiagnostic Methods
ScoringScoring
PrognosisPrognosis
Treatments for HCCTreatments for HCC
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Staging
SizeSize
Degree of liver diseaseDegree of liver disease
Tumor biologyTumor biology
LocationLocation
EvaluatesEvaluates
Determines prognosisDetermines prognosis
Bases treatments on the stageBases treatments on the stage
Uses Barcelona Clinic Liver Cancer (BLCL) Staging System
Uses Barcelona Clinic Liver Cancer (BLCL) Staging System
Staging and Scoring Interaction Staging and Scoring Interaction
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Scoring − MELD
Model for End Stage Liver Disease (MELD)Model for End Stage Liver Disease (MELD)
Determines how liver transplants are allocated
Is a complex equationPredicts the likelihood of
mortality from cirrhosis complications
Gives liver transplant to highest MELD score
Gives HCC patients higher MELD scores
Determines how liver transplants are allocated
Is a complex equationPredicts the likelihood of
mortality from cirrhosis complications
Gives liver transplant to highest MELD score
Gives HCC patients higher MELD scores
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HCC Treatment
HCC TreatmentHCC Treatment
Liver ResectionLiver Resection
Liver TransplantLiver Transplant
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Liver Resection
Indicators Indicators
Tumor <5 cmTumor <5 cm
No cirrhosisNo cirrhosis
Hepatectomy Prognosis
HCC Recurrence HCC Recurrence
Tumor at the resection marginCirrhosisVascular involvementAdvanced tumor gradeNumber of tumorsAlpha-fetoprotein (AFP) level is
greater than 10,000Preoperative aspartate
aminotransferase test (AST) is two times normal
Patient has Hepatitis C
Tumor at the resection marginCirrhosisVascular involvementAdvanced tumor gradeNumber of tumorsAlpha-fetoprotein (AFP) level is
greater than 10,000Preoperative aspartate
aminotransferase test (AST) is two times normal
Patient has Hepatitis C
Diagnostic methods:Alpha-
fetoprotein (AFP) level
Biopsy Imaging
Diagnostic methods:Alpha-
fetoprotein (AFP) level
Biopsy Imaging
Presentation:AnemiaLow platelet
count Increased
creatinine level
Elevated liver enzymes
Increased bilirubin level
Lack of glycogen stores in liver
Presentation:AnemiaLow platelet
count Increased
creatinine level
Elevated liver enzymes
Increased bilirubin level
Lack of glycogen stores in liver
HCC:A tumor in which
the cancer starts during adulthood in cells in the liver
Primary malignancy of the liver; not metastasized from elsewhere
More prevalent in men than women
Associated with Hepatitis B and C, alcohol abuse, and metabolic liver disease
HCC:A tumor in which
the cancer starts during adulthood in cells in the liver
Primary malignancy of the liver; not metastasized from elsewhere
More prevalent in men than women
Associated with Hepatitis B and C, alcohol abuse, and metabolic liver disease
Prevention:Limit the
epidemic of Hepatitis B and C
Avoid alcohol abuse
Early screening
Prevention:Limit the
epidemic of Hepatitis B and C
Avoid alcohol abuse
Early screening
SummaryUses BCLC staging system, which considers tumor size and physical status, for scoring
Uses BCLC staging system, which considers tumor size and physical status, for scoring
Treatments:TACEAblationLiver
transplantationLiver resection
Treatments:TACEAblationLiver
transplantationLiver resection
• Basic Information• Fundamental Causes• Symptoms• Prognosis
Basic Information
Basic InformationBasic Information Colorectal Cancer StatisticsColorectal Cancer Statistics
Colorectal Cancer PathophysiologyColorectal Cancer Pathophysiology
Colorectal Cancer OccurrenceColorectal Cancer Occurrence
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Colorectal Cancer Occurrence
AdenocarcinomaAdenocarcinoma
Cecum – 20%
Sigmoid – 25%
Rectum – 20%
Rectosigmoid junction – 10%
Mucosa
Colorectal Cancer Pathophysiology
Stem cells
Differentiated cells
Fundamental Causes
EnvironmentalHigh fat dietLow fiber dietAlcohol
consumptionCholecystectomy
EnvironmentalHigh fat dietLow fiber dietAlcohol
consumptionCholecystectomy
GeneticFamily history of
colorectal cancerAdenomatous
polyps•Familial
adenomatous polyposis (FAP)
•Hereditary nonpolyposis colon cancer (HNPCC)
GeneticFamily history of
colorectal cancerAdenomatous
polyps•Familial
adenomatous polyposis (FAP)
•Hereditary nonpolyposis colon cancer (HNPCC)
Fundamental Causes
Ulcerative ColitisUlcerative Colitis
Normal Colon Colon with Ulcerative Colitis
Symptoms
SymptomsSymptoms SymptomsSymptoms
Screening GuidelinesScreening Guidelines
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Screening Guidelines
Colonoscopy every 3 yearsHigh-sensitivity fecal occult
blood test (FOBT) every year, orSigmoidoscopy every 5 years
with FOBT in between
Colonoscopy every 3 yearsHigh-sensitivity fecal occult
blood test (FOBT) every year, orSigmoidoscopy every 5 years
with FOBT in between
Colorectal Cancer Prognosis
Colorectal Cancer Prognosis Colorectal Cancer Prognosis
General Disease CourseGeneral Disease Course
StagesStages
Hepatic MetastasisHepatic Metastasis
Stages
Stage 0 – abnormal cells are found in the innermost lining of the colon. Stage 0 – abnormal cells are found in the innermost lining of the colon.
Stages
Stage I – cancer has formed and spread beyond the innermost tissue layer of the colon wall to the middle layers.
Stage I – cancer has formed and spread beyond the innermost tissue layer of the colon wall to the middle layers.
Stages
Stage II Stage II
Stage IIA – cancer has spread beyond the middle tissue layers of the colon wall or has spread to nearby tissues around the colon or rectum.
Stage IIA – cancer has spread beyond the middle tissue layers of the colon wall or has spread to nearby tissues around the colon or rectum.
Stage IIB – cancer has spread beyond the colon wall into nearby organs and/or through the peritoneum.
Stage IIB – cancer has spread beyond the colon wall into nearby organs and/or through the peritoneum.
Colorectal cancer has become metastatic colorectal cancer (MCRC).
Colorectal cancer has become metastatic colorectal cancer (MCRC).
Stages
Stage III Stage III
Stage IIIA – cancer has spread from the innermost tissue layer of the colon wall to the middle layers and has spread to as many as 3 lymph nodes.
Stage IIIA – cancer has spread from the innermost tissue layer of the colon wall to the middle layers and has spread to as many as 3 lymph nodes.
Stage IIIB – cancer has spread to as many as 3 nearby lymph nodes and has spread:
• Beyond the middle tissue layers of the colon wall, or
• To nearby tissues around the rectum, or• Beyond the colon wall into nearby organs
and/or through the peritoneum.
Stage IIIB – cancer has spread to as many as 3 nearby lymph nodes and has spread:
• Beyond the middle tissue layers of the colon wall, or
• To nearby tissues around the rectum, or• Beyond the colon wall into nearby organs
and/or through the peritoneum.
Stage IIIC – Cancer has spread to 4 or more nearby lymph nodes and has spread:
• To or beyond the middle tissues of the colon wall, or
• To nearby tissues around the colon or rectum, or
• To nearby organs and/or through the peritoneum.
Stage IIIC – Cancer has spread to 4 or more nearby lymph nodes and has spread:
• To or beyond the middle tissues of the colon wall, or
• To nearby tissues around the colon or rectum, or
• To nearby organs and/or through the peritoneum.
Stages
Stage IV – Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or the lungs.
Stage IV – Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or the lungs.
General Disease CoursePrognosis – American Joint Committee on
Cancer (AJCC) Staging of Colorectal Cancer
Prognosis – American Joint Committee on Cancer (AJCC) Staging of Colorectal Cancer
Stage
T stage N stage M Stage
Five Year Survival Rate (%)
0
I T1 or T2 N0 M0 93.2
IIa T3 N0 M0 84.7
IIb T4 N0 M0 72.2
IIIa T1 or T2 N1 M0 83.4
IIIb T3 or T4 N1 M0 64.1
IIIc Any T N2 M0 44.3
IV Any T Any N M1 8.1
General Disease CoursePrognosis – American Joint Committee on
Cancer (AJCC) Staging of Colorectal Cancer
Prognosis – American Joint Committee on Cancer (AJCC) Staging of Colorectal Cancer
Hepatic Metastasis
Liver
Portal vein
Large intestine
Stomach
Small intestine
Gallbladder Hepatic artery
Symptoms and Screening Guidelines
Symptoms and Screening Guidelines
PrognosisStagesGeneral
Disease Course
Hepatic Metastases
PrognosisStagesGeneral
Disease Course
Hepatic Metastases
Basic information
StatisticsOccurrencePathophysio
logy
Basic information
StatisticsOccurrencePathophysio
logy
Summary
Fundamental Causes
EnvironmentalGeneticUlcerative
Colitis
Fundamental Causes
EnvironmentalGeneticUlcerative
Colitis
• Treatment Options• Determining Treatment• Chemotherapy• Surgery• Transarterial
Chemoembolization• Tissue Ablation• Palliative Care
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Determining Treatment
Determining TreatmentDetermining Treatment Diagnostic − ImagingDiagnostic − Imaging
HCCHCC
MCRCMCRC
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New agentsNew agents
ChemoembolizationChemoembolization
ResectionResection
Tissue ablationTissue ablation
TransplantationTransplantation
Curative treatmentsCurative treatments
Randomized controlled trialsRandomized controlled trials
Palliative carePalliative care
Determining HCC Treatment
HCCHCC
Stage 0Stage 0 Stage A - CStage A - C Stage DStage D
Increased
Determining HCC Treatment
Stage 0PST* 0, Okuda 1
Stage 0PST* 0, Okuda 1
*PST – performance status test
Very early stage (0)1 HCCCarcinoma in situ <2 cm
Very early stage (0)1 HCCCarcinoma in situ <2 cm
1 HCC1 HCC
Portal pressure/bilirubinPortal pressure/bilirubin
ResectionResection
Normal
3 nodules <3 cm3 nodules <3 cm
Associated diseasesAssociated diseases
No Yes
Liver TransplantLiver Transplant PEI/RFAPEI/RFA
Stage 0 Treatment Stage 0 Treatment
Determining HCC Treatment
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
*PST – performance status test
Early stage (A)1 HCC or 3 nodules<3 cm, PST 0
Early stage (A)1 HCC or 3 nodules<3 cm, PST 0
3 nodules <3 cm3 nodules <3 cm
Associated diseasesAssociated diseases
No
Liver TransplantLiver Transplant
Yes
PEI/RFAPEI/RFA
Stage A Treatment Stage A Treatment
Intermediate stage (B)Multinodular PST 0
Intermediate stage (B)Multinodular PST 0
ChemoembolizationChemoembolization
Determining HCC Treatment
*PST – performance status test
Stage B Treatment Stage B Treatment
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
Determining HCC Treatment
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
Stage A-COkuda 1-2, PST* 0-2, Child-Pugh A-B
*PST – performance status test
Yes
New agentsNew agents
Advanced Stage (C)Portal invasionN1, M1, PST 1-2
Advanced Stage (C)Portal invasionN1, M1, PST 1-2
Portal invasion, N1, M1
No
ChemoembolizationChemoembolization
Stage C Treatment Stage C Treatment
Stage I (23%)Stage I (23%) Stage II (31%)Stage II (31%) Stage III (26%)Stage III (26%) Stage IV (20%)Stage IV (20%)
Determining Treatment for MCRC
Colorectal Cancer ( 94,700 cases)Colorectal Cancer ( 94,700 cases)
Local regional therapiesLocal regional therapies
Surgical resectionSurgical resection
Systemic chemotherapySystemic chemotherapy
RFARFA
Radiation microspheresRadiation microspheres
RadiationRadiation
CryoablationCryoablation
TACETACE
Recurrent (10%)Recurrent (10%)
See Stage IVSee Stage IV
5 year survival (90%)5 year survival (90%)
Surgical ResectionSurgical Resection
Stage I (23%)Stage I (23%)
Determining Treatment for MCRC
Stage I Treatment Stage I Treatment
Stage II (31%)Stage II (31%)
SurgerySurgery Surgery andadjuvant
chemotherapy
Surgery andadjuvant
chemotherapy
5 year survival (66%)5 year survival (66%) Recurrent (34%)Recurrent (34%)
See Stage IVSee Stage IV
Determining Treatment for MCRC
Stage II Treatment Stage II Treatment
Stage III (26%)Stage III (26%)
Surgery andadjuvant
chemotherapy
Surgery andadjuvant
chemotherapy
5 year survival (51%)5 year survival (51%) Recurrent (49%)Recurrent (49%)
See Stage IVSee Stage IV
Determining Treatment for MCRC
Stage III Treatment Stage III Treatment
Stage IV (20%)Stage IV (20%)
Palliative chemotherapy
Palliative chemotherapy
Recurrent (>95%)Recurrent (>95%)5 year survival (<5%)5 year survival (<5%)
Determining Treatment for MCRC
Stage IV Treatment Stage IV Treatment
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Surgery
SurgerySurgery
Hepatectomy PrognosisHepatectomy Prognosis
HepatectomyHepatectomy
MCRC SurgeryMCRC Surgery
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Hepatectomy Prognosis
2% mortality rate2% mortality rate
Survival rate 44 monthsSurvival rate 44 months
75% recurrence in 5 years75% recurrence in 5 years
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Transarterial Chemoembolization (TACE)
Transarterial ChemoembolizationTransarterial Chemoembolization OverviewOverview
PrognosisPrognosis
ProcessProcess
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TACE is effective and well tolerated for palliation of hepatoma and
colon metastases
TACE is effective and well tolerated for palliation of hepatoma and
colon metastases
There are many new modalities, unanswered questions
There are many new modalities, unanswered questions
Controlled studies are neededControlled studies are needed
Combined therapies may offer the best approach
Combined therapies may offer the best approach
MCRCMCRC
TACE Prognosis
Traditional TACE used as last resort
Traditional TACE used as last resort
No survival benefit on patients with reselectable tumors
No survival benefit on patients with reselectable tumors
Survival ranges from 8.5 to 10 months after treatment
Survival ranges from 8.5 to 10 months after treatment
TACE Prognosis
Tumor volume: 42.9 cc
Before TACE 3 months after TACE
Tumor volume: 14.5 cc (-66%)
1 month after TACE
Tumor volume: 57.8 cc
Imaging evaluation: Case 1 R.R.Imaging evaluation: Case 1 R.R.
Tissue Ablation
Tissue AblationTissue Ablation Radiofrequency Ablation (RFA)Radiofrequency Ablation (RFA)
Percutaneous Ethanol Injection (PEI)Percutaneous Ethanol Injection (PEI)
CryotherapyMicrowaveLaserFocused UltrasoundRadiofrequency Ablation (RFA)Percutaneous Ethanol Injection
(PEI)Cryoablation
CryotherapyMicrowaveLaserFocused UltrasoundRadiofrequency Ablation (RFA)Percutaneous Ethanol Injection
(PEI)Cryoablation
Radiofrequency Ablation (RFA)Percutaneous Ethanol Injection (PEI)
Radiofrequency Ablation (RFA)Percutaneous Ethanol Injection (PEI)
Tissue Ablation Overview
Radiofrequency Ablation (RFA)
Radiofrequency Ablation (RFA)Radiofrequency Ablation (RFA) RFA OverviewRFA Overview
RFA ProcessRFA Process
Thermal Cell DeathThermal Cell Death
RF PrinciplesRF Principles
RFA ResultsRFA Results
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RF Principles
Similar to electrocauterySimilar to electrocautery
Administers a high-frequency currentAdministers a high-frequency current
Electrical componentsElectrical components
Grounding padsGrounding pads
GeneratorGenerator
ProbeProbe
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Thermal Cell Death
Temperature (°C)
Cellular Effect
<40 No significant cell damage
40 – 49 Reversible cell damage
49 – 70 Irreversible cell damage (denaturation)
70 – 100 Coagulation (collagens converted to glucose)
100 – 200 Dessication (boiling of intra- and extra-cellular water)
>200 Carbonization
49 – 70 Irreversible cell damage (denaturation)
RFA Results
All metastases must be treated completely
All metastases must be treated completely
Entire tumor and surrounding 5 mm -10 mm of soft tissue must be ablated
Entire tumor and surrounding 5 mm -10 mm of soft tissue must be ablated
Controlled studies are neededControlled studies are needed
RFA Prognosis
MCRC < 3 cm and HCC < 4 cmMCRC < 3 cm and HCC < 4 cm
28. 9 months (2.4 years) post RFA28. 9 months (2.4 years) post RFA
44.6 months from diagnosis of metastases (Kaplan Meier)
44.6 months from diagnosis of metastases (Kaplan Meier)
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Chemotherapy
SurgeryTACETissue
AblationPEIRFAPalliative
Care
Chemotherapy
SurgeryTACETissue
AblationPEIRFAPalliative
Care
Treatment Options
Treatment Options
Summary
Determining Treatment
MCRCHCC
Determining Treatment
MCRCHCC
TreatmentTreatmentAnatomyAnatomyHCC and MCRCHCC and MCRC
Basic InformationBasic Information
Fundamental CausesFundamental Causes
SymptomsSymptoms
PrognosisPrognosis
Treatment OptionsTreatment Options
Determining TreatmentDetermining Treatment
ChemotherapyChemotherapy
SurgerySurgery
TACETACE
Tissue AblationTissue Ablation
Palliative CarePalliative Care
Course Summary
Colon AnatomyColon Anatomy
Liver AnatomyLiver Anatomy
PROPERTIES
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Disease States and Cancers of the Liver and Colon
General Disease Course
Stage Definition
T1 Tumor invades submucosa.
T2 Tumor invades muscularis propria.
T3 Tumor invades through muscularis propria into the subserosa or nonperitonealized pericolonic tissues.
T4 Tumor invades other organs or structures and or perforates visceral peritoneum.
N0 No regional lymph node metastasis.
N1 Metastasis to 1 to 3 regional lymph nodes.
N2 Metastasis to 4 or more regional lymph nodes.
M0 No distant metastasis.
M1 Distant metastasis.
Back Back AJCC T, N, and M DefinedAJCC T, N, and M Defined
General Disease Course
Stage Description
0 Abnormal cells are found in the innermost lining of the colon.
I Cancer has formed and spread beyond the innermost tissue layer of the colon wall to the middle layers.
IIa Cancer has spread beyond the middle tissue layers of the colon wall or has spread to nearby tissues around the colon or rectum.
IIb Cancer has spread beyond the colon wall into nearby organs and/ or through the peritoneum.
IIIa Cancer has spread from the innermost tissue layer of the colon wall to the middle layers and has spread to as many as 3 lymph nodes.
IIIb Cancer has spread to as many as 3 nearby lymph nodes and has spread:• Beyond the middle tissue layers of the colon wall, or• To nearby tissues around the rectum, or• Beyond the colon wall into nearby organs and/or through the peritoneum.
IIIc Cancer has spread to 4 or more nearby lymph nodes and has spread:• To or beyond the middle tissues of the colon wall, or• To nearby tissues around the colon or rectum, or• To nearby organs and/ or through the peritoneum.
IV Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or the lungs.
Back Back AJCC Stages DefinedAJCC Stages Defined