Liver Cancer

Presented By: Layal Khalid Jambi

Out line

• Definition.• Causes.• Symptoms.• Complications.• Diagnosis.• Treatment Plan.• Case study.

Definition

Liver Cancer

(HCC) Hepatocellular CarcinomaArising from the liver

Metastatic Liver DiseaseCancer that has spread to the liver,

having originated in other organs (such as the colon, stomach, pancreas, breast and lung)

Primary Secondary

Causes

Symptoms

1 2 3

4 5 6

Complications

• Gastrointestinal Bleeding.• Liver Failure.• Spread (Metastasis) of the Carcinoma.

Diagnosis

Physical examination.

Laboratory.

Imaging studies.

1

2

3

Physical Examination

Physical examination may show Enlarged, Tender Liver.

Laboratory

• ALT = Alanine Transaminase , is an Enzyme found in the Highest amount in the Liver.

• This Blood Test is used to determine if a patient has a Liver Damage.

• An increase in ALT level may due to Cirrhosis, Hepatitis, Hemochromatosis, Liver Disease and Liver Tumor.

Imaging Studies

Abdominal Ultrasound

Abdominal CT scan

Abdominal MRI scan

Treatment

Surgery Chemotherapy

RFA TheraSphere

TheraSphere

• New form of Cancer Treatment.

• Catheter is inserted to the Femoral Artery Hepatic Artery.

• Radioactive glass beads are inserted.

Side Effect

• Fatigue. • Nausea.• Fever.• Vomiting.• Stomach Pain.

Pre TheraSphere Treatment

CT Liver Volumetry Arteriogram MAA Perfusion

Scan

3 Screening Test need to be Done before the treatment to make sure that the patient is a Good Candidate.

• Mapping the Arteries.

• Insertion of Coils.

• Hepatopulmonary Shunt Study.

• Measure the exact size of the Liver Tumor.

• To decide the correct dose of Radiation for the Tumor.

• To show how much Blood Flows around the Liver and the Lungs.

Pre TheraSphere Treatment

If these test show that it is Safe to have TheraSphere, Most of the time one side of the Liver treated First and other side is treated about a month Later. Sometimes the whole Liver is treated at once. It depends on how much Liver disease and the Blood Supply to the Liver.

CT Liver Volumetry Arteriogram MAA Perfusion

Scan

When is TheraSphere not suitable ?

• If tests show that TheraSphere may Deposit in the Gastrointestinal Tract or Lungs.

• If the patient have Abnormal Liver Function.• If the liver Does not have Arteries near the tumor.• If the Arteries in the liver are Abnormal.• If the patient tend to Bleed easily.

Case Study

• A 70 year old male with history of HCC with Colonic

Resection.

Diagnosis – CT Abdomen

Liver Cirrhosis, Multiple Lesions represent HCC or Metastasis.Need to be confirmed By MRI

23-06-2010

Diagnosis – MRI Abdomen

Evidence of Cirrhotic changes, Multiple Liver Lesions has the feature of HCC.

06-07-2010

Treatment – US Radiofrequency . Ablation

They only treat 1 lesion its size is approximately 3cm which is located superficially.Follow up with MRI after 4 weeks and based on its Result, Decision & Management strategy for the other 2 lesions will be made.

24-08-2010

Follow Up – MRI Abdomen

03-10-2010

- Post RFA showing Residual Tumor.

- Interval increase in the No. & size of previously noted Hyper vascular Lesion.

31-10-2010

- Enlarging recurrence

around the RFA area.- Enlarging previously noted

Lesions.

Pre Treatment – CT Abdomen . Liver Volumetry

Pre Treatment – Blood Test

ALT = 191Normal = 10 - 45

02-11-2010

Pre Treatment – Angio 06-11-2010

4 mCi of MAA was injected for

HepatoPulmonary Shunt Study

Pre Treatment – NM Mapping 06-11-2010

Pre Treatment – NM Mapping 06-11-2010

Pre Treatment – NM Mapping 06-11-2010

Day of Treatment – Blood Test

ALT = 251Normal = 10 - 45

25-12-2010

The Day of Treatment – Angio

28-12-2010

Catheterization of the proper Hepatic ArteryFollowed by Infusion of 145 Gy of 90-Yttrium

1

23

The Day of Treatment – NM

28-12-2010

The Day of Treatment – NM

28-12-2010

The Day of Treatment – NM

28-12-2010

Post Treatment

• Drink plenty of Water and Fluids.• Medicine should be Restarted Immediately after the

procedure.• No Strenuous physical activity of any kind.• Because the beads that have been administered to the

body are Releasing Radiation, it is necessary to limit the number of visitors to the home during 3 days .

Finally

• They treat the Lesions which are Located mainly in Segment # 4 of the Liver.

• After 1 month they will Treat the other Lesions which are Located in Segment # 6 and 8 of the Liver.

• Later On they will treat the other Lesions which are Located in Segment # 5 and 7 of the Liver.

Conclusion

Overall TheraSphere can cause Fewer and Milder Side Effect than other current treatments and offers the Convenience of Outpatient Therapy.

Hope You Like it !

Thank You

References

• http://en.wikipedia.org/wiki/Hepatocellular_carcinoma• http://www.nlm.nih.gov/medlineplus/ency/article/000280.htm• http://emedicine.medscape.com/article/282814-overview• http://video.about.com/cancer/TheraSphere-Cancer-Treatment.ht

m• http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm• http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INF

ORMATION-FlexMember-Show_Public_HFFY_1126651799450.html

• http://www.mdsnordion.com/therasphere/patients-info-guide/TSGuide_ENG.pdf