肝癌NCCN英文版.pptVIP

Symptoms jaundice, anorexia, weight loss, malaise, upper abdominal pain Physical signs hepatomegaly, ascites Paraneoplastic syndromes hypercholesterolemia, erythrocytosis hypoglycemia Hepatitis panel Assessment of the presence of comorbidity Imaging studies to detect the presence of metastatic disease Evaluation of hepatic function Portal hypertention Staging (AJCC) TNM staging system Okuda system BCLC CLIP JIS CLIP classification Parameter Score Child–Pugh A0 B1 C2 Tumour morphology Uninodular and extension 50% of liver 0 Multinodular and extension 50% of liver 1 Massive or extension +50% of liver 2 Alpha fetoprotein 400 ng/ml 0 400 ng/ml 1 Macrovascular invasion No 0 Yes 1 Definition of the BCLC staging for HCC Surgery partial hepatectomy liver transplantation Local regional therapy ablation: RFA PEI embolization: bland embolization(TAE) chemoembolization(TACE) radioembolization RT:conformal or stereotactic therapy Systemic therapy Best supportive care Levels of bilirubin ,ALT, AST, ALP,LDH,albumin,protein Cr, BUN PT,INR Child-pugh score MELD score serum bilirubin, creatinine, INR 6(less ill)------40(gravely ill) * Risk Factors 2. Screening for HCC 3. Diagnosis 4. Evaluation 5. Management 1. Risk Factors Hepatitis B,C Alcohol Non-alcohol steatohepatitis(NASH) ﹡ Primary biliary cirrhosis Environment exposure to aflatoxin Auto-immune hepatitis Inherited errors of metabolism Genetic hemochromatosis Porphyria cutanea tarda Alpha1-antitrypsin deficiency Wilsonˊs disease 2.Screening for HCC 3.Diagnosis Imaging Biopsy Serum biomarkers 4.Evaluation Management *