内科学课件： 原发性肝癌-.pptVIP

StagingbyTNMclassificationStageI:T1N0M0StageII:T2N0M0StageIII:T1N1M0,T2N1M0,T3N1M0StageIV:T4N0~1M0,T1~4N0~1M1ComplicationsHepaticencephalopathyUpperGIbleedingRuptureofthenoduleSecondaryinfectionLabFindingsAlpha-Fetoprotein(AFP,甲胎蛋白)HighserumlevelsofserumAFPisastrongpointertothediagnosisofHCC.检测方法： 定性:双白琼脂扩散法,对流免疫电泳法定量:放射免疫法（RIA）,单克隆抗体酶免疫法（EIA）AFP诊断价值：AFP在400μg/L以上持续4周;AFP由低浓度逐渐升高;AFP在200μg/L以上持续8周.假阳性和假阴性问题假阳性：生殖腺胚胎瘤、妊娠、活动性肝炎、少数转移灶肿瘤假阴性：胆管细胞肝癌分化良好的肝细胞肝癌LabFindingsOtherSerumTumorMarkers：Isoenzymesofγ-GlutamylTransferase(γ-GTII)Fucosylatedα-Fetoprotei(甲胎蛋白异质体)Des-γ-CarboxyProthrombin(异常凝血酶原)α-L-Fucosidase(α-岩藻糖苷酶)……ImagingStudiesAbdominalSonographyComputedTomography(CT)MagneticResonanceImaging(MRI)HepaticArteriography(肝动脉造影)Radionuclidescanning(核素扫描)Laparoscopy(腹腔镜)原发性肝癌

primarycarcinomaoftheliver

——起源于肝细胞或肝内胆管细胞的恶性肿瘤IntroductionOneoftheleadingcausesofdeathintheworld.250000death/yrThe3rdmostcommoncancerinChina(17.86/100000);1stPulmonarycancer(32.89/100000)2ndGastriccancer(21.51/100000）The2ndmostcommoncancerinsomeareaofChina.GeographicDistribution(HCC)GeographicDistributionWorldwide：SouthAfrica60~100/100000Asia3~40/100000P.R.China：Qidong(Jiangsu)40/100000Yunnan4.44/100000SexAgeDistribution：Male:Female3~4:1Highincidenceage40~49yrsHighriskpopulation(高危人群)Olderthan35yrsandHBsAg(+)andChronichepatitisformorethan5yrs.35岁以上的乙型肝炎病毒表面抗原阳性及有慢性肝炎病史5年者.EtiologypathogenesisMulti-factorMulti-processMulti-geneMulti-mutationEtiology:riskfactorsMajorRiskFactorsChronicHBV/HCVinfectionMost(64%～80％)ofp