Hepatocellular Carcinoma: Screening, Diagnosis, and Treatment

Hepatocellular Carcinoma: Screening, Diagnosis, and Treatment
Presentation lecture by: Catherine Frenette, MD
California Pacific Medical Center
The Barry S. Levin Department of Transplantation


Hepatocellular Carcinoma
Increasing prevalence of patients with cirrhosis
Regional Variations in HCC-related Mortality
Risk Factors for HCC
Chronic Hepatitis
Cirrhosis
HCC
Chronic HBV Infection
Inactive Carrier State
Chronic Hepatitis
Clinical Outcome of Chronic Hepatitis B
HCC Epidemiology
HBV DNA Associated with Increased Risk of HCC
Primary Prevention of HCC
Surveillance Recommendations
Surveillance for HCC Prolongs Survival
Cost-Effectiveness of HCC Surveillance
Quad Phase Imaging of Hepatocellular Carcinoma
Liver transplantation
Curative treatments
Randomized controlled trials
HCC: Barcelona Clinic Liver Cancer
Staging Classification
Factors Determining Prognosis of Hepatocellular Cancer
Management of Hepatocellular Carcinoma
Newer modalities
Surgical Resection: Indications
Liver Transplantation
UNOS Criteria for Liver Transplantation for HCC
Liver Transplantation for HCC
Months After Transplantation Patients at Risk
Liver Transplantation for HCC: Outcomes Applying Milan Criteria
Liver Transplantation for HCC UCSF Criteria
Differentiated histology
Local Ablation Therapy for Transplant Candidates
Trans-Arterial Chemoembolization TACE
Catheter-Based Therapies
TACE for HCC
Radiofrequency Ablation
RFA Modalities
RFA Indications
RFA Contraindications
RFA Complications
Radiographic Outcomes
New Therapies Under Investigation
Chemotherapy

* Sorafenib* (Nexavar)
* Erlotinib (Tarceva)
* Sirolimus (Rapamune)
* Capecitabine (Xeloda)
* Floxuridine (FUDR)
* Bevacizumab (Avastin)
* Sargramostim (Leukine)
* Oxaliplatin (Eloxatin)
* Imatinib (Gleevac)
Local Therapy
Yttrium-90 Microspheres
Doxorubicin Eluting Beads
Systemic chemotherapy
GI Intergroup Recommendations
Macrovascular invasion or Metastases
Supportive Care
Conclusion

* Screening saves lives
* Resection or Transplantation best option
* RFA used for unifocal lesions < 5 cm
* TACE used for multifocal, lesions > 5 cm
o Non surgical candidates
* Combination therapies
o TACE and RFA
* New Strategies
o Yttrium-90 theraspheres
o Drug Eluting microspheres
* Sorafenib used when local treatment not an option


Hepatocellular Carcinoma: Screening, Diagnosis, and Treatment.ppt