Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

DNA restriction fragment length polymorphism analysis was carried out on a primary and recurrent hepatocellular carcinoma in a hepatitis B virus negative patient. For the primary tumour, allele losses were found on the short arm of chromosome 17 (probe: p144-D6, 17p13) and the long arm of chromosome 5 with the probe Lambda MS8 (5q35-qter); other probes showed either no allele loss or a non-informative pattern. The recurrent cancer also showed allele loss with p144-D6, but not with Lambda MS8. In addition, the recurrent tumour had allele losses with Lambda MS43 (12q24.3-qter), pYNZ22 (17p13), and DNA rearrangement revealed by the probe Lambda MS32 (1q42-43), a pattern not seen in the primary lesion. These results indicate that the second hepatocellular carcinoma was of independent clonality and probably represents a de novo neoplasm rather than a recurrence.
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PMID:Different DNA changes in primary and recurrent hepatocellular carcinoma. 135 92

HCC occurs infrequently in Western countries, with recent increases being reported in California and parts of Europe. Southeast Asia, Japan, and South Africa continue to have a high incidence of this tumor with HBV, cirrhosis, and the ingestion of aflatoxins being identified as probable risk factors. Although the majority of patients present with abdominal pain or mass indicative of extensive tumor, asymptomatic, small HCCs are being detected with increasing frequency. Early detection in high-risk individuals is best accomplished by screening with serum AFP determinations and liver ultrasonography. CT and arteriography are valuable preoperatively in defining anatomy and determining resectability. Five-year survival following resection for cure of HCC ranges from 20 to 40 per cent, with improved survival reported for small asymptomatic tumors. Resection of metastatic liver tumors from colorectal primaries results in 48 per cent 2-year and 24 per cent 5-year survivals, with an additional 5 per cent dying of recurrent cancer after 5 years. Although patients with simultaneous and metachronous metastases do equally well after resection, the presence of four or more individual deposits adversely affects survival. Hepatic artery ligation or embolization can produce a significant palliative reduction in total tumor mass in patients with unresectable liver metastases. Regional chemotherapy using implantable hepatic artery drug infusion pumps is promising, with reports of prolonged survival compared with historical controls. Regional hyperthermia, laser vaporization of tumor, and cryosurgical techniques may prove to have useful roles in the selective treatment of liver cancer in the future. Orthotopic liver transplantation has been successful primarily in those in whom the malignancy is found incidentally in the chronically diseased liver.
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PMID:Malignant tumors of the liver. 242 9

Resection and graft replacement of the vena cava for malignant disease is rarely performed, often because of the advanced tumor stage. Since August 1987 we have selectively performed caval replacement in conjunction with tumor resection in 11 patients. Three patients had superior vena cava reconstruction (SVCR) and eight had inferior vena cava replacement (IVCR). There were six males and five females whose mean age was 59.3 years (range 24 to 75 years). Two patients, each with superior vena cava obstruction, presented with symptoms from venous compression. Malignancies involving the superior vena cava were thyroid carcinoma in two patients and lymphoma in one. Cancers requiring IVCR were leiomyosarcoma in three patients, cholangiocarcinoma in two, and malignant fibrous histiocytoma, hepatocellular carcinoma, and colon carcinoma metastatic to the liver in one each. All IVCRs and two SVCRs were performed with expanded polytetrafluoroethylene grafts. The remaining SVCR was constructed with spiral saphenous vein. Six IVCRs involved replacement of the retrohepatic inferior vena cava in conjunction with major liver resection. Mean intraoperative blood transfusions were 5.3 units (range 0 to 10 units). There were no operative deaths. Complications occurred in four patients and included postoperative bleeding in two, myocardial infarction in one, and wound infection in one. There were no perioperative graft occlusions, but one patient developed graft occlusion 2 months after SVCR. All IVCR grafts have remained patent (mean follow-up of 8.8 months). Two patients with SVCRs have died from recurrent cancer at 3.2 and 3.4 years postoperatively. Six patients with IVCRs have developed tumor recurrence either locally (n = 1), at a distant site (n = 2), or both (n = 3). Importantly, eight of nine survivors have an excellent performance status. We conclude that vena cava reconstruction for malignancy can be performed safely, has few graft-related complications, and in some patients may offer the only possibility for tumor control.
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PMID:Vena cava replacement for malignant disease: is there a role? 851 20

At the University of California, San Francisco, 17 patients who met the following criteria-hepatic tumor unresectable because of location or inadequate liver reserve, no metastases, HBsAg negative, no tumor larger than 5 cm in diameter, and no more than three tumors--were enrolled prospectively in a protocol employing preoperative chemoembolization to assess whether orthotopic liver transplantation (OLT) could cure a majority of highly selected patients with hepatocellular carcinoma (HCC). Thirteen patients had biopsy-proven HCC, 2 had the fibrolamellar variant, and 2 had radiological findings of HCC but no biopsy confirmation. Fourteen had underlying liver disease. All arteriographically apparent lesions were chemoembolized using a mixture including Gelfoam powder, doxorubicin, mitomycin-c, and cisplatin. Eight patients with poor hepatic reserve were chemoembolized when a donor organ became available, whereas 9 patients were chemoembolized and then placed on the waiting list. The only complication of chemoembolization was a gangrenous gallbladder in 1 patient. Thirteen patients underwent liver transplantation (2 patients without prior histological confirmation of carcinoma had no identifiable tumor at OLT); 3 patients developed metastases between the time of enrollment and donor organ availability and subsequently died; and 1 patient underwent a trisegmentectomy. Ten of the 11 patients with biopsy-proven HCC who underwent transplantation remain free of recurrent cancer at a median of 40 months; 1 patient died at 6 months of lymphoproliferative disease with no cancer found at autopsy. Although the role of chemoembolization is uncertain, these data show that the majority of carefully selected patients with HCC may achieve long-term survival with OLT.
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PMID:Liver transplantation for hepatocellular carcinoma: results with preoperative chemoembolization. 934 74

The indications for the reoperative treatment for postoperative recurrence of cancer in the field of gastroenterology are usually limited. Interventional radiology (IVR), which is less invasive and effectively enhances the quality of life, will play an important role in the treatment of patients with postoperative recurrent cancer. This paper evaluate IVR as a therapeutic strategy for postoperative recurrent cancer in gastroenterology based on our experience. Metallic stents have proven useful for stenosis of the alimentary tract due to recurrence after surgery for esophageal or gastric cancer and for jejuno-biliary anastomotic stenosis caused by postoperative recurrent bile duct cancer. Segmental Lipiodol TAE is more effective and result in better cumulative survival rates than conventional TAE in the treatment of postoperative recurrence of hepatoma.
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PMID:[Interventional radiology for recurrent cancer]. 1033 Dec 23

The treatment of liver cancer by transplantation has evolved into a process of selecting early stage tumors that have a high likelihood of cure. Carefully selected cirrhotic patients with early hepatocellular cancer (< or = 5 cm. diameter and single; < or = 3 cm. diameter if multiple and 3 or fewer lesions; no vascular invasion) have 5-year actuarial survival rates of approximately 75% after transplantation. Preoperative imaging should be as extensive as necessary to accurately define the characteristics of tumor size, location, and number and exclude signs of extrahepatic involvement. Adjuvant and neoadjuvant chemotherapy became part of treatment protocols in many centers at the same time that more stringent criteria for transplant candidacy were applied to patients with cancer, making it difficult to attribute improved results to the chemotherapy. Nevertheless, neoadjuvant chemoembolization for hepatocellular cancer is logical for patients who may wait long periods before receiving transplants. The fibrolamellar variant of hepatoma is a less aggressive tumor and patients can do well after transplantation, but late recurrences are common. Hepatoblastoma in children can respond very favorably to chemotherapy combined with transplantation. Cholangiocarcinoma remains a dreadful malignancy. The rare cases of insitu cholangiocarcioma in patients who receive transplants for sclerosing cholangitis can be cured, but known cholangiocarcinoma has an exceedingly high rate of recurrence after transplantation alone. Recent work combining chemotherapy and radiation with transplantation has not had dramatic success at improving cure rates. Patients with metastatic neuroendocrine tumors of the liver can receive good palliation by transplantation, but the majority of patients eventually develop recurrent cancer.
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PMID:Liver transplantation for hepatic and biliary malignancy. 1120 Apr 13

Liver transplantation has emerged as an optimal treatment for stage I and II hepatocellular carcinoma for patients with underlying cirrhosis as it provides a treatment for the underlying liver disease as well as a reduced incidence of recurrent cancer. The current system of organ allocation in the United States allows an opportunity for liver transplantation for patients with tumor burden within the Milan criteria (a single tumor 2-5 cm or up to 3 lesions with none >3 cm). Outcomes of patients receiving transplants within these criteria approach outcomes for patients receiving transplants for all indications (85.9%, 74.8%, and 64.1% actuarial survival at 1, 3, and 5 years, respectively, for those with HCC receiving transplants compared with 82%, 73%, and 67% for the entire cohort). Transarterial chemoembolization, radiofrequency ablation, and other pretransplant treatment modalities aimed to slowing tumor growth for patients on a transplant waiting list are commonly used, although the impact on pretransplant disease progression or posttransplant survival remains uncertain. There is continued controversy over expanding patient selection criteria, in particular for those who have undergone downstaging of tumors. In addition, the role of certain immunosuppressive agents such as sirolimus in the reducing HCC recurrence posttransplant remains unclear.
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PMID:Liver transplantation for hepatocellular carcinoma. 1839 14

Liver transplantation is now advocated for patients with early stage hepatocellular carcinoma (HCC) not amenable to surgical resection. In this article we review our experience with liver transplantation as treatment for patients with HCC and end-stage liver disease. Between April 1998 and May 2002, 36 patients with a diagnosis of HCC underwent liver transplantation at Ochsner Clinic Foundation. A retrospective analysis was performed examining pretransplant staging of disease, pathologic staging, disease recurrence, and patient survival. Cumulative 1- and 3-year patient survival rates are 80% and 61%, respectively. To date, none of our patients has developed evidence of recurrent cancer. Our data support liver transplantation as the treatment of choice for patients with unresectable early stage HCC.
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PMID:Liver transplantation for hepatocellular carcinoma: the ochsner experience. 2282 61

Liver transplantation is the definitive therapy for patients with advanced liver disease and its complications. Patients who are transplanted with a diagnosis of hepatocellular carcinoma (HCC) are at risk of recurrent cancer, and these patients are monitored on a regular basis for recurrence. In contrast, de novo HCC following liver transplantation is a very rare complication, and recipients without HCC at the time of transplantation are not screened. We describe the clinical features of de novo HCC over a decade after achieving a sustained viral response with treatment of hepatitis C and two decades after liver transplantation. Our case highlights the necessity of screening for HCC in the post-transplant patient with advanced liver disease even after viral clearance.
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PMID:De novo Hepatocellular Carcinoma after Liver Transplantation. 2680 85

The availability of new direct antiviral agents to safely and effectively treat the hepatitis C virus represents a major advancement in the field of liver disease. Most patients achieve complete viral eradication sustained over time. In addition, the administration of these new agents is safe and does not require limitations when liver function is impaired. Some now expect the hepatitis C virus to be completely eradicated in a few years. However, not all data are positive. In April 2016, we published a cohort study suggesting that viral eradication with the new agents could be associated in time with the emergence of recurrent cancer sites in patients previously treated for hepatocellular carcinoma. In this review, we update our report and summarize the data provided in recent publications. We also speculate about the mechanisms for cancer emergence and stress the need for further studies.
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PMID:Liver Cancer Emergence Associated with Antiviral Treatment: An Immune Surveillance Failure? 2838 36


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