Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The frequent occurrence of metastases from the primary tumor present a major therapeutic problem in hepatocellular cancer because of the hematogenous spread of cancer cells. Standard imaging diagnostics methods do not allow for an early detection of relapse of the disease, as opposed to the analysis of molecular cell markers, especially mRNA-based methods, in peripheral blood samples by RT-PCR. Analysis of alphafetoprotein expression is the "gold standard" in the diagnostics of HCC at the protein and mRNA level because of its specificity for liver cancer. However, working out an analysis protocol is problematic and the utility of the marker in monitoring a patient's status in the perioperative period remains controversial. New HCC markers are being searched for among the highly liver-specific ones and those shared between various cancers types. Markers associated with freely circulating nucleic acids are also studied and quantitative assays are used. An assay for several markers simultaneously could give satisfactory results.
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PMID:[Molecular markers of micrometastasis in the blood of hepatocellular carcinoma patients]. 1755 34

Although remarkable progress has been made in the treatment of hepatocellular carcinoma HCC, local control is still the most important consideration. Liver resection is and will continue to be the first-line therapeutic modality for local control of a primary HCC, including cases with intrahepatic metastases. For a large HCC, or multiple HCCs with vascular invasion, aggressive liver resection must be pursued. In cases with poor liver functional reserve, liver transplantation would be a good therapeutic option, after considering age, and tumor-related factors. To prevent deterioration of the liver function should be the second priority in the treatment of HCC. As for liver resection, extensive removal of the non-cancerous parenchyma, such as lobectomy and hemihepatectomy, should be avoided as much as possible. Anatomic resection, which involves systematic elimination of the main tumor with its minute metastases and preserves liver function, is strongly recommended. The treatment algorithm, which is based on evidence picked up from published papers, is now available and useful to determine the therapeutic choice depending on the tumor- and liver function-related conditions.
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PMID:Surgical management of hepatocellular carcinoma. Liver resection and liver transplantation. 1767 97

With the current practice of surveillance programs in high-risk patients, early stage hepatocellular carcinoma HCC is commonly diagnosed. This poses great challenge to clinicians, in terms of prognostic estimation, patient stratification to various treatment modalities and patient management during long-term follow-up. This review focuses on the current trends in the management of HCC, with special attention to tumor staging, treatment algorithm, and outcome of various treatment modalities. According to the American Association for the Study of Liver Diseases AASLD practice guideline, Barcelona Clinic Liver Cancer BCLC staging system has fulfilled the criteria that HCC patients can be stratified into different prognostic subgroups, to which optimal treatments can be offered. Under this management scheme, curative treatments hepatic resection, liver transplantation, and percutaneous ablation would be reserved to the subgroup of patients with relatively good prognosis. For patients with advanced malignancy localized to the liver, local ablation or transarterial chemoembolization TACE may offer effective symptomatic palliation, and prolongation of patients' survival. For patients with distant metastases, no effective therapy can be offered, and symptomatic palliative care is the best option. Until now, favorable survival outcomes have been reported following hepatic resection, liver transplantation, and local ablation for HCC. Although the therapeutic effect of TACE is less pronounced than curative treatments, randomized controlled studies have proven its survival benefit for HCC patients. A comprehensive treatment algorithm involving these treatment modalities is mandatory to ensure optimal care of patients with HCC.
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PMID:Current treatment strategy for hepatocellular carcinoma. 1776 55

Primary cancer of the liver (hepatocellular carcinoma [HCC]) and metastatic cancer to the liver from a distant primary site of origin are very common problems in the United States and the world. The management of these diseases has become progressively complex as the available treatment options have improved and propagated. One option that has been gaining acceptance is image-guided tumor ablation. Image-guided tumor ablation has been applied to numerous cancers, including renal cell carcinoma, prostate cancer, lung cancer, and liver cancer with promising short-term results. Radiofrequency ablation has been the most widely studied and utilized ablation modality. However, cryoablation has several relative advantages (most significantly, the ability to produce larger and more precise zones of ablation) over RF ablation and the other heat-based ablation modalities. This manuscript is designed to be an up to date, practical and thorough review of the indications for, techniques of, and patient management issues associated with hepatic cryoablation.
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PMID:Cryoablation for liver cancer. 1798 Mar 18

Multidetector computed tomography (MDCT), is the latest breakthrough in CT technology. Thin sections can now be acquired a routine basis in a single-breathhold with 3D-isotropic reconstructions. This results in improved lesion detection of benign as well as malignant abdominal tumours. The ability to scan through the entire abdomen in seconds allows multiphasic acquisitions. Therefore precise timing and optimized contrast is of great importance. Hypervascularized solid abdominal tumours are best depicted within the time generally regarded as the arterial dominant phase in MDCT, conversely hypovascular lesions are best depicted during venous phase imaging. The acquisition of an early arterial phase provides precise documentation of the arterial vascular system and should be obtained in preoperative abdominal imaging. Three clear separate circulatory phases enable best results in the pretherapeutic work-up of abdominal patients. Regarding follow-up oncologic work-up in colorectal metastatic disease a venous dominant phase might be the optimal protocol. Regarding contrast optimization, the traditional concept of imaging, where the injection duration equals the scanning duration cannot be used without modifications. To ensure adequate vessel opacification as well as soft tissue imaging with fast MDCT acquisitions, the iodine administration rate needs to be increased. This can be achieved either by an increase of injection flow rate or -more conveniently- by using a higher iodine concentration of the contrast medium. Especially for hypervascular tumours, e.g. HCC, a considerably to far higher contrasts can be achieved using higher concentrated contrast material. The overall improvement in precise timing and better visibility enable a comprehensive approach to abdominal imaging in MDCT.
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PMID:Abdominal MDCT: protocols and contrast considerations. 1863 34

Ultrasound is the most commonly used liver imaging modality worldwide. Unfortunately, ultrasound has limited sensitivity in the detection of small tumour nodules. Moreover, ultrasound findings are often non-specific, as there is enough variability and overlap in the appearance of benign and malignant liver lesions to make a definite distinction problematic. Recently, the introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. The advent of second-generation agents that have higher harmonic emission capabilities has been instrumental in improving the easiness and the reproducibility of the examination. Over the past few years, several reports have shown that real-time contrast-enhanced ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast-enhanced ultrasound has entered clinical practice. The guidelines define the indications and recommendations for the use of contrast agents in focal liver lesion detection, characterization and posttreatment follow-up. In this paper, we discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging with regard to four clinical scenarios: (1) characterization of focal liver lesions of incidental detection; (2) diagnosis of HCC in patients with cirrhosis; (3) detection of hepatic metastases in oncology patients; (4) guidance and assessment of the outcome of percutaneous tumour ablation procedures.
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PMID:European federation of societies for ultrasound in medicine and biology (EFSUMB) guidelines for the use of contrast agents in liver ultrasound: what is the impact in clinical practice? 1863 36

Hepatocellular carcinoma is one of the most common cancers worldwide. Several treatment modalities have been proposed, but hepatic resection is still considered the first-line therapeutic option for most of the patient carries of HCC. The proper selection of patients candidate to hepatic resection for HCC and the eradication whenever is possible of the intrahepatic metastases are the most crucial steps for improving the surgical outcome in HCC. This article reviews the current state of the art of the surgical treatment of HCC.
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PMID:Hepatic resection for hepatocellular carcinoma in cirrhosis. 1872 73

We report a long-term survival case of hepatocellular carcinoma with lymph node metastases treated with surgery and radiotherapy. A 71-year-old man was admitted to our department at Kumamoto University Hospital in May 2003 for a treatment of local recurrent HCC after transarterial chemoembolization. CT showed an infiltrative type tumor, 2.5 cm in diameter, in the segment 8 of the liver. We treated the liver tumor with a right paramedian sectionectomy in May 2003. Postoperatively, lymph node metastases and recurrent HCC were diagnosed. Three times of local ablation therapies for recurrent HCC, twice lymph node dissections, and twice radiotherapies for lymph node metastases were successfully achieved. The patient survived without recurrence for 60 months after the initial hepatectomy.
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PMID:[A long-term survival case of hepatocellular carcinoma with lymph node metastases treated with surgery and radiotherapy]. 1910 35

Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. Metastasis to spleen is mostly via hematogenous metastasis, direct metastasis to spleen was very rare. We report a case of P-HCC presenting as a left upper abdominal lesions which involved the spleen that was actually a P-HCC with splenic metastasis. This case is unique as P-HCC directly involved the spleen which is not via hematogenous metastasis.
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PMID:Pedunculated hepatocellular carcinoma and splenic metastasis. 1989 Oct 29

A 73-year-old woman was admitted to our hospital for hemorrhagic shock due to HCC rupture and treated by transcatheter arterial chemoembolization (TACE) in July 2007, followed by partial hepatic resection two months later. Multiple pulmonary and remnant liver metastases were detected by CT six months after the surgery. Since treatment with UFT for two months was not effective, the chemotherapy was changed to S-1 100 mg/body/day in June 2008. After S-1 treatment for three months, lung metastases remarkably diminished, as did the serum AFP level. Meanwhile, although the S-1 dose was gradually reduced to 50 mg/body/day due to adverse effects, pulmonary lesions and serum AFP level remained stationary for five months. While there is no established regimen for distant metastases of HCC, S-1 may be effective even at a reduced dose.
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PMID:[A case of multiple pulmonary and remnant liver metastases of hepatocellular carcinoma (HCC) after partial hepatic resection remarkably responding to S-1]. 2015 99


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