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Query: UMLS:C0345904 (liver cancer)
 15,188 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A cholestatic syndrome secondary to extrahepatic biliary obstruction as the presenting manifestation of hepatocellular carcinoma is described in three cases. The mechanism is related to the invasion of intrahepatic bile ducts by the carcinoma. The consequent mechanical obstruction is due to either a continuous distally growing tumor cast of the biliary tree, distal migration of a necrotic tumor fragment, or hemobilia. In the cirrhotic patient with a predisposition for the development of liver cancer, the physician should be aware of the presentation with obstructive jaundice as a mechanical complication of hepatocellular carcinoma.
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PMID:Obstructive jaundice caused by hepatocellular carcinoma. Report of three cases. 21 Jun 57

Serum glutathione reductase activity was measured in various conditions including acute hepatitis, chronic hepatitis, liver cirrhosis, malignant neoplastic diseases, and obstructive jaundice. A statistically significant elevation of the enzyme activity was found in all of these clinical conditions above normal value, especially in patients with acute hepatitis, some liver cancer, and malignant biliary obstruction. Comparison with other liver function tests showed the existence of statistically significant correlations of serum glutathione reductase with SGOT, SGPT and alkaline phosphatase in acute hepatitis, and with alkaline phosphatase in cirrhosis. In parenchymatous liver disease, serial determination was found to be important. High values in obstructive jaundice suggest the malignant obstruction.
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PMID:Clinical significance of serum glutathione reductase in various clinical conditions, especially in liver diseases. 125 42

737 samples of sera were determined for gamma-glutamyl transtidase Iscenzyme (PGGT). The samples were obtained from 121 healthy adults, forty pancreatic-head-cancer patients, and 576 patients with other hepato-biliary-pancreatic diseases. The positive rates of PGGT greater than 4u/l and PGGT/TGGT greater than 0.1 were 62.5% (25/40) in pancreatic-head-cancer patients, 27.02% (10/37) in patients with non-pancreatic extrahapatic-biliary-duct malignant obstructive jaundice, 1.21% (1/82) in patients with benign extrahepatic-biliary duct obstructive jaundice (biliary stones), 1.29% (1/77) in liver cancer patients, and 0% (0/380) in patients with other general surgical diseases, respectively. The positive rate of PGGT greater than 4u/L and PGGT/TGGT greater than 0.1 was significantly higher in patients with pancreatic head cancer than in patients with hepato-biliary-duct obstructive jaundice (including benign and malignant diseases) and liver cancer (x = 99.45, p less than 0.001). The study showed that the serum TGGT was mainly of hepatic origin, and its level was elevated in patients with pancreatic or/and biliary diseases, which resulted in the obstruction of the pancreatic duct and bile duct at the same time. Hence, the serum PGGT greater than 4u/L together with POGT/TGGT greater than 0.1 was mainly found in patients with pancreatic head cancer.
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PMID:[Clinical values of serum PGGT (pancreas gamma-glutamyltranstidase and PGGT/TGGT ratio in diagnosis of cancer of the head of pancreas]. 167 66

Percutaneous ethanol injection therapy, a kind of non-vascular intervention, has recently been high-lighted as an effective therapy for small liver cancer. According to our experience, results of this therapy were excellent in cases where the amount of ethanol injected could be elevated over 1.5 times the estimated tumor volume. This result indicates that treatment with ethanol injection alone should be confined to small hepatocellular carcinoma with diameter below 3 cm. In patients with hepatocellular carcinoma who do not sufficiently respond to transcatheter chemoembolization, the combined use of ethanol injection therapy can improve therapeutic results. That is, ethanol injection therapy is indicated in cases where tumor has collateral blood supply other than hepatic artery, cases where hepatic artery has been obstructed, and cases where Lipiodol used for trans-catheter chemoembolization cannot be retained in tumor tissue. Furthermore, cases of giant hepatocellular carcinoma or tumor accompanied by obstructive jaundice have sometimes been treated with a combination of incomplete chemoembolization and ethanol injection therapy. Even in patients showing intraportal tumor thrombus, ethanol injection effectively relieved the thrombus.
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PMID:[Percutaneous ethanol injection therapy for hepatocellular carcinoma]. 216 75

The usefulness of the serum aspartate aminotransferase (AST): serum alanine aminotransferase (ALT) ratio as a guide to the presence of alcoholism was evaluated in four groups of patients. In alcoholics with elevated transaminases the mean AST:ALT ratio was found to be 1.50 (95% confidence interval (CI): 1.49-1.51), in hepatitis B infection 0.51 (95% CI: 0.50-0.52), in liver cancer 1.25 (95% CI: 1.20-1.29), and in nonmalignant obstructive jaundice 0.59 (95% CI: 0.57-0.61). In alcoholics with normal transaminases the AST:ALT ratio was 1.64 (95% CI: 1.61-1.67). The combination of an AST:ALT ratio of greater than 1.00 with an erythrocyte mean cell volume (MCV) above 90.0 fL resulted in a sensitivity of 97.3% and a specificity of 88.9% for detecting alcoholism in these four groups of patients.
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PMID:A combination of raised serum AST:ALT ratio and erythrocyte mean cell volume level detects excessive alcohol consumption. 238 15

Fifty-nine colorectal cancer patients with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to February 1989 were reviewed. Excisions of metastatic liver cancer were performed in 36 patients and 23 had nonresectable metastatic liver cancer. Catheter troubles, including severe infections (8), extravasations (3), obstruction (1) and other (1) occurred in 13 (22.0%) patients, and 6 patients (10.2%) were unable to receive IAIC. Three patients did not undergo IAIC because of hepatitis or other reasons. Serious complications following IAIC, including sclerosing cholangitis (SC) (6), extravasations (6) and obstructions (3) were observed in 15 patients (30.0%). 5-Flourouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps weekly or every two weeks. Total infused doses of 5-FU ranged from 7,000 to 26,250 mg (mean: 11,800 + 7,700 mg) and those of MMC from 24 to 84 mg (mean: 45.3 + 25.8 mg) in 6 patients (12%) with SC, 4 resectable and 2 non-resectable cases. All six patients with SC had cholangiographic abnormalities of the biliary tract by endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), but serial CT examination of the liver did not show any progression of the tumor at the hilum in these patients. Segmental stricture at the common hepatic duct and bifurcation appeared specific to IA-5-FU induced SC. Obstructive jaundice occurred in 3 patients. Four patients had epigastralgia and 3 exhibited elevated alkaline phosphatase level prior to the cholangiographic examination. The elevated level of alkaline phosphatase was reversible in one patient without obstructive jaundice. Although the relation of the sclerosing process to IA-5-FU dose is not yet clear as well as IA-FUDR, it should be important to make an early detection of SC by ERCP and also to discontinue IAIC as soon as possible. In our opinion, SC may relate to the arterial delivery of 5-FU. In order to prevent SC, devascularization of the right hepatic artery via surgical procedures may well be effective, because retrograde flow from the right hepatic artery was confirmed by several clinical and anatomical studies.
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PMID:[Complications of intra-arterial infusion chemotherapy in patients with colorectal cancer with liver metastasis, with special reference to IA-5-FU induced sclerosing cholangitis]. 250 36

Thirty-eight colorectal cancer patients (pts) with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to April 1988 were reviewed. Excisions of metastatic liver cancer were performed in 23 pts and 15 pts had nonresectable metastatic liver cancer. Catheter troubles including infections and obstructions occurred in 7 pts, and 4 pts (10.5%) were unable to receive IAIC. Fifteen resectable cases and 12 nonresectable cases were discussed. 5-Fluorouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps every week. Total infused doses of 5-FU and MMC were 0.5-12.2 g (mean, 5.3 +/- 3.8 g) and 4-144 mg (mean, 51.1 +/- 41.9 mg) in pts with 15 resectable cases, whereas 1.5-20.7 g (mean, 7.8 +/- 3.8 g) and 18-128 mg (mean, 49.7 +/- 29.2 mg) in 12 nonresectable cases. Four of 34 pts (11.8%) with IAIC had major complications; 2 obstructive jaundice, 1 gastric perforation, 1 toxic dermatitis. Four pts (26.7%) had recurrent liver cancer during 6-20 months follow-up after hepatic resection. Three of 12 nonresectable pts were responders (25.0%). Two completely and another partially responded. Another study is needed to clarify the effect of IAIC in survival. IAIC should be done not only for the treatment of nonresectable metastatic liver cancer, but also for resectable metastatic liver cancer in pts with colorectal advanced cancer.
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PMID:[Results of intra-arterial infusion chemotherapy in colorectal cancer patients with metastatic liver cancer]. 313 79

Patients with jaundice and hyperbilirubinemia over 34 mumol/l have been examined by different methods in order to assess the diagnostic value of the methods. 340 patients were examined clinically and by laparoscopy, 168 patients and 92 healthy persons were examined by 10 laboratory indices, 639 patients--by ultrasonography, 95 patients--by scintigraphy, 116 patients--by computer tomography, 83 patients--by endoscopic retrograde cholangio-pancreatography (ERCPG), 17 patients--by percutaneous transhepatic cholangiography (PTC), 70 patients--by directed liver biopsy. In the patients with cholestasis the 5'-nucleotidase, alkaline phosphatase, glutamyl transpeptidase (lipoprotein X is positive in 92% of the patients) and cholesterol are increased most. The extrahepatic obstructions are diagnosed by ultrasonography in 94.8% of the patients (the biliary ducts are dilated), in 88.7% of the patients the localization of the obstruction and in 74.7% of the patients the cause of the obstruction are found. In parenchymal jaundice the sonography reveals the disease which has caused jaundice in 62.1% of the patients. The scintigraphy gives correct diagnosis in 50% of the patients with hepatitis and jaundice, in 78% of the patients with cirrhosis and jaundice and in 87.5% of the patients with liver cancer. The computer tomography reveals the obstructive jaundice in 94.7% of the patients and the focal processes in the liver in 96.7% of the patients. The ERCPG gives a clear picture of the biliary ducts in 72.28% and of the pancreatic duct in 83.13% of the patients with jaundice, simultaneously the biliary and the pancreatic ducts--in 45.78% of the patients and correct diagnosis in 83.1% of the patients examined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Differential diagnosis of jaundice]. 343 27

Nine (1.66%) out of 542 cases of HCC treated surgically in our hospital between 1985 and 1992, had macroscopic bile duct thrombi. Three cases presented preoperatively with obstructive jaundice. Two of these received thrombectomy in the hilar bile duct and died of hepatic insufficiency on postoperative days 10 and 66, the other case underwent extended left lobectomy, but also died of renal failure and sepsis 3 months after the operation. In addition, we also treated 6 cases diagnosed at earlier stages than those presenting with obstructive jaundice with both hepatectomy and thrombectomy. In these patients the outcome was as follows: 2 died of recurrent HCC 3 months and 16 months, respectively, after operation, 1 died of apoplexy with no recurrence after 19 months, 1 had a recurrence 5 months after the operation, but is still alive after 7 months, and 2 are still alive 24 months and 60 months after surgery with no recurrence. The outcome is still poor in our series with obstructive jaundice. But in this report, we propose radical surgical treatment for HCC with bile duct thrombi in accordance with our classification, especially for those cases without obstructive jaundice.
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PMID:Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. 795 70

Five patients with primary liver cancer presented with obstructive jaundice due to extension of tumour thrombus into the biliary ducts. Three patients had hepatocellular carcinoma, two of whom had alcoholic cirrhosis, and the other two had a peripheral cholangiocarcinoma. Preoperative diagnosis of biliary thrombus was best achieved by ultrasonography and computed tomography which showed peripheral hepatic tumour with dilated bile ducts containing dense material. All patients underwent liver resection associated with biliary exploration, clearance and T-tube drainage. Major hepatectomy was required in four cases. There were no postoperative deaths; one patient developed a subphrenic collection of bile which was drained percutaneously. All patients survived more than a year; median survival was 29 months. There are two long-term survivors without recurrence at 29 and 80 months. Patients with primary liver cancer and jaundice due to migrated tumour fragments in the common bile duct may benefit from surgical resection which can result in long-term resolution of symptoms and occasional cure.
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PMID:Surgery for biliary obstruction by tumour thrombus in primary liver cancer. 918 20


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