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肝癌肝昏迷医学知识讲座专家讲座.pptx

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PartfourDiseasesofDigestiveSystemChapter15HepatocellularCarcinomaOverviewDefinitionHeaptocellularcarcinoma(HCC)originatedinthelivercellsorintrahepaticbileductcells.Incidencerate14.58~46/100,000.HCCisupto2~5timesmorecommoninmenthanwomenandusuallyarisesinacirrhoticliver.ChronicliverdiseaseAflatoxinDrinkingWaterPollutionOtherfactorsChronicliverdiseaseviralhepatitis1.HBV:HBV-DNAmaybeintegratedintothehostDNAoflivercells,andchangesgeneexpressioninlivercells.2.HCVCirrhosisAbout50~90%ofHCCaccompaniedcirrhosis.Acuteandchronichepatitis→Cirrhosis→HCCAflatoxinB1DrinkingWaterPollution:AlgaetoxincouldcontaminatewatersourcesChemicalcarcinogens:nitrite,organicchlorinepesticidesParasite:liverflukePathologyMorphologicaltypingBlocktype(>5cm)Nodulartype(＜5cm)DiffusetypeSmallhepatocarcinoma(＜3cm)CellclassificationHepatocellularBileductcelltypemetastasis1.Intrahepaticmetastasis2.Extrahepaticmetastasis（1）Hematogenousmetastasis（2）Lymphaticmetastasis（3）implantationmetastasisSubclinicalhepatocellularcarcinoma:WithoutanysignsandsymptomsAFPhepaticregionpain:PersistentpainordullpainProgressiveenlargeliver:Qualityhard,unevensurface,noduleorgiantblocks,raggededge,tenderness,vascularmurmurJaundiceCirrhosissymptomsandsigns:liverdysfunctionandPortalhypertension:SuchasSplenomegaly,ascites,collateralcirculationSystemicmanifestationsofmalignanttumors:Fatigue,weightloss,cachexia,fever,anorexiaMetastasisfeatures:thelung,bone,chestParaneoplasticsyndrome:suchashypoglycemia、ErythrocytosisandsoonSYMPTOMS（一）Detectionoflivercancermarkers1.Alpha-fetoprotein(AFP)ClinicalSignificance:livercancercensus(high-riskgroups),diagnosis,JudgingtreatmentandrelapseAFPdiagnosticcriteriaforlivercancerAFP>500μg/L>4WAFP:FromlowtohighAFP>200μg/L>8WFalsepositive:Pregnancy,chronichepatitis,cirrhosis,GonadalblastomaFalse-negative:DetectionofAFPheterogeneity2.Otherlivercancermarkerr-glutamyltransferaseisoenzymepeptide（r-GT）abnormalprothrombin（APT）seruma-l-fucosidase(AFU)ALPisoenzyme（ALP-I）（