a12. hepatoma (hcc)

7/28/2019 a12. Hepatoma (HCC)

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ANATOMI HATI

T.D. 2 LOBUS : KANAN & KIRI.

LOBUS KIRI SEG. LATERAL .SEG. MEDIAL .

BATAS LIG . FALSIFORMIS.

LOBUS KANAN SEG. ANTERIOR .SEG. POSTERIOR.


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This is the external surface of a normal liver.

The color is brown and the surface is smooth.

A normal liver is about 1200 to 1600 grams.


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Surgical Treatment of HCC Budi Irwan 5


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METABOLISME GARAM EMPEDU,PIGMENEMPEDU

METABOLISME KARBOHIDRAT

PEMBENTUKAN UREA,PENYIMPANAN

PROTEIN(ASAMAMINO),METABOLISME

LEMAK,KETOGENESIS SINTESIS

KOLESTEROL,DAN PENIMBUNAN LEMAK

PENIMBUNAN VITAMIN DAN MINERAL METABOLISME STEROID

DETOKSIFIKASI

GUDANG DARAH DAN FILTRASI


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KHS (KARSINOMA

HEPATOSELULAR),HEPATOMA PRIMER DR

SEL HEPATOSIT

KARSINOMA

KOLANGIOSELULAR,HEPATOMA PRIMER

YANG BERASAL DARI EPITEL SALURAN

EMPEDU INTRAHEPATIK KARSINOMA CAMPURA HEPATOSELULAR

DAN KOLANGIOSELULAR


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TIPE MASSIF,PD SATU LOBUS DAN HANYA

SATU NODUL SAJA

TIPE NODULER,PALING SERING

DIJUMPAI,HATI MEMBESAR,NODUL YG

BANYAK (IRREGULER)

TIPE DIFFUS,UMUMNYA SEL HATI MASIH

DALAM BATAS NORMAL TETAPI TERISI OLEHSEL KARSINOMA YG DIFFUS


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TUMOR HATI PRIMER ( HEPATO CELLULAR

CARCINOMA ) AS, JARANG DISTRIBUSI DENGAN ANGKA KEJADIAN

TERTINGGI DI ASIA TIMUR,SUB SAHARA

AFRIKA DAN MELANESIA,

JARANG DITEMUKAN PADA USIA MUDA

INSIDENS MENINGKAT PADA USIS TUA


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Hepatocellular carcinoma (HCC) a primarymalignancy of the liver, hepatocellularorigin HCC is a major cause of death from cancerin Eastern Asia and sub-Saharan Africa HCC causes 662,000 deaths per year,about half of them in China. Males >> females Age of 30 to 50.


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HBV

70-90% of chronic cases in cirrhosis Treatment decrease risk

HCV 1-3% of HCV develop HCC

Treatment decrease risk Co-infection Aflatoxins (Aspergillus fumigatus)

4 fold increased risk HCC

Alcohol >50-70g/day Synergist with HCV and HBV

Nonalcoholic Steatohepatitis?

El-Serag, H.B. and K.L. Rudolph, Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology, 2007. 132(7): p. 2557-76.Brunetto M.R., O.F., Koehler M., et al., Effect of interferon-alpha on progression of cirrhosis to hepatocellular carcinoma: a retrospective cohort study.

International Interferon-alpha Hepatocellular Carcinoma Study Group. Lancet, 1998. 351(9115): p. 1535-9.


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Obesity

Diabetes Mellitus

Hemochromatosis Alpha-1 antitrypsin deficiency

Autoimmune hepatitis

15-50% of HCC in the US have noestablished risk factors


15/43Thorgeirsson, S.S. and J.W. Grisham, Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet, 2002. 31(


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HCC with cholangiolar features, moderately

differentiated


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Hepatic Fibrosis

Cirrhosis Liver Cancer

Healthy Liver


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Hepatic Fibrosis

Cirrhosis Liver Cancer

Healthy Liver


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KANKER HATI

20% infeksi kronis 80%Infeksi HCV: kronis

berakhir dengan sirosis

25% sirosis berakhir

dengan kanker hatiatau gagal hati

Kelompok Risiko Tinggi HCV:

Pengguna Narkoba Suntik

Penerima Transfusi

Pasien terpapar alat medis

yang tak steril


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Here is another example of macronodular cirrhosis. Viral hepatitis (B or

C) is the most common cause for macronodular cirrhosis. Wilson's

disease and alpha-1-antitrypsin deficiency also can produce a

macronodular cirrhosis.


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METASTASE TUMOR HATI DIAFRAGMA PERI PORTAL LIMPH NODE

PARU - PARU

TULANG

ADRENAL

OTAK


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D/ SUBKLINIS HEPATOMA,STAD.DINI,TANPA

GEJALA DAN TANDA FISIK YG JELAS

D/NON INVASIF

D/PATOLOGIS


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1. Clinis2. Imaging3. Blood level of alphafetoprotein4. Needle biopsy


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RIWAYAT ALKOHOL ATAU SIROSIS

RASA SAKIT ATAU TIDAK ENAK

TERABA MASSA

BERAT BADAN MENURUN

ASITES

JAUNDICE

ANOREKSIA,PERUT GEMBUNG

LETIH,BERAT BADAN MENURUN,

PERDARAHAN


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DIAGNOSA

AFP MENINGGI 50 90 % . TUMOR KECIL BISA NORMAL / SDKT . AFP JUGA BISA ME PADA SIROSIS HATI .

TIDAK BERMAKNA.

MONITOR KEBERHASILAN RESEKSI

KURATIF.AFP


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PARA NEOPLASTIC COMPLIKASI :HIPOGLISEMIA

HIPERKALSEMIA

ERITROSITOSIS

HIPERTROFI PULMONARI

OSTEOARTROPATI


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CT Scan MRI Preferred USG Nuclear Medicine Angiography Less usefull Plain film


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BIOPSI

USG . STAGING .

STAGING SYSTEM HCC ( AJCC )

KLASIFIKASI TNM


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TNM SISTEM,OKUDA,MORPHOLOGY,MET,VI

OKUDA SISTEM, BILLIRUBIN,ALB,ASC

CLIP (CANCER OF THE LIVER ITALIAN

PROGRAM),CHILD PUGH

JIS SCORE (JAPAN INTEGRATED STAGING)

BCLC(BARCELONA CLINIC LIVER CANCER)

,CHILD PUGH,PH,BILLIRUBIN


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STAGE GROUP

- STAGE I T 1 N0 M0

- STAGE II T2 N0 M0

- STAGE III T3 N0 M0

T 1-3 N1 M0

- STAGE IVa T4 Any N M0

- STAGE IVb Any T Any N M1


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PENATALAKSANAAN :

TERAPI DEFINITIF

OPERASI

HANYA 10 30 % MASIH OPERABLE HANYA 50 70 % YANG CURATIVE

KRITERIA NON OPERATIF :

ADA PENYAKIT EKTRA HEPATIK

GANGGUAN FUNGSI HATI BERAT MASA TUMOR YANG MASIF

V. PORTA ATAU V. CAVA SUDAH TERLIBAT

KONTRA INDIKASI RELATIF


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HEMANGIOMA

ABSESS HEPAR

TUMOR METASTASE


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TERAPI OPERASI

RESEKSI

TRANSPLANTASI HATI

TERAPI NON OPERATIP

RFA (RADIO FREKWENSI ABALATIO) INJ.ETANOL MRNI (95%),INTRA TUMOR

PERKUTANTAS


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KEMOEMBOLISASI ARTERI HEPATIK

PERKUTANERAPI OPERASI

KEMOTERAPI SISTEMIK

RADIOTERAPI

TAMOXIPEN

INJ.ASAM ASETAT PERKUTAN

SORAFENIF (95%)


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Treatment modality

1. Livertransplantation

2. Hepatic resection3. Thermal ablation

(Radiofrequency,microwave,la

ser)

4. Cryotherapy

Limitations

1.Donor avaibility, Three orfewer lesions, none > 3 cm ,

Solitary lesion < 5 cm2.Minimal or no cirrhosis, threeor fewer lesions

3.Three or fewer lesions, each

a12. hepatoma (hcc)

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