Evaluation of Clinical and Laboratory Parameters in patients with Hepatocellular Carcinoma.

Mahadevan, B (2009) Evaluation of Clinical and Laboratory Parameters in patients with Hepatocellular Carcinoma. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Hepatocellular carcinoma (HCC) is a major health problem responsible for fifth most common neoplasm in the world, and third most common cause of cancer related deaths. Age adjusted incidence is 5.5 – 14.9 per 100,000 population worldwide. Age adjusted incidence for HCC in developing countries are two to three fold higher than those in the developed countries. Almost 80% of liver cancers occur in developing countries like Asia and Africa. A rise in the incidence of mortality from HCC has been observed in different countries. Approximately 77% of deaths from HCC occur in developing countries. The prognosis of HCC is dismal with 5-year survival being 1–4%.3 Global distribution of HCC is very variable. Most Western countries have a low HCC incidence (<5 cases/ y/100,000), but most Asian countries have an intermediate (5–15 cases/y/1,000,000) or high (>15 cases/y/100,000) incidence of HCC. v Low incidence of <5 cases/y/100,000 of population has been reported from India.vi This low incidence is in contrast with the widespread contamination of foods with mycotoxins and the moderately high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) related chronic liver disease in India, which are considered as the most important risk factors for the development of HCC worldwide. In India, the mean incidence of HCC in four population-based registries is 2.77% for males and 1.38% for females. The prevalence of HCC in India varies from 0.2% to 1.6%. Hepatitis B virus infection is the most common etiologic factor in high incidence areas, while hepatitis C infection is more prevalent in the low incidence areas. Unlike other low incidence zone, in India HBV is the main etiological factor associated with HCC. In the west, majority of HCC are diagnosed incidentally during routine evaluation. However, in India, most of the patients in clinical practice present at an advanced stage ruling out curative treatment in most cases. Despite India being a low incidence zone for HCC, the estimated HCC cases in 2001 was 12 750.7 However, there is paucity of published literature on profile of HCC patients in India, making formulation of a proper health care strategy difficult. Most of the published literatures were retrospective studies and moreover limited number of studies available for South Indian population. Hence we have undertaken this study to analyze the characteristics of HCC, especially with regard to their clinical, etiological, radiological and cytohistological profile. AIMS & OBJECTIVE OF THE STUDY : The study was conducted with the objective of a) To study the clinical, etiological, radiological and cytohistological profile in patients with Hepatocellular carcinoma. b) To identify the association between serum alpha fetoprotein with stage of the disease. CONCLUSION : 1. The study includes total of seventy two patients, mean age was 54 years with male female ratio of 3:1. 2. Nearly half of the patients belong to the age group of 60 to 70 years. 3. Mean preadmission duration of illness was 54 days. 4. Twenty two percent of patients had cirrhosis and asymptomatic hepatocellular carcinoma (HCC) observed only in 2 cases. 5. Among the symptoms abdominal pain (66.7%) and weight loss (66.7%) were most commonly observed symptoms. 6. Hepatic decompensation was seen in half the patients at first presentation with ascites in 56.9%, jaundice in 22.2% and hepatic encephalopathy in 4.2% of patients. 7. Abdominal lump as a presentation observed in 12.5% of patients. 8. Hemorrhagic ascites noted in 11.1% of our cases. 9. The median serum AFP value of 515 ng/ml (range 1.3–92625) observed in the study population. Diagnostic value of AFP >400 ng/ml was present in only 61.5% cases with normal AFP in 14 of 70 (18.5%) patients. 10.More than three fourth of cases had esophageal varies with gastric varices of 8.3%. 11. HBV was the most common viral etiologic agent associated with HCC, observed in 23 of 52 (31.9%). Alcohol or HCV alone as an etiological agent was observed in 20.8% and 9.7% of cases respectively. 12. The average size of HCC was 6±4 cm (mean±SD). Very large tumors (>5 cm) were seen in two-third of cases. 13.CT appearance of HCC was hypo dense in 21.4%, mixed or heterogeneous density in 52.4% and hyper dense in 26.2% patients. 14.Vascular invasion of either major branch of splenoportal axis was seen in one fifth of the patients. 15. Diagnosis of HCC was made based on cytohistology in 31/36 (86.1%) patients. 16. More than three-fourth of HCC was in Okuda stage 2 (72.8%). Only five patients had Okuda stage 1 lesion. More than ninety percent of patient had CLIP score of ≥2. The serum AFP level was not associated with different stages of Okuda and CLIP Score (P >0.05, NS).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical ; Laboratory Parameters ; patients ; Hepatocellular Carcinoma.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:07
Last Modified: 13 Jul 2017 04:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/1557

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