Clinical Biochemical and Virological Profile of Hepatocellular Carcinoma

Jayaprakash, S (2008) Clinical Biochemical and Virological Profile of Hepatocellular Carcinoma. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: The incidence of hepatocellular carcinoma varies greatly with geographic location, ethnic background, and sex. For instance, incidence rates among men in sub-Saharan Africa and Asia may be 20 times higher than those among men in the United States (see the map). This disparity between countries is probably related to endemic rates of viral hepatitis and environmental carcinogens. HCC frequently arises in the setting of cirrhosis, appearing 20-30 years following the initial insult to the liver. However, 25% of patients have no history or risk factors for the development of cirrhosis. The extent of hepatic dysfunction limits treatment options, and as many patients die of liver failure as from tumor progression. The prevalence of HCC worldwide parallels that of viral hepatitis and the majority of cases are associated with HBV and HCV. The increase in HCC incidence in the developed world is likely to be a direct result of the HCV epidemic occurring some 20–30 years after the rise in this infection in target populations. Alcohol, genetic hemochromatosis, and rarely primary biliary cirrhosis are associated. Although it is currently one of the most common worldwide causes of cancer death, a major impact on the incidence of HCC should be achieved through current vaccination strategies for hepatitis B virus (HBV) infection, screening and treatment for hepatitis C virus (HCV) infections, and from the reduction of alcoholic liver disease. However, because the latency period from hepatic damage to HCC development is very long, it may be many years until the incidence of HCC decreases as a result of these interventions. HCC is the fifth most common cancer in men and the eighth most common cancer in women worldwide. An estimated 560,000 new cases are diagnosed annually. The incidence of HCC worldwide varies according to the prevalence of hepatitis B and C infections. Areas such as Asia and sub-Saharan Africa with high rates of infectious hepatitis have incidences as high as 120 cases per 100,000 populations. AIM OF STUDY: 1. To study the clinical & demographic pattern of hepatocellular carcinoma in our centre. 2. To study the biochemical parameters &imaging characteristics of hepatocellular carcinoma. 3. To analyze the virological pattern of HCC with the help of serology. MATERIALS AND METHODS: This is a prospective observational study conducted in Government Rajaji Hospital, Madurai from July 2006 to April, 2007. All patients with clinical and biochemical evidence of cirrhosis were screened with Abdominal ultrasonogram and serum alpha-fetoprotein estimation. A total of 45 cases were selected for the study from department of Medicine, and department of Medical gastroenterology based on the following criteria proposed by British society of Gastroenterology. Inclusion criteria: • All patients with histopathological evidence of hepatocellular carcinoma in Liver biopsy. • Any patient with mass lesion (>2cm) in liver with • Serum Alpha-fetoprotein level more than 400ng/ml. • Rising AFP levels even if the value is less than 400ng/ml. Exclusion criteria: • Any liver mass (<2cm) with normal alpha-fetoprotein level. • Any liver mass with primary malignancy of GIT, Testis, Breast, and Lung. CONCLUSIONS: 1. We conclude that hepatocellular carcinoma is not an uncommon malignancy in south India. 2. Hepatocellular carcinoma has a Predominantly Male Preponderance. The major occurrence of HCC is in the sixth decade. 3. Commonest symptoms found are abdominal pain & swelling, anorexia, weight loss, jaundice, and fever. 4. Commonest signs are Hepatomegaly, Ascites, and Splenomegaly. Jaundice at presentation is not uncommon. 5. Majority of cases of HCC occur in the background of cirrhosis. Nearly half of the patients present with esophageal varices. 6. Commonest site of tumor is right lobe of the liver. 7. Majority of cases are in decompensated stage of cirrhosis and inoperable at presentation. 8. HBV infection is the leading cause of HCC in our study. The importance of occult HBV infection is also emphasized in this study. 9. Majority of cases present with significant elevation of alphafetoprotein. This helps to make the diagnosis without the need for liver biopsy. 10. The clinical, biochemical and virological profile of hepatocellular carcinoma in south India is similar to data from north India.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical ; Biochemical ; Virological Profile ; Hepatocellular Carcinoma.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 10 Mar 2018 05:00
Last Modified: 10 Mar 2018 05:00

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