1. “Hepatocellular Carcinoma” (HCC) By Faiza Asghar

2. Cancer Mutation  Un - controlled cellular growth  Tumor!! Benign Tumors Malignant

3. Cancer in Progress…

4. Liver Cancer BenignMalignant Primary e.g. Cholangio carcinoma Hepatocellular carcinoma Angiosarcoma Secondary

5. Etymology  Chronic, primary liver cancer.  Starts in hepatocytes.  Metastatic; spreads through blood stream and lymphatic system.  More frequent in men especially, in cirrhotic patients.

7. Statistics  Common in Asia, China, Japan, U.S., Africa, Latin America, and Eastern European countries.  6 th most common cancer in the world.  5 th most common disease in men.  8 th most common disease in women.  HCC rate in Pak. is 2.69%/Yr.

9. Etiology

11. Disease Mechanism Mutation  inactivation of tumor repressor genes and cell cycle regulators  activation of oncogenic pathways. Two steps: 1.Activation of specific pathways triggering proliferation of cancer e.g. EGFR, IGF, MAP kinase, Wnt, mTOR etc. 2.Activation of generic mechanisms involved in all types of cancers e.g. VEGFR, Insensitivity of apoptosis, Inactivation of cell cycle check points, Preserving unlimited replicative potential.

12. Mol. Biology involved…  α1 -antitrypsin deficiency.  Lower expression of p27kip1 protein.  Integration of viral proteins (HBV, HCV).  Telomerase is active in 90% of human HCC. It appears to be necessary for the immortal proliferation capacity of HCCs.  Research still going on…

13. Symptoms 1.Weight loss. 2.High level of AFP & ALP. 3. 4. 5. Anorexia Hepatomegaly Jaundice

14. Continued… 6. 8. 9. 7. Abdominal Fluid (Ascites ) Nausea Abdominal Pain Fatigue

15. Diagnosis  Full physical exam.  Ultrasonography.  M.R.I.  C.T scans etc. M.R.I CT Scan

16. Continued…  Biopsy.  L.F.T.  A.F.P serology. Biopsy L.F. T

17. Clinical Treatment  Tumor ablation. i.RFA ii.Ethanol injection iii.Cryotherapy etc.  TACE.  Partial hepactomy.  Endoscopic palliation.  Liver transplant.

18. Cryotherap y Chemo- embolizatio n RFA

19. Prevention  Vaccination against HBV & HCV.  Regular screening.  Balanced diet.  Regular exercise.  No alcohol.  No food storage!

20. BioTech Services... Ongoing Research for Molecularly targetted drugs. e.g. Sorafenib, Nexavar. DNA microarray to determine recurrence %age in future. Telomerase inhibition to impair proliferation or using it as an anticancer agent. Development of new markers to improve screening for early lesions. Antibody treatment against HCC surface markers have been reported to lower recurrence rates after liver transplantation. R