scholarly journals Análise das características associadas à dificuldade de rastreamento e diagnóstico precoce do carcinoma hepatocelular em pacientes de risco / Analysis of features associated with difficulty in screening and early diagnosing hepatocellular carcinoma in risk patients

2021 ◽  
Vol 66 (1u) ◽  
pp. 1
Author(s):  
João Eugênio Loureiro Lopes ◽  
Júlia Antunes Rizzo Bicalho ◽  
Lívia Zardo Trindade ◽  
Mariana Poltronieri Pacheco
Keyword(s):  
Hepatocellular Carcinoma ◽  
Early Diagnosis ◽  
Treatment Options ◽  
Chronic Liver ◽  
Screening Tests ◽  
Curative Treatment ◽  
Malignant Liver Tumor ◽  
Cross Sectional ◽  
Risk Patients ◽  
Lack Of Knowledge

Introdução: O carcinoma hepatocelular (CHC) é o tumor maligno primário mais comum do fígado. Através do rastreamento semestral com ultrassonografia (USG) abdominal e alfafetoproteína (AFP), em pacientes de risco, seu diagnóstico pode ser realizado de maneira precoce, quando há propostas de tratamento curativo. Entretanto, a existência de inúmeras barreiras de acesso aos exames de rastreamento do CHC impacta negativamente no prognóstico dos pacientes portadores de hepatopatias crônicas. Objetivo: O estudo teve como objetivo avaliar os determinantes que dificultam o acesso ao rastreamento e diagnóstico precoce, através da USG abdominal, em pacientes de risco para CHC ou já diagnosticados com a neoplasia. Métodos: Trata-se de um estudo descritivo e transversal, onde, para avaliar os principais fatores associados a essa dificuldade nos pacientes, foi aplicado um questionário  que aborda estes fatores mais prevalentes. Resultados: Durante o período de estudo, 60 pacientes foram abordados. Em uma primeira análise, foi observado que a maioria dos pacientes era do sexo masculino (54%) e idade média de 59 anos. Da doença hepática crônica, a etiologia mais observada foi álcool (48%) seguida da infecção pelo vírus C (32%). Apesar de 42,86% dos pacientes negarem dificuldades para realização dos exames de rastreio, fatores como financeiro (12,50%) e desconhecimento da doença (10,71%) foram apontados como dificultadores. Dos pacientes com CHC, foi notado que, ao diagnóstico, 62,5% não tinha perspectiva de tratamento curativo. Discussão: Quando diagnosticado precocemente, o CHC possui opções de tratamento curativo, como o transplante hepático, com intuito secundário de garantir melhor qualidade de vida ao paciente. Entretanto, a dificuldade de acesso ao exame ou o desconhecimento da doença retardam o acompanhamento deste paciente e, consequentemente, limitando as estratégias terapêuticas. Conclusão: A ação conjunta dos diferentes níveis de atenção de saúde para solucionar os principais problemas envolvidos na dificuldade de rastreio para o CHC podem auxiliar no diagnóstico precoce do câncer e, portanto, opções de tratamento curativo ao paciente.Palavras chave: Carcinoma hepatocelular, Rastreamento, Diagnóstico precoce, Detecção precoce do câncer, Fatores de riscoABSTRACTIntroduction: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Through semester screening with abdominal ultrasound (US) and alpha-fetoprotein (AFP) in high-risk patients, its diagnosis can be performed early, when there are proposals for curative treatment. However, the existence of access barriers to HCC screening tests negatively impacts the prognosis of patients with chronic liver diseases. Objectives: The study aimed to evaluate the determinants that hinder access to screening and early diagnosis, through abdominal US, in patients at risk for HCC or already diagnosed with the cancer. Methods: Descriptive and cross-sectional study where, to assess the main factors associated with this difficulty in patients, a questionnaire was designed that addresses the most prevalent factors. Results: During the study period, 60 patients were evaluated. In a first analysis, it was observed that most patients were male sex (54%) and mean age was 59 years. Of the chronic liver disease, the most observed etiology was alcohol (48%) followed by hepatitis C virus infection (32%). Although 42.86% of patients deny difficulties in performing the screening tests, factors such as financial (12.50%) and lack of knowledge about the disease (10.71%) were identified as hindering factors. Of the patients with HCC, it was noted that, at diagnosis, 62.5% had no prospect of curative treatment. Discussion: When diagnosed early, HCC has curative treatment options, such as liver transplantation, with the secondary aim of guaranteeing better quality of life for the patient. However, difficult access to the exam or lack of knowledge about the disease delay the follow-up of this patient and, consequently, limit therapeutic strategies. Conclusion: A joint action of different levels of health care to solve the main problems represented in the difficulty of screening for HCC can help in the early diagnosis of cancer and, therefore, curative treatment options for the patient.Keywords: Hepatocellular carcinoma, Screening, Early diagnosis, Early detection of cancer, Risk factors 

scholarly journals The APAC Score: A Novel and Highly Performant Serological Tool for Early Diagnosis of Hepatocellular Carcinoma in Patients with Liver Cirrhosis

2021 ◽  
Vol 10 (15) ◽  
pp. 3392
Author(s):  
Joeri Lambrecht ◽  
Mustafa Porsch-Özçürümez ◽  
Jan Best ◽  
Fabian Jost-Brinkmann ◽  
Christoph Roderburg ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
At Risk ◽  
Liver Cirrhosis ◽  
Early Stage ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Serum Samples ◽  
Disease Etiology ◽  
Risk Patients ◽  
Scoring Tool

(1) Background: Surveillance of at-risk patients for hepatocellular carcinoma (HCC) is highly necessary, as curative treatment options are only feasible in early disease stages. However, to date, screening of patients with liver cirrhosis for HCC mostly relies on suboptimal ultrasound-mediated evaluation and α-fetoprotein (AFP) measurement. Therefore, we sought to develop a novel and blood-based scoring tool for the identification of early-stage HCC. (2) Methods: Serum samples from 267 patients with liver cirrhosis, including 122 patients with HCC and 145 without, were collected. Expression levels of soluble platelet-derived growth factor receptor beta (sPDGFRβ) and routine clinical parameters were evaluated, and then utilized in logistic regression analysis. (3) Results: We developed a novel serological scoring tool, the APAC score, consisting of the parameters age, sPDGFRβ, AFP, and creatinine, which identified patients with HCC in a cirrhotic population with an AUC of 0.9503, which was significantly better than the GALAD score (AUC: 0.9000, p = 0.0031). Moreover, the diagnostic accuracy of the APAC score was independent of disease etiology, including alcohol (AUC: 0.9317), viral infection (AUC: 0.9561), and NAFLD (AUC: 0.9545). For the detection of patients with (very) early (BCLC 0/A) HCC stage or within Milan criteria, the APAC score achieved an AUC of 0.9317 (sensitivity: 85.2%, specificity: 89.2%) and 0.9488 (sensitivity: 91.1%, specificity 85.3%), respectively. (4) Conclusions: The APAC score is a novel and highly accurate serological tool for the identification of HCC, especially for early stages. It is superior to the currently proposed blood-based algorithms, and has the potential to improve surveillance of the at-risk population.

scholarly journals INCIDÊNCIA HIPOTIREOIDISMO CONGÊNITO EM CRIANÇAS NASCIDAS NOS HOSPITAIS PÚBLICOS DO OESTE PAULISTA

2021 ◽  
Vol 13 (1) ◽  
pp. 01-06
Author(s):  
Franciele Cardoso Leite ◽  
Patricia Martins Luizari Escoboza
Keyword(s):  
Early Diagnosis ◽  
Congenital Hypothyroidism ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Public Hospitals ◽  
Diagnosis And Treatment ◽  
Screening Tests ◽  
Cross Sectional ◽  
Prick Test

Congenital hypothyroidism is a cause of mental retardation and has nonspecific signs and symptoms. Early diagnosis and treatment are essential for the normal development of children affected by this disorder. The objective of this study was to evaluate theincidence of changes in the screening tests of public hospitals in Presidente Prudente, the average age of the newborn at the time of collection of tests and confirmation of the diagnosis. A retrospective cross-sectional study was carried out to assess the data of newborns who underwent the “heel prick test” by the unified health system in 2017. Of the 3,351 evaluated, 48 had elevated levels of Thyroid Stimulating Hormone(TSH), 13 had the diagnosis confirmed congenital hypothyroidism. It was 61.54% the children that returned between days 16 and 30 to confirm the result and 23.07% that returned after 61 days. Early diagnosis and treatment is essential, as they enable mitigating actions for the serious cognitive and behavioral disorders of affected patients.

scholarly journals ALPHA FETOPROTEIN;

2017 ◽  
Vol 24 (05) ◽  
pp. 641-645
Author(s):  
Syed Muhammad Ali Shah ◽  
Zamir Butt ◽  
Muhammad Waqas
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Liver Disease ◽  
Screening Test ◽  
Abdominal Ultrasound ◽  
Alpha Fetoprotein ◽  
Screening Tests ◽  
Cross Sectional ◽  
Score Analysis ◽  
Chronic Hcv

BACKGROUND: Hepatocellular carcinoma (HCC) is a primary tumor of theliver, which develops in the setting of chronic liver disease, particularly in patients with chronichepatitis B and C in almost 80% patients. Although there are no specific screening tests fordiagnosis of HCC but alpha-fetoprotein (AFP) and abdominal ultrasound are commonly used.AFP >400 ng/ml is considered diagnostic for HCC. Objective: The objective of study wasto validate the use of alphafetoprotein as screening test for HCC due to chronic HCV. StudyDesign: Observational cross-sectional. Period: March 2014 to August 2016. Setting: AzizBhatti Shaheed Teaching Hospital Gujrat. Materials and Methods: 134 patients aged >35years having liver cirrhosis due to chronic HCV and diagnosed with HCC using biphasic CTscan were included and were followed for 1 year. Serum AFP was divided in 3 categories anda value < 20ng/ml - normal, 20-399 ng/ml - elevated and >400ng/ml - diagnostic of HCC.Liver nodules size and site was noted and divided in 4 categories. Severity of liver diseasewas calculated using Child Pugh Score. Analysis was done using SPSS 20.0. Results: AFP isdiagnostic (>400 ng/ml) in only 29.9% of patients with sensitivity of 43.3% at cut off value of400 ng/ml and is significantly associated with severity of liver disease. Conclusion: AFP cannotbe used as screening test for HCC in patients with cirrhosis due to chronic HCV. Abdominalultrasound should be used for early detection of HCC due to chronic hepatitis C.

scholarly journals Using Lamin B1 mRNA for the early diagnosis of hepatocellular carcinoma: a cross-sectional diagnostic accuracy study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1339 ◽  
Author(s):  
Amani M. Abdelghany ◽  
Nasser Sadek Rezk ◽  
Mona Mostafa Osman ◽  
Amira I. Hamid ◽  
Ashraf Mohammad Al-Breedy ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Tumors ◽  
Normal Serum ◽  
Chronic Liver ◽  
Mrna Levels ◽  
University Hospitals ◽  
Cross Sectional ◽  
Lamin B1 ◽  
Group I ◽  
Group Ii

Background:  Hepatocellular carcinoma (HCC) is vital medical issue in Egypt. It accounts for 70.48% of all liver tumors among Egyptians. The aim of this study was to determine the diagnostic role of plasma levels of mRNA of lamin B1 by RT-qPCR as an early marker of HCC. Methods: This study was conducted at the Clinical Pathology Department in collaboration with the Department of Tropical Medicine and Infectious Diseases at Ain Shams University Hospitals. It included 30 patients with primary HCC and viral cirrhosis (all were hepatitis C virus-positive) (Group I), in addition to 10 patients with chronic liver diseases (Group II) and 10 healthy age- and sex-matched subjects (Group III). Group I was further classified according to the Barcelona-Clinic Liver Cancer Staging System. Serum α-fetoprotein (AFP) chemiluminescent-immunoassays and RT-qPCR analysis of plasma lamin B1 mRNA levels were performed for all participants. Results: AFP and lamin B1 significantly elevated in patients with HCC compared to those in the other studied groups. AFP and lamin B1 status could discriminate group I from group II and III. A significant increase was found among the three Barcelona stages with regards to AFP and lamin B1 levels. A significant decrease was found between group II and stage 0, A and B with regards to AFP and lamin B1. Lamin B1 and AFP could both differentiate HCC patients with one tumor nodule (T1) from those with two or more tumor nodules (T2&Tm), as well as between those with tumor sizes >3 cm and ≤3 cm. Conclusion: Measurement of lamin B1 mRNA is recommended in patients with chronic liver disease with normal serum AFP, especially in known cirrhotic patients that deteriorate rapidly without any apparent etiology.

scholarly journals Hepatocellular Carcinoma (HCC), Where do we stand? Current situation

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Muhammad Hafeez ◽  
Muhammad Nadeem ◽  
Mahmood Ahmed ◽  
Faheem-ur- Rehman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Performance Status ◽  
Treatment Options ◽  
Eastern Cooperative Oncology Group ◽  
Previous Treatment ◽  
Current Situation ◽  
Military Hospital ◽  
Cross Sectional ◽  
Time Of Presentation ◽  
First Time

Objective: To identify the stage of Hepatocellular Carcinoma (HCC) at the time of presentation. Methods: This cross sectional observational prospective study was carried out at Gastro Department of Combined Military Hospital (CMH) Multan from August 2017 to December 2018. Patients were diagnosed on the basis of alpha fetoprotein, abdominal ultrasound, triphasic contrast enhanced computerized tomography (CECT). They were evaluated for etiology including Hepatitis B, C and non B & C. The patients were inquired about the previous treatment and when they came to know about the HCC. Staging of the tumor was done on the basis BCLC (Barcelona cancer liver clinic) and Melan’s criteria. Performance status (PS) of the patient was checked by Eastern Cooperative Oncology Group (ECOG) criteria. Severity of cirrhosis was assessed by CTP (Child Turcotte Pugh) and Model for end stage liver disease (MELD) score. The data was analyzed in IBM SPSS version 22. Results: Out of 135 patients 78% were males and 22% females. Age Mean SD was 58.81± 9.366. Frequency of hepatitis C, B, combined B, C and non-B non-C was 80%, 11%, 2.8% and 6.2% respectively. 96(73.8%) never got the treatment before for Hepatitis. 81(62.3%) came to know first time on this index admission. Maximum numbers of patients were in BCLC stage B i.e. 82(55.2%) with ECOG grade of one i.e.57 (39.3%), at the time of presentation. Mean MELD and CTP score were 12.24, 7.34 (class B) respectively. Conclusion: HCV was the most common in HCC, never treated before, presented for the first time in advance stage of the disease where very limited treatment options left behind. doi: https://doi.org/10.12669/pjms.36.3.1594 How to cite this:Hafeez M, Nadeem M, Ahmed M, Faheem-ur-Rehman. Hepatocellular Carcinoma (HCC), Where do we stand? Current situation. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1594 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Regional variations in hepatocellular carcinoma incidence, routes to diagnosis, treatment and survival in England

2021 ◽  
Author(s):  
Anya Burton ◽  
Vinay K. Balachandrakumar ◽  
Robert J. Driver ◽  
Daniela Tataru ◽  
Lizz Paley ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Early Diagnosis ◽  
Service Providers ◽  
Population Based ◽  
Incidence Rates ◽  
Curative Treatment ◽  
The North ◽  
Geographical Inequalities ◽  
One Year ◽  
Training Services

Abstract Background Hepatocellular carcinoma (HCC) incidence, management and survival across England were examined to determine if geographical inequalities exist. Method 15,468 HCC cases diagnosed 2010–2016 were included. Age-standardised incidence rates, net survival and proportions receiving potentially curative treatment and presenting through each route to diagnosis adjusted for age at diagnosis, sex and area-based deprivation quintile, were calculated overall and by Cancer Alliance. Results HCC incidence rates increased in men from 6.2 per 100,000 in 2010 to 8.8 in 2016, and in women from 1.5 to 2.2. The highest incidence rates, found in parts of the North of England and London, were nearly double the lowest. The adjusted proportion presenting as an emergency ranged 27–41% across Cancer Alliances. Odds increased with increasing deprivation quintile and age. Only one in five patients received potentially curative treatment (range 15–28%) and odds decreased with increasing deprivation and age. One-year survival in 2013–2016 ranged 38–53%. Conclusion This population-based, nationwide analysis demonstrates clear differences in HCC incidence, management and survival across England. It highlights socioeconomic-associated variation and the need for improvement in early diagnosis and curative treatment of HCC. This research should assist policymakers, service providers and clinicians to identify regions where additional training, services and resources would be best directed.

scholarly journals INCIDÊNCIA HIPOTIREOIDISMO CONGÊNITO EM CRIANÇAS NASCIDAS NOS HOSPITAIS PÚBLICOS DO OESTE PAULISTA

2021 ◽  
Vol 13 (1) ◽  
pp. 1-6
Author(s):  
Franciele Cardoso Leite ◽  
Patricia Martins Luizari Escoboza
Keyword(s):  
Early Diagnosis ◽  
Congenital Hypothyroidism ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Public Hospitals ◽  
Diagnosis And Treatment ◽  
Screening Tests ◽  
Cross Sectional ◽  
Prick Test

Congenital hypothyroidism is a cause of mental retardation and has nonspecific signs and symptoms. Early diagnosis and treatment are essential for the normal development of children affected by this disorder. The objective of this study was to evaluate the incidence of changes in the screening tests of public hospitals in Presidente Prudente, the average age of the newborn at the time of collection of tests and confirmation of the diagnosis. A retrospective cross-sectional study was carried out to assess the data of newborns who underwent the “heel prick test” by the unified health system in 2017. Of the 3,351 evaluated, 48 had elevated levels of Thyroid Stimulating Hormone (TSH), 13 had the diagnosis confirmed congenital hypothyroidism. It was 61.54% the children that returned between days 16 and 30 to confirm the result and 23.07% that returned after 61 days. Early diagnosis and treatment is essential, as they enable mitigating actions for the serious cognitive and behavioral disorders of affected patients.

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