Management of hepatocellular carcinoma: international guidelines

Hepatocellular carcinoma (HCC) is a major health problem worldwide. The incidence of HCC is increasing in Europe and in the United States. HCC is currently the leading cause of death among cirrhotic patients. Cirrhosis is the strongest and the most common risk factor for HCC. Surveillance for HCC is widely practiced and can be recommended for certain at-risk groups. Among serological screening test, alpha-fetoprotein (AFP) is the best known (cut-off 20 ng/mL, sensitivity 60%, specificity 91%). The radiological screening test most widely used is ultrasonography (sensitivity 65—80%, specificity >90%). The tests used to diagnose HCC include radiology, biopsy and AFP. Detection of hepatic mass within a cirrhotic liver is highly suspicious of HCC. If AFP is greater than 200 ng/mL and the radiological appearance of the mass is suggestive for HCC, the likelihood that the lesion is HCC is high. The Barcelona-Clinic-Liver-Cancer staging system identifies patients with early HCC who may benefit from curative therapies, those at intermediate or advanced disease stage who may benefit from palliative treatments, as well as those at end-stage with a very poor life expectancy. Today many patients are diagnosed at an early stage. The therapies that offer a high rate of complete responses and potential cure are surgical resection, transplantation and percutaneous ablation. Among non-curative therapies the only one that has been shown to positively impact survival is transarterial chemoembolization. Several steps have to be taken to improve effectiveness of HCC therapy. These include patient education on risk factors for HCC and implementation of screening programs, increasing the number of patients diagnosed in early stage.

Download Full-text

FlowCell-enriched circulating tumor cells as a predictor of lung cancer metastasis

Human Cell ◽

10.1007/s13577-021-00500-8 ◽

2021 ◽

Author(s):

Yan Lu ◽

Yushuang Zheng ◽

Yuhong Wang ◽

Dongmei Gu ◽

Jun Zhang ◽

...

Keyword(s):

Lung Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Cancer Metastasis ◽

Lung Tumor ◽

Early Stage ◽

High Rate ◽

Early Stage Lung Cancer ◽

Lung Cancer Metastasis ◽

Number Of Patients

AbstractLung cancer is the most fetal malignancy due to the high rate of metastasis and recurrence after treatment. A considerable number of patients with early-stage lung cancer relapse due to overlooked distant metastasis. Circulating tumor cells (CTCs) are tumor cells in blood circulation that originated from primary or metastatic sites, and it has been shown that CTCs are critical for metastasis and prognosis in various type of cancers. Here, we employed novel method to capture, isolate and classify CTC with FlowCell system and analyzed the CTCs from a cohort of 302 individuals. Our results illustrated that FlowCell-enriched CTCs effectively differentiated benign and malignant lung tumor and the total CTC counts increased as the tumor developed. More importantly, we showed that CTCs displayed superior sensitivity and specificity to predict lung cancer metastasis in comparison to conventional circulating biomarkers. Taken together, our data suggested CTCs can be used to assist the diagnosis of lung cancer as well as predict lung cancer metastasis. These findings provide an alternative means to screen early-stage metastasis.

Download Full-text

Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-013-1530-1 ◽

2013 ◽

Vol 139 (12) ◽

pp. 2021-2033 ◽

Cited By ~ 25

Author(s):

Jia-yan Ni ◽

Lin-feng Xu ◽

Hong-liang Sun ◽

Jing-xing Zhou ◽

Yao-ting Chen ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Surgical Resection ◽

Early Stage ◽

Meta Analysis ◽

Percutaneous Ablation ◽

Ablation Therapy

Download Full-text

Effect of a Novel Patient Garment on Perceived Privacy during Colonoscopy: A Simple Approach to Minimize Embarrassment

Gastroenterology Research and Practice ◽

10.1155/2019/2467101 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ali Aamar ◽

Zeeshan Butt ◽

Kamraan Madhani ◽

Iqra Hussain ◽

Joel Garsten ◽

...

Keyword(s):

Colorectal Cancer ◽

The United States ◽

Simple Approach ◽

High Rate ◽

The Novel ◽

Screening Programs ◽

Before And After ◽

Repeat Colonoscopy ◽

Acceptance Rates ◽

Study Participants

Background. In the United States, patients wear a one-piece, reusable cloth gown during colonoscopy procedures. Many patients report embarrassment related to bodily exposure during colonoscopy. This may limit participation in colorectal cancer screening programs. Aims. To assess whether the use of a novel, disposable patient garment (Privacy Pants, Jackson, MS), which increases patient coverage, can reduce embarrassment related to bodily exposure and increase colonoscopy acceptance rates. Methods. Patients were offered a novel gown, and they completed questionnaires before and after colonoscopy. Results. A total of 120 patients participated. 54% were female and 82% were Caucasian. The novel gown had high overall satisfaction (8.3) and was associated with a sense of respect during the procedure (9.4). 67% (80) of the patients had a prior colonoscopy, and of these, 76% would request a novel gown over a traditional gown for future procedures. Among all study participants, a high rate of acceptability for repeat colonoscopy if recommended by their doctors was reported (mean of 9.4). Nonwhites were more likely to have a concern for embarrassment addressed by using novel gowns as compared to whites (P value 0.02). Conclusion. All participants, particularly women and nonwhite participants, reported high rates of respect and satisfaction and decrease in embarrassment utilizing the novel gown during colonoscopy. Patients who had prior colonoscopy with a traditional gown preferred the novel garment. A novel procedure gown may enhance colonoscopy acceptance by minimizing embarrassment.

Download Full-text

Percutaneous Ablation-Induced Immunomodulation in Hepatocellular Carcinoma

International Journal of Molecular Sciences ◽

10.3390/ijms21124398 ◽

2020 ◽

Vol 21 (12) ◽

pp. 4398 ◽

Cited By ~ 1

Author(s):

Lucile Dumolard ◽

Julien Ghelfi ◽

Gael Roth ◽

Thomas Decaens ◽

Zuzana Macek Jilkova

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Thermal Ablation ◽

Microwave Ablation ◽

Treatment Options ◽

Ablation Techniques ◽

High Rate ◽

Percutaneous Ablation ◽

Ablative Therapies ◽

Immune Changes

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and its incidence is rising. Percutaneous locoregional therapies, such as radiofrequency ablation and microwave ablation, are widely used as curative treatment options for patients with small HCC, but their effectiveness remains restricted because of the associated high rate of recurrence, occurring in about 70% of patients at five years. These thermal ablation techniques have the particularity to induce immunomodulation by destroying tumours, although this is not sufficient to raise an effective antitumour immune response. Ablative therapies combined with immunotherapies could act synergistically to enhance antitumour immunity. This review aims to understand the different immune changes triggered by radiofrequency ablation and microwave ablation as well as the interest in using immunotherapies in combination with thermal ablation techniques as a tool for complementary immunomodulation.

Download Full-text

Long-Term Outcome of Percutaneous Ablation in Very Early-Stage Hepatocellular Carcinoma

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-011-1716-2 ◽

2011 ◽

Vol 15 (12) ◽

pp. 2165-2171 ◽

Cited By ~ 28

Author(s):

Ming Kuang ◽

Xiao-Yan Xie ◽

Cheng Huang ◽

Ye Wang ◽

Man-Xia Lin ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Early Stage ◽

Percutaneous Ablation ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma

The Scientific World JOURNAL ◽

10.1155/2013/479805 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Satoru Murata ◽

Takahiko Mine ◽

Tatsuo Ueda ◽

Ken Nakazawa ◽

Shiro Onozawa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Conservative Therapy ◽

Transcatheter Arterial Chemoembolization ◽

Early Stage ◽

Percutaneous Ablation ◽

Published Data ◽

Advanced Stage ◽

Multikinase Inhibitor ◽

The World ◽

Arterial Chemoembolization

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation) can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE), and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

Download Full-text

Treatment of Hepatocellular Carcinoma – Integrating Loco-regional and Molecular-targeted Therapies

European Oncology & Haematology ◽

10.17925/eoh.2010.06.1.65 ◽

2010 ◽

Vol 06 (01) ◽

pp. 65

Author(s):

Riccardo Lencioni ◽

Keyword(s):

Hepatocellular Carcinoma ◽

Targeted Therapies ◽

Early Stage ◽

Systemic Exposure ◽

Intermediate Stage ◽

High Rate ◽

Interventional Treatment ◽

Rf Ablation ◽

Thermal Methods ◽

Molecular Targeted Therapies

The treatment of hepatocellular carcinoma (HCC) is rapidly evolving as loco-regional and systemic therapies continue to improve. Image-guided radiofrequency (RF) ablation is established as the treatment of choice for patients with early-stage HCC when transplantation or resection are precluded. Recent refinements to technique have substantially increased the ability of RF ablation to achieve sustained complete response of target tumours in properly selected patients, and new alternate thermal and non-thermal methods for local tumour treatment are currently under investigation. Transarterial chemo-embolisation (TACE) is the standard of care for patients with multinodular disease at the intermediate stage. The introduction of drug-eluting beads, which enhance drug delivery to the tumour and reduce systemic exposure, appears to improve anticancer activity and the safety profile of TACE compared with conventional regimens. Despite these advances, the long-term outcomes of patients treated with loco-regional therapies remain unsatisfactory because of the high rate of tumour recurrence. The introduction of molecular-targeted therapies that inhibit tumour proliferation and angiogenesis has opened new prospects in this regard. Clinical trials focused on combining interventional treatment with systemically active drugs are ongoing. The outcomes of such studies are eagerly awaited, as they have the potential to revolutionise the treatment of HCC.

Download Full-text

Implementation of a triage system in the Alerta Rosa breast cancer navigation program.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19064 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19064-e19064

Author(s):

Cynthia Villarreal-Garza ◽

Jaime Tamez-Salazar ◽

Teresa Mireles-Aguilar ◽

Cynthia De la Garza-Ramos ◽

Marisol García-García ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Medical Attention ◽

Initial Contact ◽

Triage System ◽

Palpable Mass ◽

Screening Programs ◽

Medical Evaluation ◽

Number Of Patients ◽

Navigation Program

e19064 Background: Alerta Rosa is a navigation program in Nuevo Leon, Mexico that aims to reduce delays in breast cancer (BC) diagnosis and treatment initiation irrespective of healthcare coverage. Via a call center, a navigator registers each patient’s initial concern and schedules a medical evaluation. This study aimed to assess the implementation of a triage system to guide appointment prioritization for undiagnosed BC patients with abnormal breast findings or imaging studies. Methods: Women that contacted Alerta Rosa were stratified according to their clinical characteristics into three priority groups. Asymptomatic women seeking check-up information were classified as low-priority (“Green”), those with nonspecific symptoms (e.g. mastalgia) or indeterminate image studies (BIRADS 0) as intermediate-priority (“Yellow”), and patients with suspicious symptoms (i.e. palpable mass, nipple retraction or bloody discharge), abnormal image studies (BIRADS 3-5) or an established BC diagnosis as high-priority (“Red”) for an appointment. The triage system’s ability to detect undiagnosed BC was evaluated against the number of patients per category in whom BC was later confirmed. Differences in time from initial contact to first medical evaluation were explored with an independent t-test. Results: From December 2017 to 2019, 561 women with a median age of 44 years (range: 8-89) contacted Alerta Rosa. 369 (66%) reported breast symptoms, 92 (16%) sought check-up information, 68 (12%) had an indeterminate/abnormal image study and 32 (6%) had received a BC diagnosis and wanted a second opinion. Accordingly, 16% of patients were classified as “Green”, 25% “Yellow” and 59% “Red”. The median time from stratification to medical evaluation was 4 days for the “Red” group and 7 days for those in other categories ( p= 0.003). A total of 558 appointments were scheduled, of which 441 (79%) were attended. Excluding those who had received a prior BC diagnosis, 20/299 patients from the “Red” group had BC confirmed (6.7%) compared to 1/138 patient from the “Yellow” (0.7%) and none from the “Green” categories. Therefore, the “Red” category achieved a sensitivity of 95.2% (CI95%: 76.2-99.9%) and specificity of 53.8% (CI95%: 49.3-58.3%) for BC. Conclusions: The triage system adequately identified women with different probabilities of having BC. Thus, the implementation of a stratification system could help identify high risk patients in limited-resource settings where screening programs are ineffective and efforts to prioritize access to medical attention is crucial to achieve early-stage diagnoses.

Download Full-text

Gastric Cancer in Young Adults: A Different Clinical Entity from Carcinogenesis to Prognosis

Gastroenterology Research and Practice ◽

10.1155/2020/9512707 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13 ◽

Cited By ~ 2

Author(s):

Jian Li

Keyword(s):

Gastric Cancer ◽

Young Adults ◽

Epithelial Mesenchymal Transition ◽

Early Stage ◽

The United States ◽

Genetic Alterations ◽

Mesenchymal Transition ◽

Screening Programs ◽

Life Years ◽

Advanced Stages

Approximately 5.0% of gastric cancer (GC) patients are diagnosed before the age of 40 and are not candidates for screening programs in most countries and regions. The incidence of gastric cancer in young adults (GCYA) has declined over time in most countries except in the United States. Genetic alterations, environmental factors, and lifestyle may predispose some young adults to GC. According to molecular classifications, the cancer of most GCYA patients belongs to the genomically stable or microsatellite stable/epithelial-mesenchymal transition subtype, with the common genetic aberrations being mutations in CDH1. What characterizes GCYA are a higher prevalence in females, more aggressive tumor behaviors, diagnosis at advanced stages, fewer comorbidities and being better treatment candidates, and a similar or better survival outcome when compared with older patients. Considering the greater loss of life-years in younger patients, lowering the incidence of GC and diagnosing at a relatively early stage are the two most effective ways to decrease GC mortality. To achieve these goals, the low awareness of GCYA among general people, policy-makers, clinicians, and researchers should be changed.

Download Full-text