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Malignant Tumors Of The Liver

Malignant Tumors Of The Liver

1. Hepatocellular Cancer (Hepatoma, HCC)

Is hepatoma (HCC) dangerous?

Yes. The risk of life is high. Especially in the liver with cirrhosis, it increases the risk of life even more. It is 4-8 times more common in men. Hepatitis B, hepatitis C infections and fatty liver disease (NASH) also play a role in the development of hepatoma as the most common causes of cirrhosis.

What are the symptoms of HCC?

Mass or pain under the right rib, jaundice, weight loss, feeling nauseous, loss of appetite.

Is early diagnosis of HCC possible?

Yes. In patients with known cirrhosis or risk factors for the development of cirrhosis, it is possible to detect cancer at an early stage by regularly checking the level of AFP in the blood and evaluating the liver with ultrasound. Suspicious lesions are evaluated with advanced imaging. Dynamic CT or MRI is typical for HCC to see a "hypervascular, venous or late-phase washout mass" on dynamic CT or MRI. No additional biopsy is required for the diagnosis of these masses.

How does the presence of cirrhosis affect the treatment plan?

The most effective method in the treatment of hepatoma (HCC) is surgical removal of the mass. However, in a patient with cirrhosis, the liver reserve is more or less reduced depending on the degree of cirrhosis. This makes it important to know if there will be enough liver left for the patient. For example, while 75% of a normal liver can be removed withou a problem, resection of 25% of a liver with cirrhosis can be life-threatening. The patient's liver reserve is calculated by imaging and laboratory tests, and treatment planning is made accordingly.

What are the treatment options for HCC?

Treatment options for hepatoma are relatively numerous. Depending on the number and size of cancer or cancerous lesions, their relationship with the main vessels, their spread in the body, biological behavior, the cause and degree of cirrhosis, the general condition and performance of the patient, the most appropriate treatment or treatment combinations are recommended to the patient.

For example, if HCC has not spread out of the liver and the amount and quality of the liver to be left behind is sufficient, surgical removal of cancer is appropriate. However, if surgical resection is not appropriate due to cirrhosis, organ transplantation may be recommended (liver transplantation).

In patients who are not suitable for resection or transplantation, one or more of the embolization (TAKE and TARE) or ablation (RF-burning) methods can be applied together. These methods are also used to regress the cancer and make the patient suitable for resection or transplantation. This is called bridging therapy.

Chemotherapy has almost no place in the treatment of HCC. However, there are promising developments in current studies, and the use and effectiveness of targeted drugs are increasing.

2. Cholangiocellular Cancer (CCC)

Where does cholangiocellular carcinoma (CCC) originate?

It develops from the biliary tract that carries the bile produced in the liver to the intestines. Depending on where it starts, it is called intra-hepatic or extra-hepatic CCC. Jaundice is common in extrahepatic cholangiocellular carcinoma.

What are the treatment options for CCC?

Surgery is at the forefront of treatment. The goal of the surgery is to remove the tumor and ensure the flow of bile in a way that does not leave cancer tissue behind.

In patients with widespread disease and not suitable for surgery, a plastic or metal stent can be placed in the obstructed bile duct by radiological or endoscopic methods. Thus, the patient's jaundice regresses and his general condition improves.

Transplantation is recommended only in a very narrow group of patients, selected according to the Mayo protocol.

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Prof. Dr. Sedat KarademirProf. Dr. Sedat KarademirGeneral Surgery Specialist
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