Thursday, January 31, 2013

TEMPLATE FOR HEPATOCELLULAR CARCINOMA FOLLOW-UP:

DOES THE PATIENT HAVE
- JAUNDICE OR ELEVATED LFT(S) FOR USE OF DOXORUBICIN
- POOR APPETITE
- ASCITES (?THROMBUS AT HEPATIC VEIN)
- ABDOMINAL PAIN
- NAUSEA ALREADY
- WEIGHT LOSS

HX OF DM-ROLE OF INSULIN
HX OF HEPATITIS B OR C
HX OF CIRRHOSIS (LOCAL INTERVENTION)
HX OF HEMOCHROMATOSIS

LAB
- ALPHA FETOPROTEIN LEVEL
- ? DES-GAMMA-CARBOXYPROTHROMBIN
- U/S FOR DETECTION
- CT FOR MEASUREMT OF LESIONS,
- MRI FOR EXISTENCE OF CAPSULE AND PERIPHERAL INVASION, EXACT NUMBER OF LESIONS,
- PET FOR METASTATIC LESIONS AND RESPONSE TO THERAPY

TYPE OF HISTOLOGY
- FIBROLAMELLAR
- PSEUDOGLANDULAR
- PLEIOMORPHIC (GIANT CELL)
- CLEAR CELL
- ANAPLASTIC

CANDIDATE FOR
- SANDOSTATIN
- TAMOXIFEN
- ORAL SYNTHETIC RETINOIDS
- GALLIUM

P53 STATUS, MICROSATELLITE INSTABILITY, MDR,
TO PREDICT RESPONSE TO DAORUBICIN, PLATINUM, 5-FU, INTERFERON, EPIRUBICIN, TAXOL,

SORAFENIB (FATIGUE,RASH,DIARRHEA,HYPERTENSION.HAND FOOT SYNDROME)
- EGFR,VEGF

CANDIDATE
- TRANSPLANT
- PERCUTANEOUS ETHANOL
- TACE (WATCH FOR TUMOR >8CM, PORTAL VEIN THROMBUS,LFT-BILURIBIN LEVEL, SHUNT)
- RADIOFREQUENCY ABLATION (TUMOR <5CM)
- STEREOTACTIC RT
- SIRT

WHAT ABOUT IMMUNEPHERESIS AND PEXA-VEC?????

MUTATIONS IN HEPATOMA?  (CONTINUE REVIEWING LITERATURE OF COURSE I DID NOT INVENT THIS)
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