内科见习课件-原发性肝癌
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Diffuse type (弥漫型) diffused, rarely
Gross Appearance
➢小肝癌 单结节肝癌直径<3cm， 或者 相邻两个癌结节直径之和<3cm。
Microscopic Appearance
Hepatocellular carcinoma 肝细胞型(90%)
Cholangiocarcinoma 胆管细胞型(10%)
➢ Symptoms of cirrhosis 肝硬化的表现
Symptoms
➢Symptoms with metastases
❖ Lung ❖ Bone ❖ Brain
Symptoms
➢Paraneoplastic SyndБайду номын сангаасone (伴癌综合征)
❖Caused by secretion of hormones or hormone-like substances from the tumor.
➢Older than 35 yrs and HBsAg(+) and Chronic hepatitis for more than 5 yrs.
➢35岁以上的乙型肝炎病毒表面抗原阳性 及有慢性肝炎病史>5年者.
Etiology & pathogenesis
➢Multi-factor ➢Multi-process ➢Multi-gene ➢Multi-mutation
HBsAg carrier have a 7- to 29-fold risk of developing HCC.
❖ Hepatic cirrhosis ❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection
➢ The 2nd most common cancer in some area of China.
Geographic Distribution (HCC)
Geographic Distribution
➢ Worldwide：South Africa 60~100/100 000 Asia 3~40/100 000
Mixed type(混合型)
Special type(特殊类型)
Metastasis
➢Vascular invasion: intrahepatic ~
extrahepatic ~ (lung)
➢Lymphatic invasion: portal lymph node ➢Direct infiltration: not common
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection
Most (64%～80％) of patients with the primary hepatic cancer are HBsAg (+) in Asia.
Symptoms
➢ Abdominal pain (dull & continuous)
肝区疼痛——持续性胀痛或钝痛
➢ Hepatomegaly (firm & nodular)
肝肿大——进行性 质地硬 结节状
➢ Ascites (blood tinged)
腹水——血性
➢ Jaundice (obstructive) 黄疸——阻塞性多见
Pathology
➢Gross appearance ➢Microscopic appearance
Gross Appearance
Massive type(块状型) 5cm~10cm, most common
Nodular type (结节型) single or multiple, ≯5cm
原发性肝癌
primary carcinoma of the liver
——起源于肝细胞或肝内胆管细胞的恶性肿瘤
Introduction
➢ One of the leading causes of death in the world. 250 000 death/yr
➢ The 3rd most common cancer in China(17.86/100 000); 1st Pulmonary cancer (32.89/100 000) 2nd Gastric cancer (21.51/100 000）
Clinical Findings
➢Symptoms & Signs ➢Laboratory findings ➢Imaging studies
Symptoms
➢Unaware until the tumor has reached an advanced ones.
➢亚临床肝癌——患者无任何症状和体征， 在AFP和B型超声检查时偶然发现的肝癌.
➢ P.R. China： Qidong (Jiangsu) 40/100 000 Yunnan 4.44/100 000
Sex & Age Distribution：
➢Male : Female 3~4 : 1 ➢High incidence age 40~49 yrs
High risk population(高危人群)
❖ Hepatic cirrhosis
Most(70~85%) of patients with primary hepatic cancer
suffer from liver cirrhosis.
❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection ❖ Hepatic cirrhosis
❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Minor Risk Factors
❖ Cigarette smoking
❖ Chemical substances :亚硝胺类 ❖ Hereditary hemochromatosis (遗传性血色病) ❖ Water pollution: 蓝绿藻 ❖ Parasite infection: 华支睾吸虫 ……
Gross Appearance
➢小肝癌 单结节肝癌直径<3cm， 或者 相邻两个癌结节直径之和<3cm。
Microscopic Appearance
Hepatocellular carcinoma 肝细胞型(90%)
Cholangiocarcinoma 胆管细胞型(10%)
➢ Symptoms of cirrhosis 肝硬化的表现
Symptoms
➢Symptoms with metastases
❖ Lung ❖ Bone ❖ Brain
Symptoms
➢Paraneoplastic SyndБайду номын сангаасone (伴癌综合征)
❖Caused by secretion of hormones or hormone-like substances from the tumor.
➢Older than 35 yrs and HBsAg(+) and Chronic hepatitis for more than 5 yrs.
➢35岁以上的乙型肝炎病毒表面抗原阳性 及有慢性肝炎病史>5年者.
Etiology & pathogenesis
➢Multi-factor ➢Multi-process ➢Multi-gene ➢Multi-mutation
HBsAg carrier have a 7- to 29-fold risk of developing HCC.
❖ Hepatic cirrhosis ❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection
➢ The 2nd most common cancer in some area of China.
Geographic Distribution (HCC)
Geographic Distribution
➢ Worldwide：South Africa 60~100/100 000 Asia 3~40/100 000
Mixed type(混合型)
Special type(特殊类型)
Metastasis
➢Vascular invasion: intrahepatic ~
extrahepatic ~ (lung)
➢Lymphatic invasion: portal lymph node ➢Direct infiltration: not common
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection
Most (64%～80％) of patients with the primary hepatic cancer are HBsAg (+) in Asia.
Symptoms
➢ Abdominal pain (dull & continuous)
肝区疼痛——持续性胀痛或钝痛
➢ Hepatomegaly (firm & nodular)
肝肿大——进行性 质地硬 结节状
➢ Ascites (blood tinged)
腹水——血性
➢ Jaundice (obstructive) 黄疸——阻塞性多见
Pathology
➢Gross appearance ➢Microscopic appearance
Gross Appearance
Massive type(块状型) 5cm~10cm, most common
Nodular type (结节型) single or multiple, ≯5cm
原发性肝癌
primary carcinoma of the liver
——起源于肝细胞或肝内胆管细胞的恶性肿瘤
Introduction
➢ One of the leading causes of death in the world. 250 000 death/yr
➢ The 3rd most common cancer in China(17.86/100 000); 1st Pulmonary cancer (32.89/100 000) 2nd Gastric cancer (21.51/100 000）
Clinical Findings
➢Symptoms & Signs ➢Laboratory findings ➢Imaging studies
Symptoms
➢Unaware until the tumor has reached an advanced ones.
➢亚临床肝癌——患者无任何症状和体征， 在AFP和B型超声检查时偶然发现的肝癌.
➢ P.R. China： Qidong (Jiangsu) 40/100 000 Yunnan 4.44/100 000
Sex & Age Distribution：
➢Male : Female 3~4 : 1 ➢High incidence age 40~49 yrs
High risk population(高危人群)
❖ Hepatic cirrhosis
Most(70~85%) of patients with primary hepatic cancer
suffer from liver cirrhosis.
❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Major Risk Factors
❖ Chronic HBV/HCV infection ❖ Hepatic cirrhosis
❖ Aflatoxin B1(黄曲霉毒素B1)
Etiology: risk factors
➢Minor Risk Factors
❖ Cigarette smoking
❖ Chemical substances :亚硝胺类 ❖ Hereditary hemochromatosis (遗传性血色病) ❖ Water pollution: 蓝绿藻 ❖ Parasite infection: 华支睾吸虫 ……