Primary carcinomas of the liver are increasing in incidence in the developed world, probably due to dietary and environmental factors as well as the known role of infective agents such as Hepatitis C. They are usually diagnosed in the advanced stages and carry high morbidity and mortality. This volume summarises the latest developments in imaging of primary hepatic carcinomas, emphasising the multidisciplinary approach to the care of patients. In addition to extensive chapters on the radiological issues surrounding diagnosis and staging of the malignancies, individual chapters on epidemiology, pathology, and surgical and non-surgical treatment options are included. All treatment options are considered for both HCC and cholangiocarcinoma, including newer techniques such as TACE. Only by a well orchestrated multidisciplinary team approach including epidemiologists, diagnostic radiologists, hepatologists, oncologic surgeons, radiation oncologists, and pathologists can these complex malignancies be managed successfully.
Author(s): Hero K. Hussain, Isaac R. Francis
Series: Contemporary Issues in Cancer Imaging
Edition: 1
Publisher: Cambridge University Press
Year: 2009
Language: English
Pages: 263
Half-title......Page 3
Series-title......Page 4
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Series foreword......Page 11
Preface to Primary Carcinomas of the Liver......Page 13
Hepatocellular carcinoma......Page 15
Risk factors......Page 16
Cholangiocarcinoma......Page 19
Risk factors......Page 20
REFERENCES......Page 21
2 Surveillance and screening for hepatocellular carcinoma......Page 24
REFERENCES......Page 28
Macroscopic features......Page 30
Microscopic features......Page 31
Morphologic patterns of hepatocellular carcinoma......Page 32
Immunohistochemical study in the biopsy diagnosis of hepatocellular carcinoma......Page 36
Fine-needle aspiration diagnosis of hepatocellular carcinoma......Page 39
Macroscopic features......Page 40
Histologic variants......Page 41
Differential diagnosis and immunohistochemistry......Page 42
Fine-needle aspiration diagnosis of cholangiocarcinoma......Page 43
REFERENCES......Page 44
Ultrasound......Page 47
Computed tomography and magnetic resonance imaging......Page 49
Lesions greater than or equal to 2cm in diameter......Page 52
Lesions 1 to less than 2cm in diameter......Page 55
Diagnostic accuracy......Page 57
New magnetic resonance imaging techniques......Page 59
Summary......Page 60
REFERENCES......Page 61
5 Staging of hepatocellular carcinoma......Page 65
REFERENCES......Page 69
6 Surgical treatment of hepatocellular carcinoma: resection and transplantation......Page 71
Patient selection......Page 72
Preoperative imaging......Page 73
Resection......Page 74
Transplantation......Page 75
REFERENCES......Page 77
Vascular anatomy of the liver......Page 80
Rationale for transarterial chemoembolization......Page 82
Preprocedure evaluation......Page 83
Patient selection criteria......Page 84
Transarterial chemoembolization procedural steps......Page 85
Chemotherapy and embolization protocols......Page 87
Complications......Page 90
Efficacy of transarterial chemoembolization......Page 91
Conclusion......Page 92
REFERENCES......Page 93
History......Page 98
Mechanism of destruction......Page 106
Improving technology/techniques......Page 107
The role of imaging......Page 108
Complications......Page 111
Efficacy: Survival rates......Page 112
Efficacy: Intrahepatic recurrence of hepatocellular carcinoma......Page 113
REFERENCES......Page 114
Liver tolerance to radiation......Page 118
Three-dimensional conformal radiotherapy – technique......Page 120
External beam radiotherapy – Clinical trials......Page 121
Intensity-modulated radiotherapy......Page 123
Stereotactic body radiotherapy......Page 124
Proton beam and heavy ion therapy......Page 126
Selective internal radiotherapy with radioactive isotopes......Page 127
Conclusions and future directions......Page 128
REFERENCES......Page 129
Cytotoxic agents......Page 134
Biotherapy......Page 135
Targeted therapy......Page 136
Further considerations and conclusions......Page 137
REFERENCES......Page 138
Background......Page 143
Protocol......Page 144
Imaging after ablative therapy......Page 145
Imaging after transarterial therapy......Page 149
REFERENCES......Page 155
9 Radiological diagnosis of cholangiocarcinoma......Page 157
Peripheral intrahepatic cholangiocarcinoma......Page 158
Hilar intrahepatic cholangiocarcinoma (Klatskin tumor)......Page 159
Ultrasound......Page 160
Computed tomography techniques and accuracy for detection and staging of hilar cholangiocarcinoma (Klatskin tumor)......Page 161
Magnetic resonance imaging......Page 164
Associated findings......Page 168
Positron emission tomography......Page 173
Summary......Page 175
REFERENCES......Page 176
Perihilar extrahepatic cholangiocarcinoma......Page 181
Staging and assessment of resectability......Page 191
Staging and assessment of resectability......Page 193
REFERENCES......Page 194
Extrahepatic cholangiocarcinoma......Page 198
Intrahepatic cholangiocarcinoma......Page 201
Proximal extrahepatic cholangiocarcinoma......Page 202
Operative treatment......Page 204
Proximal extrahepatic bile-duct cancer......Page 205
Mid bile-duct extrahepatic cholangiocarcinoma......Page 206
Distal extrahepatic bile-duct cholangiocarcinoma......Page 207
Intrahepatic cholangiocarcinoma......Page 208
Transplantation for cholangiocarcinoma......Page 209
Summary......Page 211
REFERENCES......Page 212
Intrahepatic cholangiocarcinoma......Page 216
Perihilar cholangiocarcinoma......Page 217
Distal cholangiocarcinoma......Page 218
Adjuvant radiotherapy: Conclusions......Page 219
Neoadjuvant treatment and transplantation......Page 220
Radiotherapy considerations......Page 221
Summary and future directions......Page 223
REFERENCES......Page 224
Chemotherapy for resected cholangiocarcinoma......Page 227
Fluoropyrimidine-based regimens......Page 228
Gemcitabine-based regimens......Page 230
Conclusion......Page 231
REFERENCES......Page 232
Angiomyolipoma......Page 235
Inflammatory pseudotumor......Page 239
Mesenchymal hamartoma......Page 241
Biliary hamartoma......Page 243
Hepatic epithelioid hemangioendothelioma......Page 245
Biliary cystadenoma......Page 248
REFERENCES......Page 250
Index......Page 254
