Σταδιοποίηση σε Ca Ήπατος - ΗΚΚ

Ca Ήπατος - ΗΚΚ

AJCC Stages - Στομάχου

Stages

T

N

M

I

T1

N0

M0

II

T2

N0

M0

IIIA

T3a

N0

M0

IIIB

T3b

N0

M0

IIIC

T4

N0

M0

IVA

Any T

N1

M0

IVB

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Solitary tumor without vascular invasion

T2

Solitary tumor with vascular invasion or multiple tumors, none > 5 cm

T3a

Multiple tumors > 5 cm

T3b

Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein

T4

Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Local spread

• 3 distinct intrahepatic forms have been commonly described
  • Solitary massive tumor
  • Multiple nodules scattered throughout liver
  • Diffuse infiltration of liver
• Vascular invasion commonly seen
  • Hepatic vein invasion leads to Budd-Chiari syndrome
  • Portal venous invasion

Lymphatic spread

• Regional lymphadenopathy implies N1 disease by TNM criteria
• Regional nodal involvement (in order of prevalence)
  • Periceliac
  • Portohepatic
  • Paraaortic
  • Portocaval

• Peripancreatic
• Aortocaval
• Retrocaval

• Distant lymphadenopathy (in order of prevalence)
  • Mediastinal
  • Cardiophrenic
  • Mesenteric
  • Internal mammary
  • Perirectal
  • Retrocrural
  • Iliac
  • Paraspinal

Distant metastases (in order of prevalence)

• Lungs
• Musculoskeletal sites
• Adrenal gland
• Peritoneum &/or omentum

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Hepatocellular carcinoma (HCC)

• Usually occurs in setting of cirrhosis
• Poor prognosis

Fibrolamellar carcinoma

• Relatively rare variant of HCC
• Does not occur in setting of cirrhosis
• Better prognosis than conventional HCC