Resumo
定义
病史和体格检查
关键诊断因素
- presença de fatores de risco
- idade avançada
- hepatomegalia
其他诊断因素
- distensão abdominal
- hemorragia por varizes esofágica ou gástrica
- dor abdominal no quadrante superior direito
- saciedade precoce
- perda de peso
- edema nos membros inferiores
- encefalopatia hepática
- caquexia
- icterícia
- esplenomegalia
- asterixis (flapping)
- nevos arâneos
- eritema palmar
- veias colaterais periumbilicais
- fetor hepaticus
- diarreia
- síndrome paraneoplásica
- dor óssea
- dor abdominal intensa
- icterícia obstrutiva
- veias hemorroidais aumentadas
- sopro vascular
危险因素
- cirrose
- infecção crônica por vírus da hepatite B (HBV)
- infecção por hepatite C (HCV) crônica
- uso elevado e crônico de bebidas alcoólicas
- diabetes
- obesidade
- história familiar de câncer hepático
- exposição à aflatoxina
- exposição ao contraste radioativo com dióxido de tório
- hemocromatose
- tabagismo
- deficiência de alfa 1-antitripsina
- porfiria cutânea tardia
- colangite biliar primária (CBP)
- colangite esclerosante primária
- uso de esteroides androgênicos
- uso de contraceptivos orais
- sexo masculino
诊断性检查
首要检查
- hemograma completo
- perfil metabólico básico
- testes da função hepática
- tempo de protrombina/razão normalizada internacional (TP/INR)
- painel de hepatites virais
- alfafetoproteína (AFP)
- ultrassonografia do fígado
需考虑的检查
- tomografia computadorizada (TC) com contraste do abdome
- RNM com contraste do abdome
- biópsia hepática
- tomografia computadorizada torácica
- cintilografia óssea
治疗流程
Estádio 0-A da Barcelona Clinic Liver Cancer (BCLC) (doença muito inicial 0 ou inicial A): possível candidato cirúrgico (boa função hepática)
Estádio 0-A da BCLC (doença muito inicial 0 ou inicial A): não candidato à ressecção hepática
BCLC de estádio B: doença intermediária
BCLC de estádio C: doença avançada
BCLC de estádio D: doença em estágio terminal
recidiva
撰稿人
作者
Doan Y Dao, MD
Assistant Professor of Medicine
Director, Center of Excellence for Liver Disease in Vietnam
Johns Hopkins School of Medicine
Department of Medicine
Division of GI & Hepatology
Baltimore
MD
利益声明
DYD receives grants from Roche, Fujifilm Medical System, and DELFI Diagnostics; serves as Guest Director of Hepatology for Tech University; and is a member of the Data and Safety Monitoring Board of IQVIA.
Ngoc-Thai Truong, MD, MS
Research Assistant
Vietnam Viral Hepatitis Alliance
Reston
VA
利益声明
NTT declares that he has no competing interests.
鸣谢
Dr Doan Y Dao and Dr Ngoc-Thai Truong would like to gratefully acknowledge Dr Qingyao Daniel Huang, Dr Margaret Li Peng Teng, Dr Poh Seng Tan, Dr Badar Muneer, and Dr Smruti R. Mohanty, previous contributors to this topic.
利益声明
QDH declares that he has no competing interests. MLPT declares that she has no competing interests. PST has received sponsorship/honorarium from Bayer (South East Asia) Pte Ltd and Sirtex for attending conferences, delivering lectures, and participating in advisory board meetings. BM declares that he has no competing interests. SRM serves as a speaker for Bristol-Myers Squibb regarding the use of entecavir for the treatment of chronic hepatitis B.
同行评议者
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
利益声明
SN declares that he has no competing interests.
Ned Snyder, MD, FACP
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
利益声明
NS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023 Dec 1;78(6):1922-65.全文 摘要
Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29 (suppl 4):iv238-55.全文 摘要
European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236.全文 摘要
Su GL, Altayar O, O'Shea R, et al. AGA clinical practice guideline on systemic therapy for hepatocellular carcinoma. Gastroenterology. 2022 Mar;162(3):920-34.全文 摘要
Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline update. J Clin Oncol. 2024 May 20;42(15):1830-50.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Colangiocarcinoma
- Adenoma hepático
- Hemangioma do fígado
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