Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Malignant Tumors of The Liver Marasmus 949

■if lesion atypical on imaging studies and/or AFP level normal, liver

biopsy may be required

■assess the severity of chronic liver disease, i.e., Child-Pugh score

General Measures

■assess candidacy for resection or liver transplantation

specific therapy

Curative Treatments for HCC

■resection (Child’s class A, technically feasible, no advanced portal

hypertension, acceptable comorbidities)

■liver transplantation (single lesion <5 cm, or no more than 3 lesions

<3 cm; confined to the liver; no portal vein invasion); various pallia-

tive treatments used as “bridge” to transplantation

Palliative Treatments for HCC

■transcatheter arterial embolization

■transcatheter arterial chemo-embolization

■percutaneous ethanol injection

■intravenous or intra-arterial chemotherapy

■radiotherapy

Treatment of Metastatic Cancer

■generally palliative, using one or more of the above therapies,

with the exception of colorectal cancer where isolated lesions are

amenable to resection and potential cure

follow-up

■serial imaging studies to detect recurrent or new lesions

complications and prognosis

■natural history of untreated HCC death within 2–6 months

■cause of death usually malignant cachexia, or complications of cir-

rhosis with liver failure

MARASMUS

PATSY OBAYASHI, MS, RD, CNSD, CDE

history & physical

History

■Chronic deprivation of dietary calories and protein

Physical Signs

■Weight loss