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Clinical features in hepatocellular carcinoma and the impact of autopsy on diagnosis. A study of 530 cases from a low-endemicity area

Artikel i vetenskaplig tidskrift
Författare Jerzy Kaczynski
G. Hansson
Sven Wallerstedt
Publicerad i Hepatogastroenterology
Volym 52
Nummer/häfte 66
Sidor 1798-802
ISSN 0172-6390 (Print)
Publiceringsår 2005
Publicerad vid Hjärt-kärlinstitutionen
Sidor 1798-802
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Autopsy, Biopsy, Needle, Carcinoma, Hepatocellular/*epidemiology/*pathology/surgery, *Cause of Death, Child, Endemic Diseases/*statistics & numerical data, Female, Hepatectomy/methods, Humans, Immunohistochemistry, Incidence, Liver Function Tests, Liver Neoplasms/*epidemiology/*pathology/surgery, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Sex Distribution, Survival Analysis, Sweden/epidemiology
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) had been one of the malignancies with the highest reported increase of incidence in Sweden, but during the late 20-year period the incidence has been decreasing. The aims of our study were to state the impact of autopsy on diagnosis and to identify clinical characteristics in HCC. METHODOLOGY: This retrospective study was performed in Goteborg, Sweden and included all cases with a diagnosis of liver cancer from a period with a high autopsy frequency (1958-1979). The cases were reevaluated histopathologically and the autopsy records as well as the case files were scrutinized. RESULTS: The majority (63%) of the 530 biopsy verified cases of HCC were diagnosed unexpectedly at autopsy. Cirrhosis of the liver could be established in 71% of the cases, but was diagnosed or at least clinically suspected before the diagnosis of the tumor only in a minority (19%) of all HCC patients. At presentation, malaise (85%), weight loss (78%), anorexia (67%) and hepatomegaly (84%) were common. The median survival time from diagnosis was one month. In most cases (92%) the cause of death was either directly or indirectly related to HCC and/or underlying liver disease such as advanced tumor disease, hepatic failure and gastrointestinal bleeding. Spontaneous rupture of HCC was the cause of death in 17 cases (3%) CONCLUSIONS: In an unselected population in a low incidence area of HCC, most patients have clinically unknown cirrhosis of the liver and present with vague general paramalignant symptoms. HCC has an extremely poor prognosis. Since HCC, in a majority of cases, remains undiagnosed before death, the autopsy has great impact on the diagnosis. This should be considered in interpretation of results from epidemiological studies.

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