Hepatocellular carcinoma classification: Difference between revisions
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==Overview== | ==Overview== | ||
Hepatocellular carcinoma may be classified into different [[histological]] subtypes based on the [[microscopic]] features. The [[TNM Staging System|TNM]] | Hepatocellular carcinoma may be classified into different [[histological]] subtypes based on the [[microscopic]] features. The [[TNM Staging System|TNM]] staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account. | ||
==Classification == | ==Classification == | ||
Revision as of 17:29, 16 January 2018
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Hepatocellular carcinoma Microchapters |
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Differentiating Hepatocellular carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Hepatocellular carcinoma classification On the Web |
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American Roentgen Ray Society Images of Hepatocellular carcinoma classification |
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Risk calculators and risk factors for Hepatocellular carcinoma classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Hepatocellular carcinoma may be classified into different histological subtypes based on the microscopic features. The TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.
Classification
- Hepatocellular carcinoma may be classified according to the histological subtypes:[1][2]
- Fibrolamellar carcinoma
- Sarcomatoid HCC
- Undifferentiated carcinoma
- Combined HCC-
cholangiocarcinoma (HCC-CC) - Lymphoepithelioma
- Scirrhous hepatocellular carcinoma (scirrhous HCC)
| Hepatocellular carcinoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fibrolamellar carcinoma | Undifferentiated carcinoma | Sarcomatoid HCC | Combined HCC-CC* | Lymphoepithelioma | Scirrhous HCC | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abbreviations: Combined HCC-cholangiocarcinoma (HCC-CC)*
Staging
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis. Although the TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.
TNM staging system
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.[3]
Primary tumor
| TX | Primary tumour cannot be assessed |
| T0 | No evidence of primary tumour |
| T1 | A single tumour with no invasion into the blood vessels of the liver |
| T2 | A single tumour with invasion into the blood vessels or multiple tumours, none more than 5 cm in size |
| T3a | Multiple tumours, with any tumour larger than 5 cm |
| T3b | The tumour has grown into either the portal or hepatic vein |
| T4 | The tumour has grown into nearby organs (other than the gallbladder) or the tumour has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum) |
Regional lymph node
| NX | Regional lymph nodes cannot be assessed |
| NX | No regional lymph node metastasis |
| NX | Regional lymph node metastasis |
Distant metastasis
| M0 | No distant metastasis |
| M1 | Distant metastasis |
Clip and Okuda Staging Systems for Hepatocellular Carcinoma
Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that involves cirrhosis into account.
CLIP Classification
| Variable | Points | ||
|---|---|---|---|
| 0 | 1 | 2 | |
| i.Tumor number (%) | Single | Multiple | – |
| Hepatic replacement by tumor | <50 | <50 | >50 |
| ii. Child-Pugh score | A | B | C |
| iii. α Fetoprotein level (ng/mL) | <400 | ≥400 | – |
| iv.Portal vein thrombosis (CT) | No | Yes | – |
| CLIP stages (score = sum of points): CLIP 0, 0 points; CLIP 1, 1 point; CLIP 2, 2 points; CLIP 3, more than 3
points. | |||
OKUDA Classification
| OKUDA Classification | |||||||
| Tumor extenta | Bilirubin (mg/dL) | Albumin (g/L) | Ascites | ||||
| ≥50% | <50 | ≥ 3 | <3 | ≤3 | >3 | + | – |
| (+) | (−) | (+) | (−) | (+) | (−) | (+) | (−) |
| Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+) | |||||||
a. Liver span occupied by the tumor.
Adopted from Harrison's Textbook of Medicine*
References
- ↑ Shafizadeh N, Kakar S (2013). "Hepatocellular Carcinoma: Histologic Subtypes". Surg Pathol Clin. 6 (2): 367–84. doi:10.1016/j.path.2013.03.007. PMID 26838979.
- ↑ Matsuura S, Aishima S, Taguchi K, Asayama Y, Terashi T, Honda H, Tsuneyoshi M (2005). "'Scirrhous' type hepatocellular carcinomas: a special reference to expression of cytokeratin 7 and hepatocyte paraffin 1". Histopathology. 47 (4): 382–90. doi:10.1111/j.1365-2559.2005.02230.x. PMID 16178893.
- ↑ Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab