by Bushra Ibnauf as part of SAMA's Visiting Faculty Program in SMSB on July 11th 2011.

1. GI & Liver Malignancies Bushra Ibnauf Sulieman, MD MS Consultant, Gastroenterology & Hepatology Department of Medicine King Faisal Specialist Hospital & Research Center - Jeddah

4. Pathogenesis of Adenocarcinoma GERD Reflux Esophagitis Intestinal metaplasia (Barrett’s esophagus) Dysplasia Adenocarcinoma

5. Barrett’s HGD

13. Esophageal Cancer: Diagnosis

20. 7.5 / 12 MHz. 7.5 MHz. UC-30P UM-130 Mechanical Radial Scanning Curved Linear Array Scanning

21. EUS: Gastrointestinal Wall Mucosa Submucosa Muscularis propria Serosa Lumen Scope

22. T2N0 T3N0 T4N0

32. Gastric Cancer - Diagnosis

33. Gastric Cancer- Staging & Prognosis TNM

34. Other Gastric Tumors

39. Risk of HCC in Cirrhosis High >15% HCV HBV +iron Moderate Alcohol Low <5% Wilson PBC Autoimmune

41. Trabecular pattern, increased N:C ratio Abnormal nuclei Microtrabecular pattern, irregular hepatocytes Gastroenterology. 2002; 122:1609-1619

42. Acinar structures, bile Mixed acinar, trabecular structures Mitros F. Atlas of Liver Pathology. Virtual Hospital

43. Central vein and portal triad involvement of HCC Bizzare hepatocyte giant cell Mitros F. Atlas of Liver Pathology. Virtual Hospital

44. Histology FNH Adenoma Regenerative Nodule Well-differentiated HCC can be confused with FNH, adenoma, and macroregenrative nodules

46. Radiographics. 2002; 22: 1023-1039 Axial T2, fat-sat, fast spin echo Axial T1, in-phase, gradient echo Axial T1, arterial phase

47. Axial portal phase dynamic enhanced Coronal contrast enhanced Radiographics. 2002; 22: 1023-1039

48. Early arterial Portal venous Delayed FNH Adenoma Pre-contrast Early contrast No contrast Early contrast Portal venous Delayed Hemangioma

52. CW Pinson, AASLD 1999, post-grad course

53. CW Pinson, AASLD 1999, post-grad course

56. Complications of TACE (197 procedures) Fever 74% Abdominal pain 45% Nausea/emesis 59% Bleeding or hematoma 7% GI bleeding 3% Positive blood culture 2% Development of ascites 1% Hepatic encephalopathy 1% Variceal bleeding 1% Acalculous cholecystitis .5% Liver abscess .5% Splenic abscess .5% Cancer. 2002; 94:1747-52

57. POST- TACE PRE- TACE CW Pinson, AASLD 1999, post-grad course

58. 61 RCT 1 º treatment of HCC 26 RCT adequate control arm 14 RCT Sample size adequate 7 RCT TAE/TACE 7 RCT tamoxifen Hepatology. 2003; 37:429-442

59. Prospective RCTs of TAE/TACE # % Child A % response 1/2 yr survival Lin et al. (1988) ? TAE 21 13(70%) 42 25 TAE + IV 5-FU 21 10(48%) 20 20 IV 5-FU 21 2(10%) 13 13 Pelletier et al. (1990) ? TACE 21 7(33) 24 NA Conservative tx 21 0 33 NA Group d’etude (1995) 100 TACE 50 7(16) 62 38 Conservative tx 46 2(5) 43 26 Bruix et al. (1998) 82 TAE + coils 40 22(55) 70 49 Conservative tx 40 0 72 50 Pelletier et al. (1998 ) 76 TACE + tamoxifen 37 9(24) 51 24 Tamoxifen 36 2(5) 55 26 Lo et al. (2002) ? TACE 40 11(27) 57 31 Conservative tx 39 1(3) 31 11 Llovet et al. (2002) 70 TAE 37 16(43) 75 50 TACE 40 14(35) 82 63 Conservative tx 35 0 63 27 Hepatology. 2003; 37:429-442

72. Hepatocellular Cancer Single tumor <5cm 3 tumors, each <3cm Consider liver transplant Resection Local ablation TACE Large tumor >5cm or More than 3 tumors Resection Local ablation techniques No treatment Longer waiting list Liver Transplant Short waiting list 3-6 months Am J Surg . 2002; 183:309-316.

73. SAMA www.sama-sd.org