Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Characteristics and survival of advanced untreated hepatocellular carcinoma of non-viral etiology(Indian Society of Gastroenterology, 2024) Ekanayaka, S.P.N.; Luke, N.; Thilakarathne, S.B.; Dassanayake, A.; Gunetilleke, M.B.; Niriella, M.A.; Siriwardana, R.C.INTRODUCTION AND OBJECTIVES Hepatocellular carcinoma (HCC) is an aggressive tumor and presents late. The underlying etiology of HCC is changing rapidly. HCC in Sri Lanka is unique due to its predominant non-viral etiology (nvHCC) but lacks survival data.METHOD Data was collected from patients who presented with HCC from 2011 to 2018. There were 560/568 (98.6%) nvHCC. The patients who were not candidates for tumor-specific treatment (149/560 [26.7%]) were selected. Population characteristics, demographic data, tumor characteristics, survival and factors affecting survival were analyzed.RESULTS The median age was 64 years (range 30-88) and 86% (n = 129) were males. As many as 124 (83%) were cirrhotic. The overall performance score was 80%. Nearly 21/124 tumors were detected in cirrhotic screening. Tumors were single nodular in 32 (21%), up to three nodules in 28 (18%), more than three nodules in 33 (22%) and diffusely infiltrating in 56 (37%). The major venous invasions were present in 78 (52.3%). Extra-hepatic tumor spread was seen in 19 (12.7%) (lungs 13 [72.2%], bones 2 [11.1%]). The median survival of patients receiving palliative care was three months (1-43 months). Tumor size and cirrhotic status were significant predictors in univariate analysis.CONCLUSION A quarter of nvHCCs were not amenable to treatment at presentation as they had dismal survival.Item Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayaka, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radio frequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafmib was prescribed in four patients. Overall mean survival was 15 months. In the ‘no treatment’ group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Clinical characteristics and outcomes of hepatocellular carcinoma: results from prospective study, from a tertiary referral center in Sri Lanka(Sri Lanka Medical Association, 2018) Bulathsinhala, B.K.S.; Siriwardana, R.C.; Gunetilleke, M.B.; Niriella, M.A.; Dassanayake, A.S.INTRODUCTION:Hepatocellular carcinoma is increasing globally. Compared to global patterns, hepatitis B and C are rare in Sri Lanka whilst non-alcoholic fatty liver disease (NAFLD) and alcohol are the commonest causes of hepatocellular carcinoma.OBJECTIVE:To determine the characteristics of a cohort of Sri Lankan patients with hepatocellular carcinoma of non-viral aetiology.METHODS:Details of 550 consecutive patients with hepatocellular carcinoma referred from 2012 to 2017 were collected prospectively. Demographic data, clinical and biochemical details, aetiology, comorbidities, tumor characteristics and type of treatment offered were retrospectively analyzed.RESULTS:Median age was 62.9 years (range 12 - 88) with male preponderance (n = 473; 86%). Overall median BMI was 35.8 kgm-2. Majority (n=309; 56 %) had NAFLD induced cirrhosis, second commonest cause was alcohol (n=203;36.9 %). Tumour was single nodular 233(42.4%) and diffusely infiltrating 92(16.7%). Diagnostic rise in serum alpha-fetoprotein (over 200 micrograms) was seen in 30.2%. Venous invasion was present in 28.5% [portal vein 136 (24.7%), hepatic vein 9 (1.6%) and cava 12(2.2%)]. Extra hepatic tumor spread was seen in 6.9% [lungs 20(3.6%), bones 4(0.7%), peritoneal 6 (1.1%) and metastases at other sites 8 (1.45%)]. Curative surgery was offered in 78(14.2%). Tumour embolization was done in 192(34.9%), radio frequency ablation 34(6.2%), alcohol injection 42(7.6%) and 204(37.1%) patients were offered palliative care. Overall median survival was 20.6 months.CONCLUSION:In a large Sri Lankan cohort, most hepatocellular carcinomas were due to cryptogenic cirrhosis and it was aggressive at presentation. Screening of high-risk NAFLD patients needs to be considered and further palliative care needs to be improved.