Hepatocellular Carcinoma and the Watery Diarrhea Syndrome

A, Solinas; Biscarini, L.; Morrelli, Antonio; Favero, A. Del

doi:10.1001/archsurg.1988.01400250134033

Cited by 5 publications

(4 citation statements)

References 2 publications

(2 reference statements)

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“…Case reports have described paraneoplastic diarrhoea related to VIP and prostaglandin production. 42,43 Chronic pancreatitis may ultimately cause exocrine pancreatic dysfunction with steatorrhea. 44 Clinical studies have reported a range of 6-16% for the co-incidence of chronic pancreatitis in patients with liver cirrhosis.…”

Section: Diarrhoea Associated With Chronic Liver Diseasementioning

confidence: 99%

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Sangro

Chan

Meyer

et al. 2020

Journal of Hepatology

189

179

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Immune checkpoint inhibitors (ICIs) have reshaped cancer therapy. ICIs enhance T cell activation through various mechanisms and may help reverse the exhausted phenotype of tumour-infiltrating lymphocytes. However, disrupting the key role that checkpoint molecules play in immune homeostasis may result in autoimmune complications. A broad range of immune-related adverse events (irAEs) involve almost every organ but mostly affect the skin, digestive system, lung, endocrine glands, nervous system, kidney, blood cells, and musculoskeletal system. They are usually manageable but can be lifethreatening. The incidence of irAEs is not very different in patients with hepatocellular carcinoma (HCC) compared to other tumour types, although there is a trend towards a higher incidence of hepatic irAEs. HCC usually develops on a background of cirrhosis with associated systemic manifestations. Extrahepatic organ dysfunction in cirrhosis may cause signs and symptoms that overlap with irAEs or increase their severity. Available guidelines for the management of irAEs have not specifically considered the assessment of toxicities in the context of patients with liver cancer and cirrhosis. This review addresses the toxicity profile of ICIs in patients with HCC, focusing on the challenges that the underlying liver disease poses to their diagnosis and management. Challenges include late recognition, inadequate work-up and delayed treatment, overdiagnosis and inappropriate interruption of ICIs, complications caused by immunosuppressive therapy, and increased cost. A specific algorithm for the management of hepatic irAEs is provided.

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Section: Diarrhoea Associated With Chronic Liver Diseasementioning

confidence: 99%

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Sangro

Chan

Meyer

et al. 2020

Journal of Hepatology

189

179

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“…The production of gastrin, vasoactive intestinal polypeptide, and prostaglandins in HCC has been demonstrated by immunohistochemical studies, and treatment with antagonists of these substances and tumor resection has led to the disappearance of diarrhea, thus corroborating this mechanism. Successful therapies of paraneoplastic diarrhea in HCC have included nonsteroidal anti-inflammatory drugs, described by Saban et al (12) and Salinas et al (13), and surgical ablation described by Steiner et al (14).…”

Section: Discussionmentioning

confidence: 99%

“…A few case reports have clearly demonstrated that one of the causes of chronic diarrhea associated with HCC is paraneoplastic syndrome (12‐14). The production of gastrin, vasoactive intestinal polypeptide, and prostaglandins in HCC has been demonstrated by immunohistochemical studies, and treatment with antagonists of these substances and tumor resection has led to the disappearance of diarrhea, thus corroborating this mechanism.…”

Section: Discussionmentioning

confidence: 99%

Chronic Diarrhea as First Manifestation of Liver Cirrhosis and Hepatocarcinoma in a Teenager

Robles-Medranda

Lukashok

Novais

et al. 2006

J. pediatr. gastroenterol. nutr.

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“…However, symptoms related to predisposing risk factors (cirrhosis and viral infections) are frequent, such as ascites and esophageal varices. Paraneoplastic syndromes may be occasionally associated with hepatocellular carcinoma, such as hypoglycemia (35), erythrocytosis (36), hypercalcemia (37) diarrhea (38) and cutaneous lesions (39). Other less common presentations include fever, infections, obstructive jaundice, and hemorrhage due to tumor rupture.…”

Section: Clinical Characteristics Diagnosis and Diagnostic Testsmentioning

confidence: 99%

Hepatocellular Carcinoma in Adults

Thiesen

2021

Liver Cancer

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Hepatocellular carcinomas are the most common primary neoplasia of the liver. The global distribution of hepatocellular carcinoma is related to the prevalence of hepatitis C in the population. Other major etiologic factors include alcoholic liver disease and nonalcoholic steatohepatitis. The majority of cases are discovered when screening patients with either chronic hepatitis or cirrhosis, but occasional incidental cases have been reported. Molecular markers and associated gene alterations are a work in progress. Serological markers and radiology are used to detect the disease in high-risk populations, and to monitor response to therapy in the affected patients. Even though radiologic features are specific, tissue diagnosis may be required, particularly for atypical and smaller lesions. Ancillary studies including reticulin stain and immunohistochemistry are important for confirmatory diagnosis. Liver transplantation is curative for hepatocellular carcinoma, but due to limitations in organ availability, palliative care is required, which mostly includes chemoembolization and radio-ablation.

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Hepatocellular Carcinoma and the Watery Diarrhea Syndrome

Cited by 5 publications

References 2 publications

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Chronic Diarrhea as First Manifestation of Liver Cirrhosis and Hepatocarcinoma in a Teenager

Hepatocellular Carcinoma in Adults

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