Steenbergmcginnis7692

Liver cancer is the third most common cause of cancer related death worldwide, 90% being hepatocellular carcinoma (HCC) and about half of all HCCs estimated to occur in China. Imaging plays a pivotal role in the management of HCC. When stringent criteria are applied to at-risk populations, it enables HCCs to be diagnosed by imaging alone without further need of invasive histology confirmation. To optimize HCC imaging diagnosis and reporting, several systems have been proposed. The Liver Imaging Reporting and Data System (LI-RADS®) is currently the most comprehensive of these systems, providing guidance on all imaging-related aspects of HCC, from technique for acquisition, reporting, assessment of treatment response and management. For diagnosis, LI-RADS uses major and ancillary imaging features to assign hierarchical categories that communicate the relative probability of HCC to focal liver observations detected in patients at risk. Two LI-RADS algorithms yield high specificity and positive predictive value for HCC diagnosis on contrast enhanced ultrasound (CEUS), CT and MRI. The standardized lexicon and interpretation provided by LI-RADS also improve inter-reader agreement for imaging features and lesion categorization. Additionally, a LI-RADS treatment response algorithm (LR-TR) provide imaging criteria for assessment of response to locoregional therapy. LI-RADS is designed for universal adoption and in this review, we highlighted the most relevant aspects of LI-RADS for the diagnosis of HCC in clinical practice and discussed areas where LI-RADS and Asian guidelines are different.Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer related mortality worldwide, with the most common underlying etiologies being chronic hepatitis B and hepatitis C infections. Treatment of these viral hepatidities in the setting of HCC has been debated, and there is increasing study addressing this topic. Patients with advanced HCC of either etiology are unlikely to benefit from antiviral treatments, and futility should be considered prior to starting antiviral therapy. Hepatitis B treatment has demonstrated improved survival, decreased risk of hepatitis B reactivation, and decreased risk of late HCC recurrence. The mainstay treatment of chronic hepatitis B has been nucleos(t)ide analogues (NAs), and in the setting of HCC, entecavir and tenofovir are preferred given their higher potency and barriers to resistance. Those who were already on a NAs at the time of HCC diagnosis should be continued on them regardless of the HCC management planned. Patients who are suitable candidates to start NAs should start them at the time of HCC diagnosis. Direct-acting antivirals (DAAs) are the first line therapies for hepatitis C. Unlike with hepatitis B, those with HCV-associated HCC are recommended to start treatment 3-6 months after complete treatment of their HCC, given lower rates of sustained virologic response (SVR) with active HCC. There are also controversial concerns about DAAs contributing to a more aggressive HCC phenotype, but data are limited by retrospective studies, and more recent retrospective studies are more reassuring. In transplant candidates, starting DAAs may be deferred until after transplant depending on median regional wait times, availability of HCV positive organs, and the degree of the patient's liver dysfunction. Overall, in patients with HCC from hepatitis B or C, treatment of the underlying viral hepatitis should be considered unless advanced stage limits benefits and results in futility.Access to healthcare in Mexico is available to its population via publicly and privately funded institutions. The public sector, administered by both the local and federal government under the jurisdiction of the Department of Health, provides healthcare to the majority of the country's population. Privately funded institutions vary in size and scope of practice, ranging from small clinics focused on family practice, to large tertiary hospitals with capacity for treating patients with complex conditions and performing clinical research. The evaluation and treatment of patients with cancer in Mexico is also available through both sectors. In the country's capital, Mexico City, patients with glioblastoma are primarily treated at the National Institute of Neurology and Neurosurgery and the National Institute of Oncology. Epidemiological data is incomplete due to the lack of a national cancer registry. In the case of neoplasms of the central nervous system, the available information suggests that gliomas represent 33% of all intracranial tumors. Bufalin clinical trial The treatment of patients in Mexico diagnosed with glioblastoma has not been standardized owing to the lack of resources in some communities and the expense of antineoplastic agents. Current options range from a biopsy only to maximal safe resection followed by adjuvant treatment with radiation and chemotherapy. Currently, basic science and clinical research is being conducted in academic institutions associated with universities and in private hospitals. Studies include the evaluation of tumor biology, neuroimaging biomarkers and new treatment options such as the use of chloroquine.The indication of systematic lymphadenectomy in advanced ovarian cancer without apparent macroscopic lymph node involvement has been controversial over the past three decades, and the recommendation to perform it or not has been based on multiple retrospective studies, small cohort studies, and few randomized studies with several biases; however, it seems that this controversy has come to an end after the recent publication of a randomized clinical trial. The study of lymph node disease in ovarian cancer has intensified in the last two decades, so far that it was part of the changes of the last update of the International Federation of Gynecology and Obstetrics (FIGO) staging; In this review, a search was made of the available literature to understand the evolution of knowledge about the implications of the realization or not of lymphadenectomy in two scenarios of advanced ovarian cancer (namely, the presence or not of lymph node disease macroscopic), without losing the landscape of the importance of peritoneal disease in these stages, which, as we will see throughout the review, the complete cytoreduction of the tumor remains an integral part of the treatment, since residual disease is one of the most relevant prognostic factors.