The importance of a multidisciplinary approach to hepatocellular carcinoma

Osama Siddique,1 Eric R Yoo,2 Ryan B Perumpail,3 Brandon J Perumpail,4 Andy Liu,5 George Cholankeril,6 Aijaz Ahmed3 1Department of Medicine, Brown University, Providence, RI, 2Department of Medicine, University of Illinois College of Medicine, Chicago, IL, 3Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 4Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, 5Department of Medicine, California Pacific Medical Center, San Francisco, CA, 6Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA Abstract: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners. In most cases, HCC is diagnosed by abdominal imaging studies, preferably with a triphasic computed tomography scan of the abdomen or magnetic resonance imaging of the abdomen. Histopathological diagnosis using a guided liver biopsy may be needed in noncirrhotic patients or when radiological diagnostic criteria are not fulfilled in the setting of cirrhosis. The Barcelona Clinic Liver Cancer staging system facilitates a standardized therapeutic strategy based on the tumor burden, extent of metastasis, severity of hepatic decompensation, comorbid medical illnesses, functional status of patient, HCC-related symptoms, and preference of the patient. Treatment options include curative surgery (hepatic resection and liver transplantation) and palliative measures (radiofrequency ablation, transarterial chemoembolization, and chemotherapy with sorafenib). The role of the multidisciplinary team is crucial in promptly reconfirming the diagnosis, staging the HCC, and formulating an individualized treatment plan. In potential liver transplant candidates, timely liver transplant evaluation and coordinating bridging/downsizing treatment modalities, such as radiofrequency ablation and transarterial chemoembolization, can be time-consuming. In summary, a multidisciplinary team approach provides a timely, individualized treatment plan, which can vary from curative surgery in patients with early-stage HCC to palliative/hospice care in patients with metastatic HCC. In most tertiary care centers in the US, a multidisciplinary liver tumor board has become the standard of care and a key component of best practice protocol for patients with HCC. Keywords: multidisciplinary team, MDT, hepatocellular carcinoma, HC

Obesity and Diabetes: Pathophysiology of Obesity-Induced Hyperglycemia and Insulin Resistance

Insulin resistance along with type 2 diabetes (T2D) is some of the complications of obesity. Insulin resistance occurs due to the increased discharge of fatty acids, lipids, and other advancing factors, by the adipose tissue, leading to a myriad of complications. Several other substances namely glycerol, enzymes, inflammatory factors, and hormones are also involved in the overall mechanism. At the point when resistance towards insulin occurs, along with abnormally functioning β-cells, the overall burden of the inability to control elevated glucose levels in the blood ensues. Anomalies in β-cell are thus more critical in the development of T2D and its related symptoms. This information is encouraging investigation of the molecular and hereditary basis of the ailment and new ways to deal with its management and avoidance