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Oncology > 78 HCC > Flashcards

78 HCC Flashcards

1
Q

First line option for non cirrhotic patients at early stage HCC with solitary tumors

A

Surgical resection

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2
Q

Most widely used primary treatment of unresectable HCC worldwide

A

TACE

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3
Q

Mass/nodule on ultrasound. Less than 1 cm. What to do?

A

Repeat ultrasound at 4 months

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4
Q

Mass/nodule on ultrasound. 1-2 cm or more than 2 cm. What to do?

A

4 phase CT or dynamic contrast enchanced MRI

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5
Q

Represents 90% of primary liver cancers

A

HCC

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6
Q

Reason for high prevalence of HCC in Asia and Sub-Saharan Africa

A

High prevalence of HBV infection

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7
Q

Main risk factor for HCC

A

Cirrhosis

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8
Q

How many of cirrhotic patient develop HCC?

A

One third

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9
Q

Predictor of liver cancer development

A

Liver diase severity (platelet count less than 100K presence of portal hypertension)
Degree of liver stiffened by transient elastograph

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10
Q

Causes of HCC and their percentages

A

HBV infection 50%
HCV infection 30%
Alcohol, metabolic symptoms 20%

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11
Q

Associated with polymorphism with fatty and alcoholic chronic liver disease and HCC occurence

A

PNPLA3

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12
Q

Mutations associated with tobacco and alfatoxin B leading to HCC

A

TP53

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13
Q

Most common mutational drivers in HCC

A

TERT 56% common in HBV
TP53 27% common on alfatoxin B1
CTNNB1 26% common in HCV

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14
Q

When is surveillance needed for HCC

A
  1. Cirrhotic patients
  2. HCV related fibrosis Metavir score of F3
  3. HBV infection, Asian more 40 yrs old and African more than 20 yrs old
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15
Q

Recommended method for surveillance in HCC

A

Ultrasound every 6 months

Every 3 months if a less than 1 cm nodule is found

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16
Q

Is AFP useful in HCC?

A

60% sensitivity but only 20% of early tumor present with abnormal AFP

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17
Q

Radiologic diagnosis of HCC

A

More than 2 cm AND

Radiological hallmark

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18
Q

Typical contrast enhanced imaging hallmark of HCC

A

Vascular update of the nodule in the arterial phase with washout in the portal venous or delayed phase
95-100% sensitivity

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19
Q

AFP levels suspicious for HCC nit not diagnostic

A

More than 400 ng/dL

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20
Q

When is liver biopsy needed

A
  1. Patient without cirrhosis

2. Radiology is not typical in one of two imaging techniques( CT and MRI)

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21
Q

4 stains for HCC. How many should be positive to be specific for HCC?

A 
GPC3
Glutamine synthase
HSP70
Clathrin heavy chain
2 out of 4
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22
Q

HCC readiological hallmark

A

Arterial hypervascularity

Venous phase washout

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23
Q

Most accepted staging system for HCC

A

Barcelona Clinic Liver Cancer BCLC classification

24
Q

Five treatments that have been demonstrated to improve survival in HCC

A 
Surgical resection
Liver transplantation 
Radiofrequency ablation
Chemoembolization
Systemic therapies
25
Q

What are the systemic therapies in HCC

A 
sorafenib
refgorafenib
lenvatinib
cabozatinib
ramucirumab
26
Q

Three parameters relevant for defining treatment strategy in HCC

A

tumor status
cancer related symptom
liver dysfunction

27
Q

What is the treatment? Stage 0. CPS A. ECOG 0. Single nodule less than 2 cm

A

Ablation

28
Q

What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure normal. Bilirubin normal.

A

Resection

29
Q

What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure and bilirubin increased. No associated diseases

A

Transplantation

30
Q

What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure and bilirubin increased. With associated diseases

A

Ablation

31
Q

What is the treatment? Multinodular. ECOG 0.

A

Chemoembolization

32
Q

What is the treatment? Portal invasion. N1, M1. ECOG 1-2.

A

Systemic therapies

33
Q

What is the treatment? CPS C. ECOG more than 2.

A

Supportive care

34
Q

Represents the major complication of resection and occurs how many percent at 5 years?

A

Tumor recurrence. Occurs 70% at 5 years. Mostly intrahepatic metastases

35
Q

First treatment of choice for cirrhotic patients with single tumor less than 5 cm and portal hypertension or small multinodular (less than 3 nodules and less than 3 cm)

A

Liver transplantation

36
Q

Recommended primary ablation technique

A

Radiofrequency ablation

37
Q

Limitation of RF

A

Failure rate increases in tumors more than 3 cm

38
Q

Standard of care systemic therapy for HCC

A

Sorafenib

39
Q

Recommended daily dose of sorafenib and median treatment duration

A

800 mg daily for 6 months

40
Q

Classification of cholangiocarcinoma and its percentage

A

Intrahepatic 30%
Perihilar 50 %
distal 20%

41
Q

Second most common liver cancer following HCC

A

Cholangiocarcinoma or CCA

42
Q

Genetic aberrations in iCCA

A

FGFR2 fusion

43
Q

Genetic aberrations in pCCA and dCCA

A

PRKACA or PRKACB fusion

44
Q

Classic risk factors for development of CCA

A

Primary sclerosing cholangitis (PSC)
Biliary duct cyst
Hepatolithiasis
Caroli’s disease

45
Q

Most common cancer of the biliary tract

A

Gallbladder cancer

46
Q

Major risk factor for gallbladder cancer

A

Cholelithiasis

47
Q

What are at risk of transforming to gallbladder cancer and at what size?

A

Gallbladder polyp are at risk for transforming to gallbladder cancer if more than 10 mm in diameter

48
Q

Most accurate technique to define staging and vascular and biliary tract invasion in gallbladder cancer

A

MRCP

49
Q

Main treatment of gallbladder cancer

A

surgical

50
Q

Two most important prognostic factor in gallbladder cancer

A

Regional nodal status and depth of tumor invasion

51
Q

Chemotherapy used with Stage III and IV unresectable gallbladder cancer

A

gemcitabine and cisplatin

52
Q

Rare form of primary liver cancer that affects children without background of liver disease

A

Fibrolamellar hepatocellular carcinoma FLC

53
Q

Mainstay treatment of FLC

A

surgical resection

54
Q

Most common primary liver tumor in children

A

Hepatoblastoma HB

55
Q

Most common benign liver tumors

A

hemangiomas
focal nodular hyperplasia
hepatocellular adenoma

Oncology (7 decks)

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