Chapter 51: Liver- HCC Flashcards

1
Q

What is it?

A

Most common primary malignancy of the liver

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2
Q

By what name is it also known?

A

Hepatoma

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3
Q

What is its incidence?

A

Accounts for 80% of all primary malignant liver tumors

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4
Q

What are the associated risk factors?

A
  1. Hepatitis B virus
  2. cirrhosis
  3. aflatoxin
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5
Q

What percentage of patients with cirrhosis will develop hepatocellular carcinoma?

A

≈5%

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6
Q

What are the signs/symptoms?

A

Dull RUQ pain

hepatomegaly

(classic presentation: painful hepatomegaly)

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7
Q

What tests should be ordered?

A
  1. Ultrasound
  2. CT scan
  3. angiography
  4. tumor marker elevation
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8
Q

What is the tumor marker?

A

Elevated α-fetoprotein

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9
Q

What is the most common way to get a tissue diagnosis?

A

Needle biopsy with CT scan/ultrasound/laparoscopic guidance

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10
Q

What is the most common site of metastasis?

A

Lungs

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11
Q

What is the treatment of hepatocellular carcinoma?

A
  • Surgical resection, if possible (e.g., lobectomy)
  • liver transplant
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12
Q

What are the treatment options if the patient is not a surgical candidate?

A
  1. Percutaneous ethanol tumor injection
  2. cryotherapy
  3. intra-arterialchemotherapy
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13
Q

What are the indications for liver transplantation?

A
  1. Cirrhosis
    • and NO resection candidacy
    • as well as no distant or lymph node metastases
    • and no vascular invasion
  2. the tumor must be:
    • single <5-cm tumor
    • or have three nodule with none >3 cm
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14
Q

What is the prognosis under the following conditions:

Unresectable?

A

Almost none survive 1 year

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15
Q

What is the prognosis under the following conditions: Resectable?

A

≈35% are alive at 5 years

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16
Q

Which subtype has the best prognosis?

A

Fibrolamellar hepatoma (young adults)