Chapter 51: Liver- HCC Flashcards
What is it?
Most common primary malignancy of the liver
By what name is it also known?
Hepatoma
What is its incidence?
Accounts for 80% of all primary malignant liver tumors
What are the associated risk factors?
- Hepatitis B virus
- cirrhosis
- aflatoxin
What percentage of patients with cirrhosis will develop hepatocellular carcinoma?
≈5%
What are the signs/symptoms?
Dull RUQ pain
hepatomegaly
(classic presentation: painful hepatomegaly)
What tests should be ordered?
- Ultrasound
- CT scan
- angiography
- tumor marker elevation
What is the tumor marker?
Elevated α-fetoprotein
What is the most common way to get a tissue diagnosis?
Needle biopsy with CT scan/ultrasound/laparoscopic guidance
What is the most common site of metastasis?
Lungs
What is the treatment of hepatocellular carcinoma?
- Surgical resection, if possible (e.g., lobectomy)
- liver transplant
What are the treatment options if the patient is not a surgical candidate?
- Percutaneous ethanol tumor injection
- cryotherapy
- intra-arterialchemotherapy
What are the indications for liver transplantation?
- Cirrhosis
- and NO resection candidacy
- as well as no distant or lymph node metastases
- and no vascular invasion
- the tumor must be:
- single <5-cm tumor
- or have three nodule with none >3 cm
What is the prognosis under the following conditions:
Unresectable?
Almost none survive 1 year
What is the prognosis under the following conditions: Resectable?
≈35% are alive at 5 years