HCC Flashcards
When do you not need liver biopsy of a suspicious lesion?
LI-RADS 5 lesion in cirrhotic liver or in a patient with chronic HBV without cirrhosis
How to workup a LI-RADS 3 lesion?
Repeat imaging in 3-6 months
What defines early HCC?
<3 tumors
No extrahepatic spread
No vascular invasion
Teratment options (3) of early HCC?
Transplant, Surgery, TACE
Criteria for resectable HCC? (2)
Size and function.
Liver remnant must be >25-30%
and preserved liver function
Patient with early HCC undergoes surgical resection. What now?
Adjuvant atezo-bev improved RFS
What makes a patient with HCC a transplant candidate? (2)
Unresectable
1 lesion <5cm or 3 tumors that are 3 cm or smaller
Criteria for HCC ablation? (3)
Each lesion up to 4 cm
Child Pugh A or B
Not near major blood vessel
Patient with unresectable HCC with Child Pugh B and no extrahepatic disease or vascular invasion. What to do for teratment?
TACE, TARE, or RFA
1st line treatment for advanced HCC (2)
Atezo + Bev
Durva + Tremelimumab
2nd line therapy for advanced HCC? (5)
Regorafenib
Cabozantinib
Ramucirumab (If AFP >400)
Ipi/Nivo
Lenvatinib
Sorafenib
Pembro
Indication for Ramuricumab in advanced HCC?
2nd line, if AFP >400
Treatment options for 1st line advanced HCC with Child Pugh B?
Sorafenib (B7)
Nivo
Atezo-Bev
Durva
Second line therapy options for advanced HCC with Child Pugh B? (2)
Sorafenib (B7)
Nivo
Patient with advanced HCC about to start treatment with Atezo + Bev. What needs to be done within the first 6 months of treamtent?
EGD to rule out varices
