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Gastro > HCC > Flashcards

HCC Flashcards

1
Q

What is the most common cause of HCC worldwide?

A

Hep b

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2
Q

What are risk factors for HCC development?

A 
Hep B
- viral load
- HBeAg positive (active viral replication)
- HBV genotype (C and D highest risk)
- co infection with hep c or d
Sex
Hep C
Cirrhosis from any cause
Smoking 
Nafld
Iron overload
Alpha1antitrpsin
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3
Q

Is there a gender difference in incidence with HCC?

A

M:F 4:1

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4
Q

What is the most common cause of HCC in Australia?

A

Hep c

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5
Q

What are risk factors for HCC?

A 
Cirrhosis - of any cause
Hep B
Hep C - even after SVR obtained
Age
Aflatoxin found in peanuts etc.
Diabetes
NAFLD
Haemochomotosis
Alpha-1 anti trypsin
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6
Q

What is the recommended screening for HCC

A

6 monthly USS

- some contribution of AFP but adds significant false positives

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7
Q

Who should have surveillance for HCC?

A

All patients with cirrhosis
Those without cirrhosis who have
- hep b and high viral load
- hep c and bridging fibrosis

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8
Q

What can cause elevations in AFP?

A

Alcoholic liver disease
Pregnancy
HCC
Seminomatus germ cell tumor

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9
Q

What are is the characteristic imaging finding of HCC?

A

Hypervascular in arterial phase with washout in portal venous phase on multi detector CT or contrast enhanced MRI

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10
Q

What staging system is used for HCC and what does it take into account?

A 
Barcelona clinic liver cancer staging
Performance status
Child Pugh score
Size and number of lesions
Elevated portal pressures
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11
Q

What makes a BCLC stage 0 and what treatments can be considered?

A

Child Pugh A
PS 0
Single HCC less than 2cm

Curative treatments: resection, RFA
Liver transplant if candidate

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12
Q

What is a BCLC stage A and treatment?

A

Child Pugh A-B
PS 0-2
A single nodule less than 5cm or 3 nodules all less than 3cm

Curative treatments: resection, RFA, transplant

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13
Q

What is a BCLC stage B and treatment?

A

CP A-B
PS 0-2
Multi-modular disease

Treatment: TACE

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14
Q

What is BCLC stage C and treatment?

A

CP A-B
Advanced disease - portal involvement, nodes, mets

Treatment: sorafenib

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15
Q

What is BCLC stage D and treatment?

A

Child Pugh C
PS greater than 2

Supportive treatment only

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16
Q

Who may benefit from liver transplant?

A

Those with child Pugh C
And either
- one nodule less than 5cm
- or 3 nodules less than 3cm

17
Q

What are curative treatments of HCC?

A

Resection
Transplant
RFA
PEI (percutaneous ethanol injection, less effective then RFA)

18
Q

What are some palliative treatments of HCC?

A

TACE

Sorafenib

19
Q

What is sorafenib?

A

Multi tyrosine kinase inhibit which blocks PDGf, VEGF, c-kit and raf

20
Q

Side effects of sorafenib?

A 
Hand and foot
Diarrhoea
Bleeding
Hypertension
Clots
Risk of renal impairment
21
Q

What AFP level is diagnostic of HCC?

A

400

Gastro (11 decks)

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