HCC

Question 1

Most common

Answer 1

HCC

Question 2

HCC Develops in healthy vs cirrhotic

Answer 2

90% develops in cirrhotic liver

10% develops in healthy liver

Question 3

CT aspect of cirrhosis

Answer 3

unregular surface
recanalized ombilical vein
perigastric circulation
splenomegaly

Question 4

Most HCC are diagnosed when ?

Answer 4

late

Question 5

When to suspect HCC

Answer 5

Previously stable cirrhotic patient with:

• sudden decompensation
• ascites
• icterus
• varicose bleeding
• enceophalopathic signs
• without sign of infection

Question 6

Early detection of HCC

Answer 6

Screening with AFP (cave not all tumors produce AFP)
US every 6 months
CT or MRI is a lot more sensitive and specific

Question 7

TTT for HCC

Answer 7

always in team
Surgical resection is therapy of choice, 
must have 
- normal portal pressue
- normal bilirubin
ideally in
- localized tumor
  - Stage 0 : single < 2cm
- non cirrhotic
- Child Pugh A
Only possible in 10% of cases

Ideally OLT

Question 8

TTT for HCC if early phase

Answer 8

US/CT alcohol instillation
RF Ablation
10% of cases will develop abdominal pain.
seldom bone marrow depression, cholecystitis, ischemia

Question 9

TTT for HCC if palliative

Answer 9

TACE Trans Arterial Chemo Embolization
if Liver function is ok:
Chemotherapy with Sorafenib (multikinase inhibitor)