Hepatocellular Flashcards
Epidemiology -4
Males > Female (2.9:1),
mean age ~50-60,
rare but rising in US due to Hep C,
higher incidence in China, Africa, Asia
Risk Factors -9
HBV, HCV, cirrhosis, anabolic steroids, hereditary hemochromatosis, aflatoxin chemical that contaminates corn, soybeans, peanuts in China, Africa (high incidence of HCC in these), nitrosamines, vinyl chloride, arsenic
Prevention -2
HBV (vax),
HCV (dec blood transfusions, needles, unprotected sex)
Screening -2
Screen pts at high risk of HBV, HCV, and cirrhosis.
alpha-fetoprotein (AFP) levels in clinical trials.
Signs and Symptoms -7
hepatic mass (need to r/o different primary cancer or benign dz),
R upper abd pain,
wt loss (anorexia, early satiety),
obstructive jaundice,
sudden LFT inc,
sudden ascites (rapid loss of hepatic function),
tumor fever
Diagnosis
AFP, LFTs, PT, PTT, HBV, HCV, spiral CT, MRI with contrast to confirm
bx rarely needed and should avoid to decrease possible tumor seeding prior to resection
Prognostic Factors -3
OS unresected 3-4mo.
resected 5-yr DFS 5% with recurrence rates 70-100%.
AFP, PS, ascites (liver function), mets most common to bone and lung but pts die most often of liver failure
Treatment Options SURGERY -3
surg is std of care.
5 yr OS 30-40% if among 30% pts who qualify for surg. median OS ~3yr.
cirrhosis pts do poorly (transplant an option in some if can get liver in <6mo IF RESECTED).
locoregional therapy -5
- TACE: doxorubicin, ciplatin, or mitomycin c.
- Hepatic arterial chemo -5FU or fluorodeoxyuridine (FUDR) +/- cis or doxo.
- Percutaneous ethanol inj
- radiofrequency ablation
- cryosurg
radiation -2
palliative only, commonly as chemoXRT
liver can not tolerate much XRT
treatment by stage - chemo - advanced dz -3
WHAT IS SOC?
FYI NO SOC FOR 2nd line
no std of care,
RR <20%, median OS 4-9 mo
doxo, 5FU, FUDR, mitomycin c, PIAF (cisplatin, interferon, doxorubicin, 5FU), gem, thalid, gem/cis, doxo/cis, gem/oxal, gex/oxal/bev
SHARP trial - targeted therapy - metastatic -4
sorafenib 400mg PO bid is SOC (cat 1).
Use for unresectable or mets
med OS 11.5 vs 8.5 mo with placebo
TTP 6 vs 3 mo.
First systemic tx to prolong survival.
immune therapy -2
interferon used in HCV pts
both chemopreventative and adj tx after tumor ablation
treatment by stage - localized resectable dz. -2
SURGERY IS SOC
adj chemo or adj chemoembo is investigational STUDY
treatment by stage - localized or locally advance unresectable dz -5
- no real std of care
- locoregional tx (if tumor <5cm)
- targeted tx (sorafenib std if not transplant candidate)
- chemo no OS benefit