Hepatocellular Flashcards

1
Q

Epidemiology -4

A

Males > Female (2.9:1),

mean age ~50-60,

rare but rising in US due to Hep C,

higher incidence in China, Africa, Asia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk Factors -9

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prevention -2

A

HBV (vax),

HCV (dec blood transfusions, needles, unprotected sex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Screening -2

A

Screen pts at high risk of HBV, HCV, and cirrhosis.

alpha-fetoprotein (AFP) levels in clinical trials.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs and Symptoms -7

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prognostic Factors -3

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment Options SURGERY -3

A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

locoregional therapy -5

A
  1. TACE: doxorubicin, ciplatin, or mitomycin c.
  2. Hepatic arterial chemo -5FU or fluorodeoxyuridine (FUDR) +/- cis or doxo.
  3. Percutaneous ethanol inj
  4. radiofrequency ablation
  5. cryosurg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

radiation -2

A

palliative only, commonly as chemoXRT

liver can not tolerate much XRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment by stage - chemo - advanced dz -3

WHAT IS SOC?

FYI NO SOC FOR 2nd line

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SHARP trial - targeted therapy - metastatic -4

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

immune therapy -2

A

interferon used in HCV pts

both chemopreventative and adj tx after tumor ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment by stage - localized resectable dz. -2

A

SURGERY IS SOC

adj chemo or adj chemoembo is investigational STUDY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

treatment by stage - localized or locally advance unresectable dz -5

A
  • no real std of care
  • locoregional tx (if tumor <5cm)
  • targeted tx (sorafenib std if not transplant candidate)
  • chemo no OS benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

sorafenib ADR -5

25% of pts stopped tx due to ADR

A

diarrhea

HFS

rash or desquamation

anorexia

alopecia

17
Q

Surgery candidate

A

Nothing beyond cirrhosis child pughs A
<=3 tumors
No extrahepatic