hepatocellular ca

Question 1

def of hepatocellular ca

Answer 1

primary malignancy of hepatocytes, usually occuring in a cirrhotic liver

Question 2

aetiology of hepatocellular ca

Answer 2

• chronic liver disease eg alcoholic liver disease, hep B, C, autoimmune disease, PBC
• metabolic disease eg haemochromatosis
• alfatoxins - aspergillus flavus fungal toxin found on stored grains or biological weapons
• HBV leading cause worldwide
• AIH
• non-alcoholic fatty liver
• clonorchis sinesis
• anabolic steroids

Question 3

RF of hepatocellular ca

Answer 3

cirrhosis

HBV, HBC

chronic heavy alcohol use

dm

obesity

FH of liver cancer

Question 4

epidemiology of hepatocellular ca

Answer 4

Common making up 1–2% of all malignancies, but less common thansecondary liver malignancies.

Rare in West (1–2 in 100 000/year).

Very common malignancy in areas where Hepatitis B and C are endemic, i.e. Asia and sub-Saharan Africa (500 in100000/year).

Primary hepatocyte neoplasia accounts for 90% of primary liver cancers

men more than women

Question 5

sx of hepatocellular ca

Answer 5

• symptoms of malignancy - malaise, weight loss, loss of appetite, fatigue
• symptoms of chronic liver disease - abdo distension, jaundice
• history of carcinogen exposure - high alcohol intake, HBV, HVC, aflatoxins
• RUQ pain
• fever
• jaundice
• may rupture = intraperitoneal haemorrhage

Question 6

signs of hepatocellular ca

Answer 6

haemobilia (bleeding into the biliary tree)

signs of malignancy - cachexia, lymphadenopathy

hepatomegaly - nodular but may be smooth, deep palpation may elicit tenderness, may be bruit over liver

signs of chronic liver disease - jaundice, ascites

abdo mass

Question 7

ix of hepatocellular ca

Answer 7

blood

abdo US - not sensitive for tumours <1cm

duplex scan of liver - large vessel invasion eg into hepatic/portal veins

CT thorax, abdo, pelvis - define structural lesion/spread

hepatic angiography - using lipiodol (an iodized oil)

liver biopsy - confirms histology of the tumour, small risk of tumour seeding along the biopsy tract

staging - CXR, CT thorax, abdo, pel, radionucleotide bone scan

screening - AFP and abdo US in at high risk individuals

Question 8

blood for hepatocellular ca

Answer 8

• FBC
• clotting
• hepatitis serology
• raised AFP - tumour marker with high sensitivity, levels do not correlate with size, stage, or prognosis
• Vitamin B12-binding protein is a marker of fibrolamellar hepatocellular carcinoma.
• LFT has poor specificity and sensitivity but may show biliary obstruction.