Hepatocellular carcinoa Flashcards
what is the typical presentation of hepatocellular carcinoma?
Weight loss + jaundice + palpable mass in RUQ
Associated with HepB/C
define hepatocellular carcinoma?
Primary malignancy of the liver parenchyma (primary cancer arising from hepatocytes)
Most common primary cancer of liver however met are SOOOO MUCH more common (and if it is due to mets then AFP won’t be high)
what are the common cancers to metastasise to the liver?
colon, breast and upper GI
what is hepatocellular carcinoma associated with?
FH
Chronic liver damage
- Alcoholic liver disease
- Hepatitis B
- HepatitisC
- Autoimmune disease
Metabolic disease
- E.g. haemochromatosis
- DM/obesity
Aflatoxins
- E.g. Aspergillus flavus - cereals contaminated with fungi
outline the epidemiology of hepatocellular carcinoma?
COMMON - much more common in males
1-2% of all malignancies
LESS common than liver metastases
High incidence in regions where hepatitis B and C are endemic
what are the presenting symptoms of hepatocellular carcinoma?
Symptoms of Malignancy
- Malaise
- Weight loss
- Loss of appetite
Symptoms of chronic liver disease: abdominal distension, jaundice, RUQ pain, cachexia
- History of Exposure to Carcinogens
- High alcohol intake
- Hepatitis B or C (e.g. sexual activity, IV drug use)
- Aflatoxins
what are the signs of hepatocellular carcinoma on physical examination?
Signs of Malignancy
- Cachexia
- Lymphadenopathy
Hepatomegaly (may be nodular), splenomegaly, deep palpation may elicit tenderness, may hear bruit over liver
Jaundice
Ascites
Asterixis
Spider naevi
Palmar erythema
Fetor hepaticus
what is the gold standard for staging hepatocellular carcinoma?
CT/MRI
describe the bloods for hepatocellular carcinoma
FBC – microcytic anaemia/ thrombocytopenia
ESR
LFTs – poor specificity and sensitivity but may show biliary obstruction
Clotting
a-fetoprotein- tumour marker for liver cancer
B12 binding proteinis a marker of fibrolamellar HCC
Hepatitis serology (viral hepatitis panel)
what are the markers for hepatocellular carcinoma?
a-fetoprotein- tumour marker for liver cancer
B12 binding proteinis a marker of fibrolamellar HCC
describe the imaging for hepatocellular carcinoma?
Consider urgent abdominal US if in GP setting– not sensitive for tumours <1cmbut poorly defined margins and coarse, irregular internal echoes
CT/MRI - GOLD STANDARD for staging
describe histology/ cytology for hepatocellular carcinoma?
Ascitic tap may be sent for cytological analysis
Liver biopsy: confirms histology of tumour but small risk of tumour seeding along biopsy tract
describe the staging of hepatocellular carcinoma?
CT scan (thorax/abdo/pelvis), used to define structural lesion and spread
CXR
Also radionuclide bone scan
Duplex scan of liver may be used to demonstrate large vessel invasion, e.g. into hepatic/portal veins
