Hepatocellular carcinoma

Question 1

Define hepatocellular carcinoma

Answer 1

Primary malignancy of liver parenchyma

Question 2

Aetiology of hepatocellular carcinoma

3

Answer 2

Associated with:

Chronic liver damage
alcoholic liver disease
hep C
autoimmune disease

Metabolic disease
e.g. haemochromatosis

Aflatoxins
e.g. cereals contaminated w/ fungi

Question 3

Epidemiology of hepatocellular carcinoma

prevalence x3, location

Answer 3

COMMON
1-2% of al malignancies
Less common than liver metastases
High incidence in regions where hep B & C are endemic

Question 4

Presenting symptoms of hepatocellular carcinoma

3 malignancy + 3 carcinogen exposure + 2

Answer 4

Symptoms of malignancy
Malaise
Weight loss
Loss of appetite

History of exposure to carcinogens
High alcohol intake
Hepatitis B or C (e.g. sexual activity, IV drug use)
Aflatoxins

Abdominal distention
Jaundice

Question 5

Signs of of hepatocellular carcinoma on physical examination
(6)

Answer 5

Cachexia
Lymphadenopathy
Hepatomegaly (may be nodular)
Jaundice
Ascites 
Bruit over liver

Question 6

Investigations for hepatocellular carcinoma

4

Answer 6

Bloods
Imaging
Histology/cytology
Staging

Question 7

Investigations for hepatocellular carcinoma - bloods

6

Answer 7

FBC
ESR
LFTs
Clotting
α-fetoprotein (tumour marker for liver cancer)
Hepatitis serology

Question 8

Investigations for hepatocellular carcinoma - imaging

2

Answer 8

Abdo US

CT/MRI - GOLD STANDARD for staging

Question 9

Investigations for hepatocellular carcinoma - histology/cytology

Answer 9

Ascitic tap may be sent for cytological analysis

Question 10

Investigations for hepatocellular carcinoma - staging

Answer 10

CT scan (chest/abdo/pelvis)