Hepatocellular Carcinoma

Question 1

What are the types of liver cancer?

Answer 1

1. Metastatic (90%)

2. Primary (10%) (e.g HCC)

Question 2

What are the risk factors for HCC? (5 things)

Answer 2

1. Viral hepatitis (hep B + C) –> cirrhosis
2. Alcohol
3. Smoking
4. Age
5. FHx

Question 3

What are the pathophysiological steps of HCC? (4 steps)?

Answer 3

1. Chronic injury
2. Inflamm.
3. Hepatocyte regen.
4. Driver mutations of HCC

Question 4

What are the clinical features of HCC? (4 + 2 things)

Answer 4

Liver cirrhosis features

1. Fever / Fatigue
2. RUQ Pain
3. Hepatomegaly (irreg)
4. WL

Liver failure features (ADVANCED)

6. Jaundice
7. Ascites

Question 5

What are some differentials that present similarly to HCC? (3 things)

Answer 5

1. Infectious hepatitis
2. Cardiac failure
3. Benign hepatocellular adenoma

Question 6

How do you differentiate between Infectious hepatitis and HCC?

Answer 6

Do serology

Question 7

How do you differentiate between Cardiac failure and HCC?

Answer 7

CF = SMOOTH hepatomegaly

HCC = IRREG hepatomegaly

Question 8

What lab tests should be done for suspected HCC? (4 things)

Answer 8

1. LFTs
2. FBC
3. Clotting
4. AFP

Question 9

What tests do LFTs include? (4 things)

Answer 9

1. ALP
2. ALT
3. AST
4. Bilirubin

Question 10

What would a FBC of HCC show?

Answer 10

Low platelets

Question 11

What would a clotting test of HCC show?

Answer 11

Prolonged clotting time

Question 12

What is AFP and what is it used for in HCC?

Answer 12

Alpha fetoprot (raised in 70%)

Used to monitor treatment + recurrence

Question 13

What imaging can be done for HCC? (3 things)

Answer 13

1. US (gold standard)
2. CT
3. MRI Liver

Question 14

What is the gold standard imaging used for HCC?

Answer 14

US

Question 15

What is the diagnostic criteria on an US of HCC? (2 things)

Answer 15

1. 2cm + mass

2. Raised AFP

Question 16

What is a CT used for in HCC?

Answer 16

Staging

Question 17

What is an MRI Liver used to assess in HCC? (2 things)

Answer 17

1. Rising AFP
2. Sus US nodules

(Done if can’t diagnose with US)

Question 18

How can a biopsy be done for HCC? (2 things)

Answer 18

1. FNA

2. Percutaneously

Question 19

When should a biopsy be done for HCC?

Answer 19

If diagnosis still in doubt after other scans

Question 20

Why is biopsy a last resort in HCC? (3 things)

Answer 20

1. Difficult with ascites
2. Deranged clotting
3. Risk of tumour seeding

Question 21

What is the staging system for HCC called?

Answer 21

Barcelona Clinic Liver Cancer Staging (BCLC)

Question 22

What does the BCLC staging for HCC take into account? (3 things)

Answer 22

1. Tumour stage
2. Liver function
3. Physical status

Question 23

What are the only curative management methods for HCC? (2 things)

Answer 23

1. Surgical resection

2. Transplant

Question 24

What is the curative management of HCC limited by? (3 things)

Answer 24

1. Tumour size
2. Liver function
3. Co-morb

Question 25

What are the indications for surgical resection of HCC? (2 things)

Answer 25

1. W/o cirrhosis

2. Good health

Question 26

What are the indications for transplantation in HCC? (3 things)

Answer 26

Milan Criteria

1. 1 lesion 5- cm / 3 lesions each 3- cm
2. No extrahepatic manifestations
3. No vasc infiltration

Question 27

What are the non-surgical management options for HCC? (2 things)

Answer 27

1. Image guided ablation

2. Transarterial Chemoembolisation (TACE)

Question 28

When is Image guided ablation done in HCC?

Answer 28

EARLY HCC

Question 29

What is Image guided ablation of HCC?

Answer 29

US probes places in tumour mass –> induce necrosis

Question 30

When is Transarterial Chemoembolisation (TACE) done in HCC?

Answer 30

For large multinodular tumours

Question 31

What is Transarterial Chemoembolisation (TACE) of HCC? (2 things)

Answer 31

1. High conc chemo drugs inj directed directly into hepatic artery
2. Embolising agent added –> induce ischaemia

Question 32

What is the average survival time of HCC after diagnosis?

Answer 32

6 months