Hepatocellular Carcinoma

Question 1

What is the main risk factor for HCC?

What are examples of driver mutations?

Answer 1

Liver cirrhosis due to:

• viral hepatitis
• alcohol
• NAFLD
• CLD

Telomerase reverse transcriptase (TERT) promotor mutation
TP53 mutation
CTNNB1 mutation

Question 2

Why does HCC have a poor prognosis?

Answer 2

It remains asymptomatic for a long time meaning that when patients present the cancer is more advanced

Question 3

What are non-specific symptoms associated with HCC?

Answer 3

Weight loss 
Abdominal pain 
Anorexia 
Nausea and vomiting 
Jaundice 
Pruritis

Question 4

What investigations can be done for HCC?

Answer 4

Alpha-fetoprotein= specific tumour marker

USS= used to identify the tumour

CT/MRI used to diagnosis + staging

Question 5

How can HCC be managed?

Answer 5

Resection of diseased area in early disease (usually not diagnosed early enough for this to happen)

Liver transplate when HCC is isolated to liver

Kinase inhibitors= inhibit proliferation of cancer cell
-Sorafenib/Regorafenib/Levantinib
(Used to extend life by months)

Chemo and radio tend to be used as part of palliative treatment due to HCC generally being resistent to them