Hepatocellular Carcinoma

Question 1

What is hepatocellular carcinoma?

Answer 1

primary malignancy of hepatocytes

Question 2

How common are hepatocellular carcinomas?

Answer 2

forms 90% of primary liver tumours (cholangiocarcinoma the other 10%)

Question 3

What are RF for hepatocellular carcinoma?

Answer 3

1. Cirrhosis due to hepatitis
2. alcohol or drugs
3. AI hepatitis
4. Haemochromatosis
5. NAFLD
6. PBC

Question 4

What are the signs and symptoms of hepatocellular cancer?

Answer 4

1. Present late
2. FLAWS
3. Signs of chronic liver failure
4. May present with decompensation

Question 5

What are signs of chronic liver failure?

Answer 5

1. Hepatosplenomegaly
2. Pruritus
3. Jaundice

Question 6

What are signs of decompensation?

Answer 6

1. Acute deterioration in liver function

2. Hepatic encephalopathy

Question 7

What are the Ix for hepatocellular carcinoma?

Answer 7

• Screening for high risk groups
• Bloods – aFP tumour marker
• Imaging - USS

Question 8

What are high risk groups?

Answer 8

patients with cirrhosis secondary to hepatitis or alcohol or haemochromatosis

Question 9

What are you looking for in bloods for hepatocellular carcinoma?

Answer 9

aFP tumour marker

Question 10

What is the management for hepatocellular carcinoma early disease?

Answer 10

• Surgical resection – non-cirrhotic

* Liver transplantation – cirrhotic

Question 11

What is the management for hepatocellular carcinoma unsuitable for surgery?

Answer 11

• Percutaneous ethanol injection for peripheral lesions

* Sorafenib – multikinase inhibitor

Question 12

What are possible complications of hepatocellular carcinoma?

Answer 12

1. Liver failure
2. Secondary mets
3. Death

Question 13

What are possible ddx of hepatocellular carcinoma?

Answer 13

1. Cholangiocarcinoma

2. Secondary mets