Hepatocellular Carcinoma

Question 1

What is hepatocellular carcinoma (HCC)?

Answer 1

It is defined as a primary liver cancer that originates from the hepatocyte cells

Question 2

What is the most common primary liver cancer?

Answer 2

Hepatocellular carcinoma

Question 3

What are the nine risk factors associated with hepatocellular carcinoma?

Answer 3

Male Gender

Non-Caucasian Ethnic Origin

Family History

Liver Cirrhosis

Viral Hepatitis B

Viral Hepatitis C

Alcoholic Liver Disease

Non-Alcoholic Fatty Liver Disease

Haemochromatosis

Aflatoxin

Question 4

What are the two most common risk factors of hepatocellular carcinoma?

Answer 4

Viral Hepatitis B

Viral Hepatitis C

Question 5

What are the five clinical features associated with hepatocellular carcinoma?

Answer 5

Abdominal Pain

Jaundice

Nausea & Vomiting

Weight Loss

Pruritis

Question 6

What three investigations are used to diagnose hepatocellular carcinoma?

Answer 6

Blood Tests

Ultrasound Scan

CT/MRI Scans

Question 7

What six blood test results indicate hepatocellular carcinoma?

Answer 7

Increased Alpha-Fetoprotein Levels

Increased ALT Levels

Increased AST Levels

Increased ALP Levels

Increased Gamma GT Levels

Increased Bilirubin Levels

Question 8

Which tumour marker is associated with hepatocellular carcinoma?

Answer 8

Alpha-fetoprotein

Question 9

What is the feature of hepatocellular carcinoma on ultrasound scan?

Answer 9

A hypoechoic lesion

Question 10

What is the gold standard investigation used to diagnose hepatocellular carcinoma?

Answer 10

CT/MRI scan

Question 11

How are CT/MRI scans used to investigate hepatocellular carcinoma?

Answer 11

It is used to confirm the findings established on ultrasound and to determine the staging

Question 12

Which additional CT/MRI scan should be conducted in suspected hepatocellular carcinoma? Why?

Answer 12

Pelvic CT/MRI

To examine the testes

This is due to the fact that testicular tumours are associated with elevated alpha-fetoprotein levels

Question 13

Why should liver biopsies not be conducted in suspected hepatocellular carcinomas?

Answer 13

The cancer cells can seed along the biopsy tract and cause local recurrence

Question 14

What is the pharmacological management option of hepatocellular carcinoma?

Answer 14

Tyrosine kinase inhibitors

Question 15

Name three tyrosine kinase inhibitors used to manage hepatocellular carcinoma

Answer 15

Sorafenib

Regorafenib

Lenvatinib

Question 16

What is the mechanism of action of tyrosine kinase inhibitors?

Answer 16

They inhibit tyrosine kinase phosphorylation, which in turn inhibits the proliferation of cancer cells

Question 17

How are tyrosine kinase inhibitors used to manage hepatocellular carcinoma?

Answer 17

They are not used as curative measures, however, can potentially extend life by months

Question 18

What are the two surgical management options used in hepatocellular carcinoma?

Answer 18

Liver Resection

Liver Transplant

Question 19

What is liver resection?

Answer 19

It involves surgical removal of the section of liver affected by malignancy

Question 20

When is liver resection used to manage hepatocellular carcinoma?

Answer 20

It can be used as a curative measure in early disease confined to liver

Question 21

What is liver transplant?

Answer 21

It involves surgical removal of the whole liver, with replacement of a donor liver

Question 22

When is liver transplant used to manage hepatocellular carcinoma?

Answer 22

It can be used as a curative measure in early disease confined to liver

Question 23

In hepatocellular carcinoma, can chemotherapy and radiation be used as a management option?

Answer 23

No - it is generally considered resistant to chemotherapy and radiotherapy

In certain circumstances, it can be used in a palliative setting