Hepatocellular Carcinoma Flashcards
What are the types of liver cancer?
- Metastatic (90%)
- Primary (10%) (e.g HCC)
What are the risk factors for HCC? (5 things)
- Viral hepatitis (hep B + C) –> cirrhosis
- Alcohol
- Smoking
- Age
- FHx
What are the pathophysiological steps of HCC? (4 steps)?
- Chronic injury
- Inflamm.
- Hepatocyte regen.
- Driver mutations of HCC
What are the clinical features of HCC? (4 + 2 things)
Liver cirrhosis features
1. Fever / Fatigue
2. RUQ Pain
3. Hepatomegaly (irreg)
4. WL
Liver failure features (ADVANCED)
6. Jaundice
7. Ascites
What are some differentials that present similarly to HCC? (3 things)
- Infectious hepatitis
- Cardiac failure
- Benign hepatocellular adenoma
How do you differentiate between Infectious hepatitis and HCC?
Do serology
How do you differentiate between Cardiac failure and HCC?
CF = SMOOTH hepatomegaly
(HCC = IRREG hepatomegaly)
What lab tests should be done for suspected HCC? (4 things)
- LFTs
- FBC
- Clotting
- AFP
What tests do LFTs include? (4 things)
- ALP
- ALT
- AST
- Bilirubin
What would a FBC of HCC show?
Low platelets
What would a clotting test of HCC show?
Prolonged clotting time
What is AFP and what is it used for in HCC?
Alpha fetoprot (raised in 70%)
Used to monitor treatment + recurrence
What imaging can be done for HCC? (3 things)
- US (gold standard)
- CT
- MRI Liver
What is the gold standard imaging used for HCC?
US
What is the diagnostic criteria on an US of HCC? (2 things)
- 2cm + mass
- Raised AFP
What is a CT used for in HCC?
Staging
What is an MRI Liver used to assess in HCC? (2 things)
- Rising AFP
- Sus US nodules
(Done if can’t diagnose with US)
How can a biopsy be done for HCC? (2 things)
- FNA
- Percutaneously
When should a biopsy be done for HCC?
If diagnosis still in doubt after other scans
Why is biopsy a last resort in HCC? (3 things)
- Difficult with ascites
- Deranged clotting
- Risk of tumour seeding
What is the staging system for HCC called?
Barcelona Clinic Liver Cancer Staging (BCLC)
What does the BCLC staging for HCC take into account? (3 things)
- Tumour stage
- Liver function
- Physical status
What are the only curative management methods for HCC? (2 things)
- Surgical resection
- Transplant
What is the curative management of HCC limited by? (3 things)
- Tumour size
- Liver function
- Co-morb
What are the indications for surgical resection of HCC? (2 things)
- W/o cirrhosis
- Good health
What are the indications for transplantation in HCC? (3 things)
Milan Criteria
1. 1 lesion 5- cm / 3 lesions each 3- cm
2. No extrahepatic manifestations
3. No vasc infiltration
What are the non-surgical management options for HCC? (2 things)
- Image guided ablation
- Transarterial Chemoembolisation (TACE)
When is Image guided ablation done in HCC?
EARLY HCC
What is Image guided ablation of HCC?
US probes places in tumour mass –> induce necrosis
When is Transarterial Chemoembolisation (TACE) done in HCC?
For large multinodular tumours
What is Transarterial Chemoembolisation (TACE) of HCC? (2 things)
- High conc chemo drugs inj directed directly into hepatic artery
- Embolising agent added –> induce ischaemia
What is the average survival time of HCC after diagnosis?
6 months
