Hepatocellular Carcinoma Flashcards

1
Q

Define hepatocellular carcinoma.

A

Primary malignancy of hepatocytes, usually occurring in a cirrhotic liver.

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2
Q

What are the risk factors for hepatocellular carcinoma?

A
  • Cirrhosis
  • HBV, HCV
  • Alcohol use heavy
  • Diabetes, Obesity → NAFLD
  • FH of liver cancer
  • Aflatoxins
  • Haemochromatosis
  • Cigarette smoking
  • Alpha-1 antitrypsin deficiency
  • Porphyria cutanea tarda
  • PBC, PSC
  • Androgenic steroids
  • Oral contraceptive
  • Male sex
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3
Q

What is the pathophysiology of hepatocellular carcinoma?

A

Chronic inflammation + cirrhosis play key parts. Acquiring HBV early in life → longer duration of disease and chronic inflammation/cirrhosis

HCC usually begins with nodules of high or low grade dysplasia and 33% of high-grade nodules develop into HCC within 2 years and 80% within 5 years.

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4
Q

How common is HCC?

A
  • 6th most common malignancy worldwide
  • Varies accord to HBV/HCV prevalence
  • 44% due to HBV
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5
Q

How does HCC present?

A

Symptoms of malignancy - malaise, weight loss, loss of appetite

Symptoms of chronic liver disease -abdominal distension, jaundice

History of carcinogen exposure - high alcohol intake, HBV, HCV, aflatoxins.

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6
Q

What investigations would you do for hepatocellular carcinoma?

A

1st line:

  • USS - not sensitive if tumour <1cm
  • AFP - high sensitivity, high in 60%

Blood:

  • Vitamin B12-binding protein is a marker of fibrolamelalr hepatocellular carcinoma
  • LFT has poor specificity and sensitivity but may show biliary obstruction
  • Coagulation screen - for extent of liver disease

Imaging:

  • CT (thorax, abdo, pelvis) - defines structural lesion and spread

Invasive:

  • Liver biopsy - core-needle biopsy; confirms histology of tumour but there is small risk of tumour seeding along biopsy tract

Other:

  • Staging - CXR, CT (TAP), radionucleotide bone scan
  • Screening - AFP and abdominal ultrasound in at-risk individuals
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7
Q

What is the management of HCC?

A

Depends on Barcelona Clinic Liver Cancer (BCLC) staging

  1. Resection
  2. Thermal ablation,
  3. Transplant
  4. Transarterial chemo-embolisation (TACE) - not curative
  5. Percutaneous ablation - ethanol injection or radiofrequency ablation
  6. Advanced disease: atezolizumab/bevacizumab, TK inhibitors
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8
Q

What are the complications of HCC?

A
  • Biliary obstruction
  • Cachexia
  • Hypoglycaemia (non-diabetic) - due to IGF-1 production
  • Hepatic failure
  • Watery diarrhoea
  • Hypercalcaemia
  • Intraperitoneal bleeding due to tumour rupture
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9
Q

What is the prognosis with HCC?

A

5yr survival is 20%

HCC is very aggressive and clinical course depends on stage at diagnosis

Intermediate stage HCC treated with TACE only has 19-20months survival

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