Hepatocellular carcinoma Flashcards
What are the typical radiological findings for HCC?
Enhancement in arterial phase with washout in the non peripheral venous phase with a capsule surrounding the mass on background of cirrhosis.
Management of early HCC: Single nodule or <3 nodules each <3cm?
Single lesion -> resection or ablation. <3 nodules <3cm -> liver transplant or ablation if transplant contraindicated
Management of early HCC: Multinodular with preserved liver function
Consider liver transplant if meets criteria or TACE if well defined nodules and preserved portal flow. If diffuse bilobar involvement for systemic treatment.
What is the most common mutation found in HCC?
TERT promotor mutation
What investigation must be done prior to starting first line atezo/bev?
OGD- varices must be G1 or below or G2 on treatment (carvedilol) with no recent bleeding.
Most common side effects of sorafenib?
Diarrhoea, fatigue, hand-food syndrome
When would you consider lenvatinib?
If contraindications to immunotherapy or not tolerated sorafenib within the first 3 months (lose regorafenib and cabozantinib in second line)
What are second line options in HCC?
Sorafenib if atezo/bev first line.
Regorafenib if progressed on sorafenib but tolerated at least 50% dose.
Cabozantanib if didn’t tolerate sorafenib (or give in 3rd line)
Ramicurumab if AFP >400
What is a major difference between HCC and fibromellar carcinoma?
Fibromellar carcinoma has no associated between cirrhosis or chronic hepatitis.
When is the DNAJB1-PRKACA fusion typically seen?
In nearly all fibrolamellar carcinomas
Most common cause of HCC worldwide?
Chronic HBV infection
What is the most frequent fatal event occurring on bevacizumab?
Haemorrhage
