Hepatocellular Carcinoma Flashcards
What is the most common type of primary liver cancer?
Hepatocellular Carcinoma (HCC)
HCC is primarily associated with liver cirrhosis.
What is the main risk factor for developing HCC?
Liver cirrhosis
This can be secondary to Hepatitis B/C, alcohol, haemochromatosis, or primary biliary cirrhosis (PBC).
What is the most common cause of liver cirrhosis worldwide?
Chronic Hepatitis B
Chronic Hepatitis C is the most common cause in Europe.
List some other risk factors for HCC.
- Male
- Diabetes Mellitus (DM)
- Metabolic syndrome
- Drugs (e.g., oral contraceptive pills, anabolic steroids)
- Aflatoxin exposure (from wheat, soya, rice, corn, nuts)
- Alpha-1 antitrypsin deficiency
What are some symptoms of HCC?
- Jaundice
- Ascites
- Right upper quadrant (RUQ) pain
- Pruritus
- Splenomegaly/hepatomegaly
Symptoms typically present late in the disease.
What is meant by decompensation in the context of HCC?
Liver can no longer compensate and perform its actions
This indicates a more severe stage of liver disease.
What blood test results are indicative of HCC?
- HIGH AST
- HIGH ALT
- HIGH Bilirubin
- Low Albumin - synthetic function of liver impaired
- Tumour marker: Alpha fetoprotein (AFP)
Tumour marker for HCC
Alpha fetoprotein (AFP)
What is the recommended initial investigation for suspected HCC?
URGERNT 2 week wait referral: USS Liver (Ultrasound)
Patients are typically referred for a 2 week wait.
What are the surgical management options for HCC?
- Resection in early disease
- Liver transplant in late disease
What are some therapeutic options for HCC?
- Radiofrequency ablation
- Transarterial chemoembolisation
- New drugs: Sorafenib (multikinase inhibitor)
Who should be screened for HCC?
At-risk patients (those with liver cirrhosis)
Screening typically involves USS +/- alpha-fetoprotein.
