HEPATOCELLULAR CARCINOMA

Question 0

S and S?

Answer 0

Signs of liver disease (non-specific, liver, portal HTN)

Palpable mass
Lived bruit over vascular HCC
Paraneoplastic
- hypoglycemia from insulin like growth factors
- erythrocytosis
- hypercalcemia from PTHrP

Question 1

What are causes?

Answer 1

Chronic viral hepatitis
Alcohol cirrhosis
Non- alcoholic steatohepatitis 
Hereditary haemachromatosis
A-antitripsin deficiency 
Primary biliary cirrhosis
Autoimmune hepatitis

HCC is an end result of liver disease not a cause

Question 2

Lab Ix?

Answer 2

CBE EUC LFT CRP BGL
COAGS 
Tumour markers 
- AFP  
HBV and HCV serology 
Fe studies if indicated  
Liver biopsy for equivocal lesions in non-cirrhosis liver

Question 3

Radiological?

Answer 3

US to screen
CT/MRI - enhancement during arterial phase (due to hypervascularity) (A) washout in portal phase (B) (radiolucency venous?)

Question 4

Why is early detection important? When should it be done and how?

Answer 4

85% of cancers occur in the setting of cirrhosis.
US 6 months
A-fetoprotein not recommended for surveillance low sensitivity (SNOUT)

Question 5

What is a paraneoplastic syndrome? What are the types?

Answer 5

Consequence of cancer mediated by hormones or cytokines excreted by tumour cells not a mass effect.

Endocrine, neurological, mucocutaneous and haematological

Question 6

Which paraneoplastic syndrome do you get in HCC?

Answer 6

Endocrine and haematological.

Causing
hypoglycaemia - increased tumour metabolic needs
Hypercalcemia - secretion of parathyroid hormone related protein
Erythrocytosis - tumour secretion of EPO

Question 7

What are the tumour markers for HCC, COLORECTAL, CHOLANGIOCARCINOMA, LYMPHOMA?

Answer 7

HCC - AFP
Cholangiocarcinoma CA 19.9
Colorectal - CEA
Lymphoma - LDH

Question 8

How do you diagnose HCC?

Answer 8

If > 2cm -> diagnosed with radiology
If 1-2cm -> 2 forms of imaging I.e MRI/MDCT plus CT/MRI/biopsy
If < 1cm -> US every 3-6 months

Question 9

Management?

Answer 9

Surgical if early stage coupled with local ablation with percutaneous ethanol injection/radiofrequency

Intermediate: transarterial chemo embolisation with chemo (sorafenib + doxorubicin)

Question 10

What is Milan’s criteria?

Answer 10

Liver transplant requirements

1) one lesion < 5cm OR up to 3 lesions <3cm AND
2) no extra hepatic manifestations
3) no vascular invasion

Question 11

What is the leading cause of cancer related death?

Answer 11

HCC