Hepatocellular Carcinoma

Question 1

HCC

Answer 1

Main Cause = Cirrhosis

Main RFs:

• 2dry to Hep B and C
• 2dry to ETOH
• 2dry to Haemochromatosis
• 2dry to PBC

NB EXCEPTION HERE = WILSON’S DISEASE (does not cause HCC)

Other RFs:

• alpha-1 antitrypsin deficiency
• glycogen storage disease
• hereditary tyrosinosis (build up of amino acid tyrosine in the blood and tissues due to inability metabolise it)
• aflatoxin (poisonous and cancer causing chemicals produced by certain molds)
• Drugs: COCP, Anabolic steroids
• Porphyria Cutaena Tarda
• male sex
• DM
• Metabolic syndrome

Question 2

HCC

Answer 2

= Third most common cause of cancer worldwide
Chronic Hep B is most common cause of HCC worldwide
Chronic Hep C is most common cause in Europe

Features:

• tends to present late
• Fx of liver cirrhosis or failure may be seen (jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly)
• possible presentation = Decompensation in a patient with CLD

Screening:
- With Ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as
> patients with liver cirrhosis 2dry to Hep B, C or Haemochromatosis
> Men with liver cirrhosis 2dry to ETOH

Mx:

• Early disease = surgical resection
• Liver Transplantation
• Radiofrequency ablation
• Transarterial chemoembolisation
• Sorafenib = a multikinase inhibitor