Hepatocellular carcinoma Flashcards
What is hepatocellular carcinoma?
Hepatocellular carcinoma = primary malignancy of hepatocytes, usually occurring in a cirrhotic liver
What is the aetiology of hepatocellular carcinoma?
Chronic liver damage Alcoholic liver disease Viral - Hep B/C AI - DM Metabolic Haemochromatosis
Toxins
Aspergillus flavus fungal toxin found on stored grains/biological weapons
Smoking
Radioactive contrast
What are the risk factors of hepatocellular carcinoma?
Cirrhosis Chronic hep B/C infection Chronic heavy alcohol use DM Obesity FH Aflatoxin Radioactive contrast Haemochromatosis Smoking Alpha-1-antitrypsin deficiency
What is the epidemiology of hepatocellular carcinoma?
1-2% of all malignancies
6th most common cause of cancer worldwide
2nd leading cause of cancer related death
Less common than liver metastases
Rare in the West
Very common in areas where hep B/C are endemic – e.g. Asia
What are the symptoms of hepatocellular carcinoma?
FLAWS
Malaise
Weight loss
Loss of appetite/early satiety
Chronic liver disease
Abdominal distention
Jaundice
Upper GI bleeding
History of carcinogen exposure – alcohol, hep B/C, aflatoxins
What are the signs of hepatocellular carcinoma?
Signs of malignancy
Cachexia
Lymphadenopathy
Signs of Chronic liver disease Jaundice Ascites Splenomegaly Palmar erythema Spider naevi
Hepatomegaly
Nodular, but may be smooth
RUQ pain - Deep palpation may elicit tenderness
Bruit
What are appropriate investigations for hepatocellular carcinoma?
Bloods
FBC - Microcytic anaemia, Thrombocytopenia
Basic metabolic - Hyponatraemia, Uraemia
LFTs - Elevated ALT, AST, ALP and bilirubin, Low albumin
PT/INR: Normal/elevated
Viral screen: May be +
AFP - Alpha fetoprotein = tumour marker with high sensitivity
Vitamin-B12 binding protein is a marker of fibrolamellar HCC
Liver US - Poorly defined margins, Coarse, irregular internal echoes
CT thorax/abdo/pelvis - Define structural lesion/spread
(Staging)
Liver biopsy - Small risk of tumour seeding along biopsy tract
