Hepatocellular Carcinoma

Question 1

Define:

Answer 1

Primary malignancy of the liver parenchyma

Question 2

Aetiology/Risk factors:

Answer 2

Chronic liver damage:

• Hep B and C
• Alcoholic hepatitis
• Cirrhosis

Metabolic disorders:
-Haemochromatosis

Aflatoxins:
-Aspergillus Flavus (found in cereal)

Question 3

Epidemiology:

Answer 3

Common

Less common than liver metastases

Found more in areas endemic with Hep B and C

1-2% of malignancies

Question 4

Symptoms:

Answer 4

Of malignancy:

• Weight loss
• malaise
• Fever

Liver damage:

• Jaundice
• Abdo distension

History of exposure to carcinogens:
Hep B and C (unsafe sex, travel and drug use)
Aflatoxins
alcohol intake

Question 5

Signs:

Answer 5

Of malignancy:

• cachexia
• lymphadenopathy

Hepatomegaly (deep palpation may lead to tenderness. may hear bruits over the liver)

Jaundice

Ascites

Question 6

Investigations

Answer 6

FBC
U+Es
clotting
ESR
A1-feroprotein (marker of liver malignancy)
LFT's
IF

CT/MRI = gold standard for imaging.
Less than 1cm = US

Liver biopsy
Ascitic tap

To stage:
CT scan 
CXR
Duplex scan 
Rudionucleotide bone scan