Hepatocellular carcinoma

Question 1

What is a hepatocellular carcinoma?

Answer 1

Hepatocellular carcinoma (HCC), also known as hepatoma, is a primary cancer arising from hepatocytes in predominantly cirrhotic liver.

Question 2

What is the epidemiology of a hepatocellular carcinoma?

Answer 2

Worldwide, HCC is the sixth most common cause of cancer and the second leading cause of cancer-related death. The global incidence of HCC varies according to the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection.

Majority of cases occurring in Asia

Question 3

What are the risk factors for a hepatocellular carcinoma?

Answer 3

Cirrhosis
Chronic Hep B/C
Chronic Heavy alcohol use
diabetes
obesity
FHx of liver cancer
Aflatoxin

Question 4

What are the signs and symptoms of a hepatocellular carcinoma?

Answer 4

Abdominal distension
Oesophageal or gastric variceal bleeding
RUQ pain
Early satiety
Weight loss
Hepatic encephalopathy 
Cachexia
Splenomegaly

Peripheral Stigmata:
Jaundice
Asterixis
Spider naevi
Palmar erythema
Periumbilical collateral veins (caput medusae)
Fetor hepaticus
Leg oedema

Question 5

What investigations might you do for a hepatocellular carcinoma?

Answer 5

Bloods
> FBC (microcytic anaemia/ thrombocytopenia)
> Metabolic panel
> LFTs
> INR and PT
> Viral panel
> Alpha fetoprotein

Liver US

Contrast CT/ MRI Abdo