Hepatocellular carcinoma

Question 1

How does it present?

Answer 1

Weight loss
Fatigue
RUQ Pain 
Liver failure
Jaundice

Question 2

What are some risk factors?

Answer 2

Chronic liver disease 
- Viral, EtOH, autoimmune
Hep B (non-cirrhotic)
Obesity
Type 2 diabetes 
NASH

Question 3

What biomaker is useful?

Answer 3

Alpha-fetoprotein

Question 4

What are the Barcelona Clinic Liver Cancer stages?

Answer 4

Stage 0 or A: Single tumour, or <3 nodules that are <3cm + preserved liver function + ECOG PS 0

Stage B: Multinodular + preserved liver function + ECOG PS 0

Stage C: Portal invasion, extrahepatic spread + preserved liver function + ECOG PS 1-2

Stage D: End-stage liver function + ECOG 3-4

Question 5

What are loco-regional therapies?

Answer 5

Ablation
• Radiofrequency, EtOH, microwave
Transarterial (chemotherapy) embolisation (TACE or TAE)
Stereotactic radiosurgery
Brachytherapy
SIRT (selective internal radiotherapy)

If fit
Surgical resection
Orthotopic liver transplantation

Question 6

What is the management of BCLC stage A + B?

Answer 6

Stage A + B: loco-regional (systemic therapy if failure)

Question 7

What is managment of BCLC stage C

Answer 7

1st line: Sorafenib or lenvatinib

2nd line: nivolumab or pembro

Question 8

What is the toxicity of sorafenib?

Answer 8

Hand-foot syndrome
Diarrhoea
HTN

Question 9

What evolving combo of biologics is maybe better than sorafenib?

Answer 9

Atezolizumab + bevacizumab