Hepatocellular Carcinoma

Question 1

Definition

Answer 1

Primary malignancy of the liver parenchyma

Question 2

Aetiology/risk factors

Answer 2

Associated with:

o Chronic liver damage
· Alcoholic liver disease
· Hepatitis C
· Autoimmune disease

o Metabolic disease
· E.g. haemochromatosis

o Aflatoxins
· E.g. cereals contaminated with fungi

Question 3

Epidemiology

Answer 3

· COMMON
· 1-2% of all malignancies
· LESS common than liver metastases
· High incidence in regions where hepatitis B and C are endemic

Question 4

Presenting symptoms

Answer 4

· Symptoms of Malignancy
o Malaise
o Weight loss
o Loss of appetite

· History of Exposure to Carcinogens
o High alcohol intake
o Hepatitis B or C (e.g. sexual activity, IV drug use)
o Aflatoxins

· Abdominal distention

· Jaundice

Question 5

Signs on physical examination

Answer 5

· Signs of Malignancy
o Cachexia
o Lymphadenopathy

· Hepatomegaly (may be nodular)

· Jaundice

· Ascites

· Bruit over the liver

Question 6

Investigations

Answer 6

· Bloods
o FBC
o ESR
o LFTs
o Clotting
o a-fetoprotein - tumour marker for liver cancer
o Hepatitis serology

· Imaging
o Abdominal US
o CT/MRI - GOLD STANDARD for staging

· Histology/Cytology
o Ascitic tap my be sent for cytological analysis

· Staging
o CT scan (chest/abdo/pelvis)