Hepatocellular Carcinoma |(malignant)

Question 1

Which type of people does it affect?

Answer 1

Those with a pre-existing liver disease eg liver cirrhosis or chronic hepatitis

Question 2

What is the aetiology of this cancer?

Answer 2

Liver cirrhosis in 80% of cases

Additional risk factors - chronic hepatitis B and C
Alcoholic liver disease
Haemochromatosis
Wilson’s disease
Autoimmune hepatitis

Question 3

What are the clinical features of this cancer?

Answer 3

Usually asymptomatic apart from symptoms of underlying disease

Possible symptoms in advanced disease - weight loss, anorexia, hepatomegaly, RUQ tenderness, jaundice, ascites

Question 4

Which diagnostic tests should be carried out?

Answer 4

Initial - US abdomen
CT or MRI if the following are detected - lesion greater or equal to 10mm, lesion of any size and Alpha fetoprotein more than or equal to 20ng/dl

Perform liver biopsy in the following cases - inconclusive multiphase imaging (ct or mri). Liver lesions suspicious for HCC in patients without cirrhosis

Lab studies to evaluate liver function and assess for underlying aetiologies

Question 5

What are the supportive findings on an US abdomen?

Answer 5

Solid nodules typically greater than or equal to 10mm of varying homogeneity or echogenicity (ability for tissue to reflect sound waves) with irregular borders
Signs of cirrhosis may be present

Question 6

What can you find on a CT or MRI scan?

Answer 6

A lesion with irregular borders and possible signs of local invasion

Question 7

What will the lab studies reveal?

Answer 7

CBC - thrombocytopenia or paraneoplartic erythrocytosis
Liverchermistries - may be abnormal in pre-existing liver disease or advanced malignancy
Coagulation screen - may be abnormal in pre-existing liver disease or advanced malignancy
Serum AF - elevated

Question 8

What will the lab tests reveal for suspected paraneoplastic syndrome?

Answer 8

Blood glucose - hypoglycaemia
Serum calcium - hypercalcemia
Lipid panel - hypercholesterolemia

Question 9

What is the treatment for very early stage HCC or early stage HCC?

Answer 9

First line - surgical resection of liver if minimal disease. If significant disease to liver - transplant (Milan criteria)
Alternative - ablative therapy eg radiofrequency ablation

Question 10

What is the treatment for intermediate stage HCC?

Answer 10

Locoregional therapy with - trans catheter chemoemoblization, trans arterial radioembolization

Question 11

What is the treatment for advanced HCC?

Answer 11

Systemic chemotherapy - first line is targeted treatment
Alternatives include non targeted chemotherapy, hepatic sartorial infusion chemotherapy

Question 12

What is the treatment for end stage HCC?

Answer 12

Typically palliative care only

Question 13

What is the prognosis?

Answer 13

5 year survival rate of early stage - 70%
5 year survival rate for advanced stage - 20%

Question 14

What are the preventive measures for HCC?

Answer 14

Reduce risk of blood borne viruses
Maintain alcohol intake within normal limits
Manage obesity