management of hepatocellular carcinoma Flashcards
predisposing factors associated with hepatocellular carcinoma
Hepatitis B virus
Hepatitis C
Cirrhosis
Aflatoxins - commonly found in peanuts and corn
OCP use in women - 8 or more
cigarette smoking, alcohol intake, diabetes and insulin
what score is used to predict the prognosis and what are the associated factors
Child - Pugh Score
BAPE A
associated factors:
bilirubin
albumin
INR
Ascites
Encephalopathy
ALBI score
Albumin - Bilirubin
different stages in HCC in cirrhotic liver
0 - very early stage - single nodule less than 2 cm
A - early stage - single or 2-3 nodules more than 3 cm
B - intermediate stage - multi nodular unresectable
C - advanced stage - portal invasion , extra-hepatic spread
D - terminal stage - non transplantable, end stage liver function
at what stage is chemoembolization used ?
intermediate stage of HCC
method of chemoembolization ?
trans-catheter arterial chemoembolization ( TACE )
trans-catheter arterial radio- embolization is the newer form but with radio therapy
may be used pre-operativley to reduce intra-operative bleeding
may be used as a palliative measure in advanced HCC
first approval first line of therapy for advanced HCC ?
sorafenib / levatinib
common AE of sorafenib ?
diarrhea
hand foot skin disease
MOA of sorafinib ?
multiple tyrosine kinase inhibitors
targets : RAF
VEGFR and PDGFR
when to use levatinib rather than sorafinib ?
a diabetic patient already
a patient requiring less side effects
opt for levatinib
second line treatment for advanced HCC ?
Cabozatinib
especially if resistance is formed against 1st line therapies
what is the immunotherapy used for HCC ?
nivolumab and pembrolizumab
when is a patient not fit for immunotherapy
patients suffering from autoimmune diseases
