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78 HCC Flashcards

(55 cards)

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1
Q

First line option for non cirrhotic patients at early stage HCC with solitary tumors

A

Surgical resection

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2
Q

Most widely used primary treatment of unresectable HCC worldwide

A

TACE

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3
Q

Mass/nodule on ultrasound. Less than 1 cm. What to do?

A

Repeat ultrasound at 4 months

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4
Q

Mass/nodule on ultrasound. 1-2 cm or more than 2 cm. What to do?

A

4 phase CT or dynamic contrast enchanced MRI

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5
Q

Represents 90% of primary liver cancers

A

HCC

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6
Q

Reason for high prevalence of HCC in Asia and Sub-Saharan Africa

A

High prevalence of HBV infection

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7
Q

Main risk factor for HCC

A

Cirrhosis

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8
Q

How many of cirrhotic patient develop HCC?

A

One third

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9
Q

Predictor of liver cancer development

A

Liver diase severity (platelet count less than 100K presence of portal hypertension)
Degree of liver stiffened by transient elastograph

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10
Q

Causes of HCC and their percentages

A

HBV infection 50%
HCV infection 30%
Alcohol, metabolic symptoms 20%

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11
Q

Associated with polymorphism with fatty and alcoholic chronic liver disease and HCC occurence

A

PNPLA3

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12
Q

Mutations associated with tobacco and alfatoxin B leading to HCC

A

TP53

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13
Q

Most common mutational drivers in HCC

A

TERT 56% common in HBV
TP53 27% common on alfatoxin B1
CTNNB1 26% common in HCV

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14
Q

When is surveillance needed for HCC

A
  1. Cirrhotic patients
  2. HCV related fibrosis Metavir score of F3
  3. HBV infection, Asian more 40 yrs old and African more than 20 yrs old
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15
Q

Recommended method for surveillance in HCC

A

Ultrasound every 6 months

Every 3 months if a less than 1 cm nodule is found

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16
Q

Is AFP useful in HCC?

A

60% sensitivity but only 20% of early tumor present with abnormal AFP

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17
Q

Radiologic diagnosis of HCC

A

More than 2 cm AND

Radiological hallmark

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18
Q

Typical contrast enhanced imaging hallmark of HCC

A

Vascular update of the nodule in the arterial phase with washout in the portal venous or delayed phase
95-100% sensitivity

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19
Q

AFP levels suspicious for HCC nit not diagnostic

A

More than 400 ng/dL

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20
Q

When is liver biopsy needed

A
  1. Patient without cirrhosis

2. Radiology is not typical in one of two imaging techniques( CT and MRI)

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21
Q

4 stains for HCC. How many should be positive to be specific for HCC?

A 
GPC3
Glutamine synthase
HSP70
Clathrin heavy chain
2 out of 4
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22
Q

HCC readiological hallmark

A

Arterial hypervascularity

Venous phase washout

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23
Q

Most accepted staging system for HCC

Study These Flashcards
A

Barcelona Clinic Liver Cancer BCLC classification

24
Q

Five treatments that have been demonstrated to improve survival in HCC

Study These Flashcards
A 
Surgical resection
Liver transplantation 
Radiofrequency ablation
Chemoembolization
Systemic therapies
25
What are the systemic therapies in HCC
``` sorafenib refgorafenib lenvatinib cabozatinib ramucirumab ```
26
Three parameters relevant for defining treatment strategy in HCC
tumor status cancer related symptom liver dysfunction
27
What is the treatment? Stage 0. CPS A. ECOG 0. Single nodule less than 2 cm
Ablation
28
What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure normal. Bilirubin normal.
Resection
29
What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure and bilirubin increased. No associated diseases
Transplantation
30
What is the treatment? Stage A. ECOG 0. Single or less than 3 nodules and less than 3 cm. Portal pressure and bilirubin increased. With associated diseases
Ablation
31
What is the treatment? Multinodular. ECOG 0.
Chemoembolization
32
What is the treatment? Portal invasion. N1, M1. ECOG 1-2.
Systemic therapies
33
What is the treatment? CPS C. ECOG more than 2.
Supportive care
34
Represents the major complication of resection and occurs how many percent at 5 years?
Tumor recurrence. Occurs 70% at 5 years. Mostly intrahepatic metastases
35
First treatment of choice for cirrhotic patients with single tumor less than 5 cm and portal hypertension or small multinodular (less than 3 nodules and less than 3 cm)
Liver transplantation
36
Recommended primary ablation technique
Radiofrequency ablation
37
Limitation of RF
Failure rate increases in tumors more than 3 cm
38
Standard of care systemic therapy for HCC
Sorafenib
39
Recommended daily dose of sorafenib and median treatment duration
800 mg daily for 6 months
40
Classification of cholangiocarcinoma and its percentage
Intrahepatic 30% Perihilar 50 % distal 20%
41
Second most common liver cancer following HCC
Cholangiocarcinoma or CCA
42
Genetic aberrations in iCCA
FGFR2 fusion
43
Genetic aberrations in pCCA and dCCA
PRKACA or PRKACB fusion
44
Classic risk factors for development of CCA
Primary sclerosing cholangitis (PSC) Biliary duct cyst Hepatolithiasis Caroli's disease
45
Most common cancer of the biliary tract
Gallbladder cancer
46
Major risk factor for gallbladder cancer
Cholelithiasis
47
What are at risk of transforming to gallbladder cancer and at what size?
Gallbladder polyp are at risk for transforming to gallbladder cancer if more than 10 mm in diameter
48
Most accurate technique to define staging and vascular and biliary tract invasion in gallbladder cancer
MRCP
49
Main treatment of gallbladder cancer
surgical
50
Two most important prognostic factor in gallbladder cancer
Regional nodal status and depth of tumor invasion
51
Chemotherapy used with Stage III and IV unresectable gallbladder cancer
gemcitabine and cisplatin
52
Rare form of primary liver cancer that affects children without background of liver disease
Fibrolamellar hepatocellular carcinoma FLC
53
Mainstay treatment of FLC
surgical resection
54
Most common primary liver tumor in children
Hepatoblastoma HB
55
Most common benign liver tumors
hemangiomas focal nodular hyperplasia hepatocellular adenoma

Oncology (7 decks)

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