Chapter 51: Liver- HCC

Question 1

What is it?

Answer 1

Most common primary malignancy of the liver

Question 2

By what name is it also known?

Answer 2

Hepatoma

Question 3

What is its incidence?

Answer 3

Accounts for 80% of all primary malignant liver tumors

Question 4

What are the associated risk factors?

Answer 4

1. Hepatitis B virus
2. cirrhosis
3. aflatoxin

Question 5

What percentage of patients with cirrhosis will develop hepatocellular carcinoma?

Answer 5

≈5%

Question 6

What are the signs/symptoms?

Answer 6

Dull RUQ pain

hepatomegaly

(classic presentation: painful hepatomegaly)

Question 7

What tests should be ordered?

Answer 7

1. Ultrasound
2. CT scan
3. angiography
4. tumor marker elevation

Question 8

What is the tumor marker?

Answer 8

Elevated α-fetoprotein

Question 9

What is the most common way to get a tissue diagnosis?

Answer 9

Needle biopsy with CT scan/ultrasound/laparoscopic guidance

Question 10

What is the most common site of metastasis?

Answer 10

Lungs

Question 11

What is the treatment of hepatocellular carcinoma?

Answer 11

• Surgical resection, if possible (e.g., lobectomy)
• liver transplant

Question 12

What are the treatment options if the patient is not a surgical candidate?

Answer 12

1. Percutaneous ethanol tumor injection
2. cryotherapy
3. intra-arterialchemotherapy

Question 13

What are the indications for liver transplantation?

Answer 13

1. Cirrhosis
   
   • and NO resection candidacy
   • as well as no distant or lymph node metastases
   • and no vascular invasion
2. the tumor must be:
   
   • single <5-cm tumor
   • or have three nodule with none >3 cm

Question 14

What is the prognosis under the following conditions:

Unresectable?

Answer 14

Almost none survive 1 year

Question 15

What is the prognosis under the following conditions: Resectable?

Answer 15

≈35% are alive at 5 years

Question 16

Which subtype has the best prognosis?

Answer 16

Fibrolamellar hepatoma (young adults)