Hepatocellular Carcinoma Flashcards
What is hepatocellular carcinoma?
Primary malignancy of the liver parenchyma (arising from hepatocytes)
Describe the incidence of hepatocellular carcinoma
Most common primary cancer of liver however mets are MUCH more common
List 3 cancers that commonly metastasise to the liver
Colon
Breast
Upper GI
What is hepatocellular carcinoma associated with?
FH
Chronic liver damage: Alcoholic liver disease, Hepatitis B, Hepatitis C, AI disease
Metabolic disease: haemochromatosis, DM, obesity
Aflatoxins: Aspergillus flavus: cereals contaminated with fungi
Describe the epidemiology of hepatocellular carcinoma
COMMON M > F 1-2% of all malignancies LESS common than liver metastases High incidence in regions where hepatitis B + C are endemic
List 3 symptoms of malignancy seen in hepatocellular carcinoma
Malaise
Weight loss
Loss of appetite
List 3 symptoms of chronic liver disease seen in hepatocellular carcinoma
Abdominal distension
Jaundice
RUQ pain
List 3 risk factors for hepatocellular carcinoma
High alcohol intake
Hepatitis B or C (e.g. sexual activity, IV drug use)
Aflatoxins
List signs of malignancy seen in hepatocellular carcinoma
Cachexia
Lymphadenopathy
List 7 signs of liver disease seen in hepatocellular carcinoma
Hepatomegaly (may be nodular), splenomegaly, deep palpation may elicit tenderness, may hear bruit over liver Jaundice Ascites Asterixis Spider naevi Palmar erythema Fetor hepaticus
What bloods are performed in hepatocellular carcinoma?
FBC: microcytic anaemia/ thrombocytopenia
ESR
LFTs: poor specificity + sensitivity but may show biliary obstruction
Clotting
a-fetoprotein: tumour marker for liver cancer
B12 binding protein is a marker of fibrolamellar HCC
Hepatitis serology (viral hepatitis panel)
What imaging is performed in hepatocellular carcinoma?
Consider urgent abdominal US if in GP setting: not sensitive for tumours <1cm but poorly defined margins + coarse, irregular internal echoes
CT/MRI: GOLD STANDARD for staging
What histological/ cytological investigations may be performed in hepatocellular carcinoma?
Ascitic tap: cytological analysis
Liver biopsy: confirms histology of tumour but small risk of tumour seeding along biopsy tract
How will primary liver cancer differ from metastases to the liver?
Primary: HIGH AFP
Mets: Normal AFP
What investigations are used for staging hepatocellular carcinoma?
CT TAP: to define structural lesion + spread
CXR
Radionuclide bone scan
Duplex scan: to demonstrate large vessel invasion, e.g. into hepatic/portal veins
