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Flashcards in HCC Deck (21):
1

What is the most common cause of HCC worldwide?

Hep b

2

What are risk factors for HCC development?

Hep B
- viral load
- HBeAg positive (active viral replication)
- HBV genotype (C and D highest risk)
- co infection with hep c or d
Sex
Hep C
Cirrhosis from any cause
Smoking
Nafld
Iron overload
Alpha1antitrpsin

3

Is there a gender difference in incidence with HCC?

M:F 4:1

4

What is the most common cause of HCC in Australia?

Hep c

5

What are risk factors for HCC?

Cirrhosis - of any cause
Hep B
Hep C - even after SVR obtained
Age
Aflatoxin found in peanuts etc.
Diabetes
NAFLD
Haemochomotosis
Alpha-1 anti trypsin

6

What is the recommended screening for HCC

6 monthly USS
- some contribution of AFP but adds significant false positives

7

Who should have surveillance for HCC?

All patients with cirrhosis
Those without cirrhosis who have
- hep b and high viral load
- hep c and bridging fibrosis

8

What can cause elevations in AFP?

Alcoholic liver disease
Pregnancy
HCC
Seminomatus germ cell tumor

9

What are is the characteristic imaging finding of HCC?

Hypervascular in arterial phase with washout in portal venous phase on multi detector CT or contrast enhanced MRI

10

What staging system is used for HCC and what does it take into account?

Barcelona clinic liver cancer staging
Performance status
Child Pugh score
Size and number of lesions
Elevated portal pressures

11

What makes a BCLC stage 0 and what treatments can be considered?

Child Pugh A
PS 0
Single HCC less than 2cm

Curative treatments: resection, RFA
Liver transplant if candidate

12

What is a BCLC stage A and treatment?

Child Pugh A-B
PS 0-2
A single nodule less than 5cm or 3 nodules all less than 3cm

Curative treatments: resection, RFA, transplant

13

What is a BCLC stage B and treatment?

CP A-B
PS 0-2
Multi-modular disease

Treatment: TACE

14

What is BCLC stage C and treatment?

CP A-B
Advanced disease - portal involvement, nodes, mets

Treatment: sorafenib

15

What is BCLC stage D and treatment?

Child Pugh C
PS greater than 2

Supportive treatment only

16

Who may benefit from liver transplant?

Those with child Pugh C
And either
- one nodule less than 5cm
- or 3 nodules less than 3cm

17

What are curative treatments of HCC?

Resection
Transplant
RFA
PEI (percutaneous ethanol injection, less effective then RFA)

18

What are some palliative treatments of HCC?

TACE
Sorafenib

19

What is sorafenib?

Multi tyrosine kinase inhibit which blocks PDGf, VEGF, c-kit and raf

20

Side effects of sorafenib?

Hand and foot
Diarrhoea
Bleeding
Hypertension
Clots
Risk of renal impairment

21

What AFP level is diagnostic of HCC?

400