Flashcards in HCC Deck (21):
What is the most common cause of HCC worldwide?
What are risk factors for HCC development?
- viral load
- HBeAg positive (active viral replication)
- HBV genotype (C and D highest risk)
- co infection with hep c or d
Cirrhosis from any cause
Is there a gender difference in incidence with HCC?
What is the most common cause of HCC in Australia?
What are risk factors for HCC?
Cirrhosis - of any cause
Hep C - even after SVR obtained
Aflatoxin found in peanuts etc.
Alpha-1 anti trypsin
What is the recommended screening for HCC
6 monthly USS
- some contribution of AFP but adds significant false positives
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
What can cause elevations in AFP?
Alcoholic liver disease
Seminomatus germ cell tumor
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
What staging system is used for HCC and what does it take into account?
Barcelona clinic liver cancer staging
Child Pugh score
Size and number of lesions
Elevated portal pressures
What makes a BCLC stage 0 and what treatments can be considered?
Child Pugh A
Single HCC less than 2cm
Curative treatments: resection, RFA
Liver transplant if candidate
What is a BCLC stage A and treatment?
Child Pugh A-B
A single nodule less than 5cm or 3 nodules all less than 3cm
Curative treatments: resection, RFA, transplant
What is a BCLC stage B and treatment?
What is BCLC stage C and treatment?
Advanced disease - portal involvement, nodes, mets
What is BCLC stage D and treatment?
Child Pugh C
PS greater than 2
Supportive treatment only
Who may benefit from liver transplant?
Those with child Pugh C
- one nodule less than 5cm
- or 3 nodules less than 3cm
What are curative treatments of HCC?
PEI (percutaneous ethanol injection, less effective then RFA)
What are some palliative treatments of HCC?
What is sorafenib?
Multi tyrosine kinase inhibit which blocks PDGf, VEGF, c-kit and raf
Side effects of sorafenib?
Hand and foot
Risk of renal impairment