HCC FRCR CO2A Flashcards
(79 cards)
1
Q
male: female ratio for incidence of HCC
A
3: 1
2
Q
High risk areas worldwide for HCC
A
East and SE Asia and sub saharan Africa
3
Q
association with Hepatitis
A
Yes, Hep B
4
Q
RFs and Aetiology
Infective
A
HBV and HCV
5
Q
RFs and Aetiology
Inflammatory
A
Hereditary haemochromatosis
wilson’s disease
Type I glycogen storage disease
6
Q
RFs and Aetiology
Chemical Injury
A
Alcohol
Aflatoxins
aflatoxins interact with alcohol to increase the risk of HCC threshold
7
Q
mutations in HCC
A
TP53 (25 to 40 %)
Beta catenin (25 %)
8
Q
what % of tumors don’t produce AFP?
A
30 %
9
Q
Symptoms of HCC
A
usually asymptomatic, incidental finding
may present with liver decompensation features
10
Q
what are liver decompensation features?
A
Ascites
Jaundice
anorexia
GI bleeding
wt loss and
encephalopathy
11
Q
Diagnosis of HCC
A
CT / MRI criteria
12
Q
where CT/MRI criteria can be applied
A
only cirrhotic patients
13
Q
feature of HCC on imaging
A
Hypervascularity in arterial phase with washout in the portal venous phase
14
Q
when should biopsy for HCC be avoided?
A
- not a candidate for therapy due to poor PS
- resection of tumor without acceptable morbidity/mortality or
- pts with decompensated disease awaiting liver transplant
15
Q
who should be kept on surveillance for HCC
A
- established Cirrhosis
- Non cirrhotic HBV pts with high viral load
- HCV pts with bridging fibrosis
16
Q
how is surveillance for HCC done
A
USG every 6 months
17
Q
surveillance result and action for new nodule
A
nodule < 1 cm, repeat USG at 4 monthly for 1 year then 6 monthly
18
Q
nodule 1 to 2 cm, on surveillance
A
4 phase CT or Dynamic contrast enhanced MRI , if hall mark of HCC Not seen, biopsy, 2nd biopsy if 1st inconclusive
19
Q
nodule > 2 cm
A
4 phase CT or Dynamic contrast enhanced MRI , if hall mark of HCC Not seen, biopsy
if biopsy again inconclusive, 4 monthly USG
20
Q
curative options for HCC
A
resection
liver transplantation
Ablative therpies
21
Q
when is local resection Rx of choice
A
non cirrhotic livers and for pts with Child pugh A solitary tumor and minimal portal Hypertension
22
Q
Liver Transplantation in HCC
Milan Criteria
A
- 1 tumor between 2 and 5 cm or 2 to 3 tumors, all < 3 cm;
23
Q
C/Is for TACE:
A
- thrombosis in main portal vein
- encephalopathy
- Biliary Obstruction and
- Child Pugh C
24
Q
SBRT dose for HCC used in studies
A
50 Gy in 3 to 10 fractions
25
when is SBRT useful
pts with portal vein thrombosis
26
SABR UK consortium, SABR inclusion criteria:
1. Tumors deemed unresectable after review by hepatobiliary MDT
2. Volume of uninvolved liver > 700 cc
3. platelets > 800000
4. Bil: < 3 x ULN
5. AST/ALT < 5 x ULN
6. INR < 1.3
7. Creat < 200 micromol/L
8. Child Pugh Class A
27
Exclusion criteria for SABR
1. active hapatitis
2. any signs of liver failure
3. ascites, clinically detectable
4. CNS mets or coagulopathy
mean dose of liver should not exceed 15 Gy
28
methods of managing respiratory motion for HCC
1. abdominal compression
2. active breathing control
3. respiratory gating
4. tumor motion tracking by placement of fiducial
29
to what level, respiratory motion be minimized?
< 5 mm
30
Dose schedule for SABR for HCC
45 to 48 Gy in 3 fractions over 8 to 10 days or 50 to 60 Gy over 14 days
31
Selective Internal targeted therapy for HCC
Source and Dose:
Yttrium 90
120 Gy
32
unresectable or metastatic HCC Systemic therapy
Atezolizumab + bevacizumab , cat 1
33
role of adjuvant chemotherapy
no
34
S/Es of sorafenib
FAtigue
diarrhoea
HFS and skin rash
Hypertension
Bleeding
Liver Dysfunction
35
Doxorubicin in HCC
response rate
of 15 to 25 %
36
stage wise 5 yr survival HCC
stage I : 60%
II: 45 %
III : 20%
IV : 10. %
37
Angiosarcoma of liver cause
exposure to polyvinyl chloride monomers
occur 10 to 20 yrs after exposure
38
Rx of angiosarcoma of liver
resection where feasible or palliative anthracycline chemo
39
What percentage of liver cancers are primary?
5%
## Footnote
Primary liver cancers are significantly less common than secondary liver cancers.
40
What is the most common primary liver cancer?
Hepatocellular carcinoma (HCC)
## Footnote
HCC accounts for 90% of primary liver cancers.
41
How many new patients are diagnosed with liver cancer in the UK annually?
More than 3000
## Footnote
This statistic highlights the prevalence of liver cancer in the UK.
42
What is the male to female ratio for liver cancer occurrence?
5:3
## Footnote
Males are more commonly affected by liver cancer compared to females.
43
What is the median age of diagnosis for liver cancer?
64 years
## Footnote
This reflects the demographic trend in liver cancer diagnoses.
44
Which chronic condition is associated with 80–90% of HCC cases?
Chronic liver disease
## Footnote
Cirrhosis is a significant risk factor for developing HCC.
45
What viruses account for 75% of HCC cases?
Hepatitis B and C
## Footnote
HCV is particularly responsible for the recent rise in HCC cases.
46
What percentage of liver cancers in Asia is attributed to alcohol consumption?
10%
## Footnote
This statistic is higher in Europe and USA, where it accounts for 20%.
47
What condition is associated with obesity and type 2 diabetes, increasing the risk of HCC?
Non-alcoholic fatty liver disease (NAFLD)
## Footnote
5% of patients with NAFLD progress to cirrhosis.
48
What is the most common presentation of HCC?
Incidental mass on USS in cirrhotic patients
## Footnote
Other symptoms may include abdominal pain and jaundice.
49
What percentage of patients may experience spontaneous bleeding from HCC?
5–15%
## Footnote
This can lead to abdominal pain and hemorrhagic ascites.
50
What is the diagnostic serum AFP level for HCC?
≥400 µg/l
## Footnote
This level is considered diagnostic for HCC.
51
What imaging techniques are used to establish the diagnosis of HCC?
Contrast enhanced CT scan and MRI scan
## Footnote
Both have 80% accuracy in diagnosing HCC.
52
What is a characteristic feature of HCC on imaging?
Specific vascular profile
## Footnote
Intense contrast intake during early arterial phase followed by washout.
53
In patients with cirrhosis, when is biopsy unnecessary for HCC diagnosis?
For >2 cm nodule with characteristic dynamic profile
## Footnote
Biopsy can be avoided depending on the timing of treatment.
54
What are the two methods of staging HCC?
TNM and Okuda staging
## Footnote
The Barcelona Clinic Liver Cancer group incorporates Okuda staging.
55
What are the treatment options for stage O and stage A HCC?
* Resection
* Transplantation
* Percutaneous tumour ablation
## Footnote
These treatments depend on tumor stage and liver function.
56
What is the 5-year survival rate for surgical resection in non-cirrhotic patients with HCC?
50%
## Footnote
Mortality rate is less than 1% for these patients.
57
What are the eligibility criteria for resection in cirrhotic patients?
* Single tumour
* No jaundice
* No portal hypertension
* No extra-hepatic disease
## Footnote
Meeting these criteria can lead to a 5-year survival of 70%.
58
Is there a role for adjuvant treatment after resection of HCC?
No
## Footnote
Adjuvant treatment is not indicated following surgical resection.
59
What is liver transplantation a treatment option for?
HCC in cirrhotic patients
## Footnote
HCC stands for hepatocellular carcinoma.
60
What percentage of patients are eligible for liver transplantation?
Only 10%
## Footnote
This indicates the strict selection criteria for candidates.
61
What are the Milan criteria for liver transplantation?
* Solitary HCC <5 cm
* Up to three HCC all <3 cm
## Footnote
These criteria help determine eligibility for transplantation.
62
What is the reported 5-year survival rate for highly selected liver transplantation patients?
>70%
## Footnote
This statistic highlights the effectiveness of the procedure in eligible patients.
63
Is liver transplantation an acceptable option for HCC in non-cirrhotic patients?
No
## Footnote
The need for intense immunosuppression makes it unsuitable.
64
What is percutaneous ablation?
A treatment option for patients with stage 0 & A disease who are not suitable for resection or transplantation and those waiting for transplantation
## Footnote
Achieved through chemical injection or thermal ablation.
65
List the methods of achieving ablation.
* Chemical injection (ethanol, acetic acid, boiling saline)
* Thermal ablation (radiofrequency, laser, cryotherapy)
## Footnote
These methods are used for treating tumors.
66
Which ablation methods are equally effective for tumors less than 2 cm?
Percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA)
## Footnote
Both methods are suitable for small tumors.
67
What treatment options are available for stage B & C disease?
* Transarterial chemoembolization (TACE)
* Transarterial embolization (TAE)
* Systemic treatment
* Chemotherapy
* Biological agents (e.g., sorafenib)
## Footnote
Palliative care is the focus for these stages.
68
What is the effect of chemotherapy on survival in stage B & C?
Low response rate and no impact on survival
## Footnote
Indicates limited efficacy of chemotherapy for these stages.
69
What effect does sorafenib have on survival in advanced HCC?
Prolongs survival compared with controls (10.7 vs. 7.9 months)
## Footnote
Sorafenib is a multi-kinase inhibitor.
70
What is the treatment focus for stage D disease?
Essentially symptomatic and supportive care
## Footnote
No curative treatment options are available.
71
What percentage of cases recur after surgical resection?
70% at 5 years
## Footnote
Indicates high recurrence rates post-surgery.
72
Differentiate between true recurrences and de novo tumors.
* True recurrences: intrahepatic metastases, occur within 2 years, associated with vascular invasion, satellite nodules, poorly differentiated tumors
* De novo tumors: occur late, not linked to previous tumors
## Footnote
Important for understanding recurrence patterns.
73
What are the treatment options for recurrence?
* Re-resection (possible in 10–20%)
* Salvage transplantation
* Palliative treatment
## Footnote
Options vary based on the patient's situation.
74
What factors influence prognosis in liver cancer?
Cancer stage and cirrhosis
## Footnote
Prognosis is closely tied to underlying liver conditions.
75
What is the 5-year survival rate for stage 0 & A after radical treatment?
50–75%
## Footnote
Indicates favorable outcomes with effective treatment.
76
What is the median survival for stage B without treatment?
16 months
## Footnote
Survival is notably improved with TACE.
77
What is the median survival for stage C without treatment?
6 months
## Footnote
Indicates poor prognosis without intervention.
78
What is the survival rate for stage D at 1 year?
<10%
## Footnote
Signifies very poor outcomes for advanced disease.
79
What screening tests are commonly used for patients with cirrhosis?
* Serum alpha-foetoprotein (AFP)
* Ultrasonography
## Footnote
These tests are crucial for early detection of liver cancer.
