Hepatocellular Carcinoma Flashcards
(8 cards)
Diagnosis and screening of hepatocellular carcinoma
90% cases associated with chronic liver disease -> HBV and chronic liver disease
- Radiological diagnosis - LIRAD criteria
- Biopsy rarely required - can be done at time of ablation
- Quad phase CT abdomen -> arterial phase, portal vein washout
Screening
* AFP elevated in HCV & untreated HBV
* Only 10-20% of early HCC present with abnormal AFP
* AFP>20 ng/ml show good sensitivity but low specificity, whereas >200 ng/ml the sensitivity drops to 22%
with high specificity
* Also increased in testicular cancer and pregnancy
* Particularly useful in HBV patients on HBV therapy
Benefit -> early treatment potentially curable, poor adherence to screening but 37% improved mortality
Options for treatment of small solitary lesions hepatocellular carcinoa (Stage 0/A)
Curative intent
Resection -> surgical, good outcome if no portal hypertension, albumin and bilirubin key factors in success
Ablation -> surgical vs radiological, RFA vs MWA (microwave more uniform), size limitation <3cm
Management of Stage B hepatocellular carcinoma
Multinodular, Child Pugh A-B, ECOG 0. Palliative intent.
Options -> TACE (chemoembilisation if no portal hypertension) or systemic therapy (see Stage C slides)
Transplant criteria for hepatocellular carcinoma
Must have no metastatic disease
Management of Stage C hepatocellular carcinoma
Features -> tumour vascular invasion e.g. portal vein, multifocal disease no longer suitable for TACE, mets
* Levatinib non inferior to sorafenib in regards to overall survival, less side effects with levatinib
* New immunotherapy option -> azetolizumab + bevicizumab (must treat varices first) - superior to sorafenib
Follow up frequency of hepatocellular carcinoma at any stage
Staging and treatment overview of hepatocellular carcinoma
Side effects of sorafenib
Rash on hands and feet
