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Y4 Cancer Care > Hepatocellular Carcinoma > Flashcards

Hepatocellular Carcinoma Flashcards

1
Q

What are the types of liver cancer?

A
  1. Metastatic (90%)
  2. Primary (10%) (e.g HCC)
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2
Q

What are the risk factors for HCC? (5 things)

A
  1. Viral hepatitis (hep B + C) –> cirrhosis
  2. Alcohol
  3. Smoking
  4. Age
  5. FHx
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3
Q

What are the pathophysiological steps of HCC? (4 steps)?

A
  1. Chronic injury
  2. Inflamm.
  3. Hepatocyte regen.
  4. Driver mutations of HCC
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4
Q

What are the clinical features of HCC? (4 + 2 things)

A

Liver cirrhosis features
1. Fever / Fatigue
2. RUQ Pain
3. Hepatomegaly (irreg)
4. WL

Liver failure features (ADVANCED)
6. Jaundice
7. Ascites

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5
Q

What are some differentials that present similarly to HCC? (3 things)

A
  1. Infectious hepatitis
  2. Cardiac failure
  3. Benign hepatocellular adenoma
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6
Q

How do you differentiate between Infectious hepatitis and HCC?

A

Do serology

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7
Q

How do you differentiate between Cardiac failure and HCC?

A

CF = SMOOTH hepatomegaly

(HCC = IRREG hepatomegaly)

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8
Q

What lab tests should be done for suspected HCC? (4 things)

A
  1. LFTs
  2. FBC
  3. Clotting
  4. AFP
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9
Q

What tests do LFTs include? (4 things)

A
  1. ALP
  2. ALT
  3. AST
  4. Bilirubin
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10
Q

What would a FBC of HCC show?

A

Low platelets

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11
Q

What would a clotting test of HCC show?

A

Prolonged clotting time

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12
Q

What is AFP and what is it used for in HCC?

A

Alpha fetoprot (raised in 70%)

Used to monitor treatment + recurrence

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13
Q

What imaging can be done for HCC? (3 things)

A
  1. US (gold standard)
  2. CT
  3. MRI Liver
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14
Q

What is the gold standard imaging used for HCC?

A

US

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15
Q

What is the diagnostic criteria on an US of HCC? (2 things)

A
  1. 2cm + mass
  2. Raised AFP
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16
Q

What is a CT used for in HCC?

A

Staging

17
Q

What is an MRI Liver used to assess in HCC? (2 things)

A
  1. Rising AFP
  2. Sus US nodules

(Done if can’t diagnose with US)

18
Q

How can a biopsy be done for HCC? (2 things)

A
  1. FNA
  2. Percutaneously
19
Q

When should a biopsy be done for HCC?

A

If diagnosis still in doubt after other scans

20
Q

Why is biopsy a last resort in HCC? (3 things)

A
  1. Difficult with ascites
  2. Deranged clotting
  3. Risk of tumour seeding
21
Q

What is the staging system for HCC called?

A

Barcelona Clinic Liver Cancer Staging (BCLC)

22
Q

What does the BCLC staging for HCC take into account? (3 things)

A
  1. Tumour stage
  2. Liver function
  3. Physical status
23
Q

What are the only curative management methods for HCC? (2 things)

A
  1. Surgical resection
  2. Transplant
24
Q

What is the curative management of HCC limited by? (3 things)

A
  1. Tumour size
  2. Liver function
  3. Co-morb
25
Q

What are the indications for surgical resection of HCC? (2 things)

A
  1. W/o cirrhosis
  2. Good health
26
Q

What are the indications for transplantation in HCC? (3 things)

A

Milan Criteria
1. 1 lesion 5- cm / 3 lesions each 3- cm
2. No extrahepatic manifestations
3. No vasc infiltration

27
Q

What are the non-surgical management options for HCC? (2 things)

A
  1. Image guided ablation
  2. Transarterial Chemoembolisation (TACE)
28
Q

When is Image guided ablation done in HCC?

A

EARLY HCC

29
Q

What is Image guided ablation of HCC?

A

US probes places in tumour mass –> induce necrosis

30
Q

When is Transarterial Chemoembolisation (TACE) done in HCC?

A

For large multinodular tumours

31
Q

What is Transarterial Chemoembolisation (TACE) of HCC? (2 things)

A
  1. High conc chemo drugs inj directed directly into hepatic artery
  2. Embolising agent added –> induce ischaemia
32
Q

What is the average survival time of HCC after diagnosis?

A

6 months

Y4 Cancer Care (17 decks)

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