Hepatocellular carcinoma\

Question 1

What is the most common primary liver ca

Answer 1

Hepatocellular carcinoma

Question 2

Epidemiology of HCC

Answer 2

Increased incidence in SE asian and African
Peak late 60s and 70s

Question 3

Causes of HCC

Answer 3

Damage and repair cycle
- CHronic hepatitis B or C
Liver cirrhosis -secondary to primary biliary cirrhosis, hematochromatosis, alpha 1 antitrypsin def
Alcohol associated liver disease
Chronic ingestion of food contaminated with aflatoxin: grains, nuts

Question 4

Clinical f of HCC

Answer 4

1/3 - ASX, incidental finding
Jaundice, upper abdo pain, weakness, swelling, weight loss, fever, indigestion, early satiety

Question 5

MC site of mets from liver

Answer 5

lungs

Question 6

Diagnostic investigations for HCC

Answer 6

LFTS show infiltrative malignancy and parenchymal disease - increase in ALT/AST - hepatocellular injury, increased ALP/GGT from biliary obstruction
Further workup shows increased AFP

Question 7

Diagnostic imaging pathway for suspected HCC

Question 8

Diagnostic imaging pathway for HCC survelillance

Question 9

Management of HCC

Answer 9

Surgical removal
- better survival rate
Radiaiton and chemi - not effective
Liver transplant via Milan criteria and MELD score