Hepatocellular Carcinoma Flashcards
what is a typical presentation for hepatocelular carcinoma?
Weight loss + jaundice + palpable mass in RUQ
Associated with HepB/C
define hepatocellular carcinoma?
Hepatocellular carcinoma (HCC), also known as hepatoma, is a primary cancer arising from hepatocytes in predominantly cirrhotic liver. However, some patients may not have cirrhosis before developing HCC, especially patients with chronic hepatitis B virus.
Most common primary cancer of liver however met are SOOOO MUCH more common (and if it is due to mets then AFP won’t be high)
state common cancers to metastasise to liver?
colon, breast, upper GI
what are the risk factors for hepatocellular carcinoma?
cirrhosis
chronic Hep B infection
chronic Hep C infection
chronic heavy alcohol use
diabetes
obesity
family history of livercancer
outline the aetiology of hepatocellular carcinoma?
FH
Chronic liver damage
- Alcoholic liver disease
- Hepatitis B
- Hepatitis C
- Autoimmune disease
Metabolic disease
- E.g. haemochromatosis
- DM/obesity
Aflatoxins
- E.g. Aspergillus flavus - cereals contaminated with fungi
summarise the epidemiology of hepatocellular carcinoma?
COMMON - much more common in males
1-2% of all malignancies
LESS common than liver metastases
High incidence in regions where hepatitis B and C are endemic
what are the presenting symptoms of hepatocellular carcinoma?
Symptoms of Malignancy
- Malaise
- Weight loss
- Loss of appetite
Symptoms of chronic liver disease
- abdominal distension, jaundice, RUQ pain, cachexia
History of Exposure to Carcinogens
- High alcohol intake
- Hepatitis B or C (e.g. sexual activity, IV drug use)
- Aflatoxins
what are the signs of hepatocellular carcinoma on physical examination?
Signs of Malignancy
- Cachexia
- Lymphadenopathy
Hepatomegaly (may be nodular), splenomegaly, deep palpation may elicit tenderness, may hear bruit over liver
Jaundice
Ascites
Asterixis
Spider naevi
Palmar erythema
Fetor hepaticus
what are blood investigatios for hepatocellular carcinoma?
FBC- microcytic anaemia/ thrombocytopenia
basic metabolic panel- hyponatraemia, high urea
LFTs- increase AST, ALT, ALP, bilirubin, low albumin
prothrombin time/INR- synthetic capacity of liver-> candiate for liver transplant
Hep serology
a-fetoprotein - tumour marker for liver cancer
B12 binding protein is a marker of fibrolamellar HCC
what are the appropriate investigations for hepatocellular carcinom?
bloods - FBC, ESR, LFTs, clotting, alpha feroprotein, hepatitis serology
imaging- abdominal ultrasound, CT/MRI
Histology/ cytology- liver biospy
staging
what imaging investigation do you need for hepatocellular carcinoma?
Consider urgent abdominal US if in GP setting – not sensitive for tumours <1cm but poorly defined margins and coarse, irregular internal echoes
CT/MRI - GOLD STANDARD for staging
what histology investigations may be useful for hepatocellular carcinoma?
Ascitic tap may be sent for cytological analysis
Liver biopsy: confirms histology of tumour but small risk of tumour seeding along biopsy tract
what investigation are needed to stage liver cancer?
CT scan (thorax/abdo/pelvis), used to define structural lesion and spread
CXR
Also radionuclide bone scan
Duplex scan of liver-> show large vessel invasion, e.g. into hepatic/portal veins
