Hepatocellular carcinoma

Question 1

Define

Answer 1

DEFINITION: primary malignancy of the liver parenchyma

Question 2

Causes

Answer 2

Associated with:

Chronic liver damage

• Alcoholic liver disease
• Hepatitis C
• Autoimmune disease

Metabolic disease

• E.g. haemochromatosis

Aflatoxins

• E.g. cereals contaminated with fungi

Question 3

Epidemiology

Answer 3

COMMON

1-2% of all malignancies

LESS common than liver metastases

High incidence in regions where hepatitis B and C are endemic

Question 4

Symptoms

Answer 4

Symptoms of Malignancy

• Malaise
• Weight loss
• Loss of appetite

History of Exposure to Carcinogens

• High alcohol intake
• Hepatitis B or C (e.g. sexual activity, IV drug use)
• Aflatoxins

Abdominal distention

Jaundice

Question 5

Signs

Answer 5

Signs of Malignancy

• Cachexia
• Lymphadenopathy

Hepatomegaly (may be nodular)

Jaundice

Ascites

Bruit over the liver

Question 6

Investigations

Answer 6

Bloods

• FBC
• ESR
• LFTs
• Clotting
• a-fetoprotein - tumour marker for liver cancer
• Hepatitis serology

Imaging

• Abdominal US
• CT/MRI - GOLD STANDARD for staging

Histology/Cytology

• Ascitic tap my be sent for cytological analysis
• Staging

CT scan (chest/abdo/pelvis)