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Hepatocellular CarcinomaHepatocellular Carcinoma

One of the most common malignancies Incidence: 1 M (annual) Ratio 4M:1F US: MR 1.9/100,000/year (low

incidence) Africa: 5-20/100,000/year (moderate) Asia: 23-150/100,000/year (high)

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Table 88-1Table 88-1

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Etiologic FactorsEtiologic Factors

Hepatitis C Virus: US: 4M carriers 10% cirrhosis 5% HCC (20,000)

Hepatitis B Virus: High association with HBeAg+ High HBVDNA viral load

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Table 88-2Table 88-2

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Clinical FeaturesClinical Features

Abdominal pain Anorexia Weight loss Weakness Ascites Jaundice Hematemesis Bone pain asymptomatic

Hepatomegaly Ascites Abdominal bruits Splenomegaly Muscle wasting Jaundice Dilated superf veins Palmar erythema edema

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Paraneoplastic syndromesParaneoplastic syndromes

Hypoglycemia Erythrocytosis Hypercalcemia Hypercholesterolemia Dysfibrogenemia Carcinoid syndrome Gynecomastia, testicular atrophy Thrombocytopenia Leukopenia

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Table 88-4Table 88-4

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Laboratory InvestigationsLaboratory Investigations

Ultrasonography Alpha Feto Protein CT Scan MRI Others: Hep B, Hep C, HBV DNA Liver biopsy

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HCC ScreeningHCC Screening

High risk groups: cirrhosis, HBV, HCV, +Family history of HCC AFP determination Ultrasonography Biannual

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TherapyTherapy

Surgical resection Local ablation: RFA – heat; 3-4cm size Injection therapy: ethanol; 3x; 3 cm size Liver transplant Systemic chemotherapy Regional chemotherapy: TACE (doxorubicin, cisplatin)

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Figure 88-1Figure 88-1

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Other tumorsOther tumors

Cholangiocarcinoma: mucin-producing AdenoCA arising from bile ducts; acc to

anatomic sites – intrahepatic, hilar, peripheral; Klatskin(CBD bifurcation); Asians Chlonorchis sinensis ( liver fluke); surgery for distal and hilar lesions

Gall bladder CA: worse prognosis; 4F:1M; Calculous cholecystitis; surgery

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Hepatic metastasesHepatic metastases

Colon Pancreas breast

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Benign tumorsBenign tumors

Hemangioma Adenoma Focal nodular hyperplasia Predominantly females