Hepatocellular carcinoma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Risk factors include: | *Risk factors include: | ||
**[[Hepatitis]] B or C | **[[viral hepatitis|Hepatitis]] B or C | ||
** | **Toxins ([[alcohol]] or aflatoxin) | ||
**Metabolic conditions ([[hemochromatosis]], [[alpha 1-antitrypsin deficiency]], [[non-alcoholic fatty liver disease]]) | **Metabolic conditions ([[hemochromatosis]], [[alpha 1-antitrypsin deficiency]], [[non-alcoholic fatty liver disease]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Cirrhosis | *[[Cirrhosis]] | ||
*[[Hepatitis]] | *[[Hepatitis]] | ||
*[[Budd-Chiari syndrome]] | *[[Budd-Chiari syndrome]] | ||
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==Evaluation== | ==Evaluation== | ||
* | *[[LFTs]], CBC, BMP, GGT | ||
*Ultrasound | *[[RUQ ultrasound|Ultrasound]] | ||
*Initial contrasted CT | *Initial contrasted CT | ||
*Multiphasic contrasted CT and MRI | *Multiphasic contrasted CT and MRI non-emergently | ||
*Biopsy | *Biopsy | ||
*Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US<ref>Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.</ref> | *Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US<ref>Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.</ref> | ||
| Line 30: | Line 30: | ||
==Management== | ==Management== | ||
*Supportive, symptomatic treatment for complications and comorbidities | *Supportive, symptomatic treatment for complications and comorbidities | ||
**Cirrhotic jaundice | **Cirrhotic [[jaundice]] | ||
**[[Hepatic encephalopathy]] | **[[Hepatic encephalopathy]] | ||
**[[Anasarca]] | **[[Anasarca]] | ||
**Variceal bleeding | **[[Variceal bleeding]] | ||
**Renal failure | **[[Renal failure]] | ||
**Extrahepatic metastases, most commonly bone, lung, abdominal viscera | **Extrahepatic metastases, most commonly bone, lung, abdominal viscera | ||
**[[Paraneoplastic]] processes, such as [[hypoglycemia]], [[hypocalcemia]], polycythemia, feminization syndrome | **[[Paraneoplastic]] processes, such as [[hypoglycemia]], [[hypocalcemia]], polycythemia, feminization syndrome | ||
Revision as of 21:10, 29 September 2019
Background
- Most common form of liver cancer[1]
- 5 new cases per 100,000 in western countries
- > 100 per 100,000 in Southeast Asia and sub-Saharan Africa
- Mean survival of 6-20 months, steady over the years despite progress in diagnosis and therapies directed at HCC
- Surgical resection with transplantation, remains the best chance for cure
- However, < 20% of patients meet criteria for resection at time of diagnosis[2]
- Thus, early diagnosis is the most important step in managing HCC
Clinical Features
- Risk factors include:
- Hepatitis B or C
- Toxins (alcohol or aflatoxin)
- Metabolic conditions (hemochromatosis, alpha 1-antitrypsin deficiency, non-alcoholic fatty liver disease)
Differential Diagnosis
- Cirrhosis
- Hepatitis
- Budd-Chiari syndrome
- Liver masses - regenerating nodules, hemangiomas, focal fat, dysplastic nodules, peliosis[3]
Evaluation
- LFTs, CBC, BMP, GGT
- Ultrasound
- Initial contrasted CT
- Multiphasic contrasted CT and MRI non-emergently
- Biopsy
- Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US[4]
Management
- Supportive, symptomatic treatment for complications and comorbidities
- Cirrhotic jaundice
- Hepatic encephalopathy
- Anasarca
- Variceal bleeding
- Renal failure
- Extrahepatic metastases, most commonly bone, lung, abdominal viscera
- Paraneoplastic processes, such as hypoglycemia, hypocalcemia, polycythemia, feminization syndrome
- Watery diarrhea, dehydration are common in HCC with cirrhosis versus cirrhosis alone
Disposition
- Discussion with oncologist for first time diagnosis
- Dependent on complications and comorbidities
See Also
External Links
References
- ↑ Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview. Pal S, Pande GK. J Hepatobiliary Pancreat Surg. 2001; 8(4):323-36.
- ↑ Liver transplantation for hepatocellular carcinoma. Bismuth H, Majno PE, Adam R. Semin Liver Dis. 1999; 19(3):311-22.
- ↑ Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation. Brancatelli G, Baron RL, Peterson MS, Marsh W. AJR Am J Roentgenol. 2003 Apr; 180(4):1007-14.
- ↑ Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.