Hepatocellular carcinoma: Difference between revisions
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==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 | ||
**Watery diarrhea, dehydration | **Watery diarrhea, dehydration are common in HCC with cirrhosis versus cirrhosis alone | ||
==Disposition== | ==Disposition== | ||
Revision as of 17:37, 13 October 2018
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
- LFT, CBC, BMP, GGT
- Ultrasound
- Initial contrasted CT
- Multiphasic contrasted CT and MRI nonemergently
- 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
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.