Difference between revisions of "Hepatocellular carcinoma"

(Management)
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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)
+
**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]]
Line 21: Line 21:
  
 
==Evaluation==
 
==Evaluation==
*LFT, CBC, BMP, GGT
+
*[[LFTs]], CBC, BMP, GGT
*Ultrasound
+
*[[RUQ ultrasound|Ultrasound]]
 
*Initial contrasted CT
 
*Initial contrasted CT
*Multiphasic contrasted CT and MRI nonemergently
+
*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

Differential Diagnosis

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

Disposition

  • Discussion with oncologist for first time diagnosis
  • Dependent on complications and comorbidities

See Also

External Links

References

  1. 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.
  2. Liver transplantation for hepatocellular carcinoma. Bismuth H, Majno PE, Adam R. Semin Liver Dis. 1999; 19(3):311-22.
  3. 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.
  4. Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.