Gastroenterology Book

http://www.fpnotebook.com/

Hepatocellular Carcinoma

Aka: Hepatocellular Carcinoma, Hepatoma
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  1. Epidemiology
    1. Most common internal cancer worldwide
    2. Highest Incidence where Hepatitis B is endemic
      1. Southeast Asia
      2. Sub-Saharan Africa
    3. Less common in the United States
    4. Incidence in men 2-4 times more common than women
    5. Incidence peaks in ages 50-70 years old
  2. Risk Factors
    1. Chronic Active Hepatitis B
      1. Highest risk if congenitally acquired
    2. Hepatitis C Infection
    3. Cirrhosis
    4. Hemochromatosis
    5. Alpha-1-Antitrypsin Deficiency
    6. Tyrosinosis
    7. Anabolic Steroid use
    8. Fungal metabolite ingestion (aflatoxin)
  3. Symptoms
    1. Weight loss
    2. Right Upper Quadrant Abdominal Pain
  4. Signs
    1. Tender, hard, palpable liver mass
    2. Ascites (25%)
    3. Peritoneal friction rub
    4. Hepatic bruit
  5. Labs
    1. Liver Function Tests
      1. Alkaline Phosphatase elevated
      2. 5'-nucleotidase elevated
    2. Tumor Marker: Serum Alpha-fetoprotein >20 ng/ml
      1. Test Sensitivity: 64%
      2. Test Specificity: 91%
  6. Radiology
    1. Liver Ultrasound
      1. Test Sensitivity: 59% to 74%
      2. Test Specificity: 94%
    2. Triphasic Liver CT (arterial contrast images)
      1. Detects tumors <2 cm in diameter
  7. Diagnosis: Liver biopsy
    1. Percutaneous
    2. Surgical (Laparoscopy or Laparotomy)
  8. Management
    1. Curative Measures
      1. Curative resection in only 5%
      2. Liver transplantation for small tumors without spread
    2. Palliation
      1. Radiation Therapy
      2. Selective arterial embolization
      3. Chemotherapy not beneficial
      4. Radiofrequency Ablation (nonresectable tumor)
        1. Small trials suggest prolonged survival or cure
        2. Wong (2001) Am J Surg 182:552-7
  9. Prevention
    1. Hepatitis B Vaccination for global immunity
  10. References
    1. Akriviadis (1998) Br J Surg 85(10):1319-31
    2. Ulmer (2000) Postgrad Med 107(5):117-24

Liver carcinoma (C2239176)

Definition (NCI) A malignant tumor that arises from hepatocytes. Hepatocellular carcinoma is relatively rare in the United States but very common in all African countries south of the Sahara and in Southeast Asia. Most cases are seen in patients over the age of 50 years, but this tumor can also occur in younger individuals and even in children. Hepatocellular carcinoma is more common in males than females and is associated with hepatitis B, hepatitis C, chronic alcohol abuse and cirrhosis. Serum elevation of alpha-fetoprotein occurs in a large percentage of patients with hepatocellular carcinoma. Grossly, hepatocellular carcinoma may present as a single mass, as multiple nodules, or as diffuse liver involvement. Microscopically, there is a wide range of differentiation from tumor to tumor (well differentiated to poorly differentiated tumors). Hepatocellular carcinomas quickly metastasize to regional lymph nodes and lung. The overall median survival of untreated liver cell carcinoma is about 4 months. The most effective treatment of hepatocellular carcinoma is complete resection of the tumor. Lately, an increasing number of tumors have been treated with liver transplantation.
Definition (NCI) A type of adenocarcinoma and the most common type of liver tumor.
Definition (MSH) A primary malignant neoplasm of epithelial liver cells. It ranges from a well-differentiated tumor with EPITHELIAL CELLS indistinguishable from normal HEPATOCYTES to a poorly differentiated neoplasm. The cells may be uniform or markedly pleomorphic, or form GIANT CELLS. Several classification schemes have been suggested.
Definition (CSP) primary malignant neoplasm of epithelial liver cells; it ranges from a well-differentiated tumor with epithelial cells indistinguishable from normal hepatocytes to a poorly differentiated neoplasm; the cells may be uniform or markedly pleomorphic, or form giant cells; associations exist with chronic hepatitis B virus infection, some types of cirrhosis, and hepatitis C virus infection.
Concepts Neoplastic Process (T191)
MSH D006528
ICD10 C22.0, M8170/3
SnomedCT 109841003, 25370001, 187769009, 154469006, 269547001
English CARCINOMA OF LIVER, Carcinoma, Hepatocellular, Carcinomas, Hepatocellular, Hepatocellular Carcinoma, Hepatocellular Carcinomas, Hepatoma, Hepatomas, CARCINOMA LIVER, HEPATOCARCINOMA, HEPATOMA, LIVER CANCER, HEPATOCARCINOMA, LIVER CARCINOMA, LIVER, CARCINOMA, PRIMARY, Hepatic Carcinoma, Hepatocellular carcinoma, NOS, Hepatoma, NOS, hepatocellular carcinoma, hepatoma, HEPATOCELLULAR CARCINOMA, LCC, LIVER CELL CARCINOMA, HCC, Hepatocellular ca. NOS, [M]Hepatocellular ca. NOS, Hepatocellular carcinoma NOS, carcinoma of liver (diagnosis), hepatocellular carcinoma of liver (diagnosis), hepatocellular carcinoma of liver, liver cell carcinoma, liver neoplasm malignant carcinoma, carcinoma of liver, Liver carcinoma, Carcinoma liver, Carcinoma of liver, Liver Cell Cancer (Hepatocellular Carcinoma), Carcinoma, Hepatocellular [Disease/Finding], Cancers, Adult Liver, Cancer, Hepatocellular, Hepatocellular Cancers, Liver Cell Carcinoma, Adult, Hepatocellular Cancer, Adult Liver Cancer, Liver Cancer, Adult, Cancer, Adult Liver, Cancers, Hepatocellular, Adult Liver Cancers, Liver Cancers, Adult, hepatomas, hepatic carcinoma, liver cell cancer, liver carcinoma, Carcinoma hepatocellular, Liver cell carcinoma, Hepatocarcinoma, Hepatoma, malignant, Hepatocellular carcinoma, Malignant hepatoma, LCC - Liver cell carcinoma, HCC - Hepatocellular carcinoma, [M]Hepatocellular carcinoma NOS, Primary carcinoma of liver, Hepatocellular carcinoma (clinical), Hepatocellular carcinoma (morphologic abnormality), Liver cell carcinoma (clinical), Liver cell carcinoma (disorder), Primary carcinoma of liver (disorder), hepatocarcinoma, carcinoma; hepatic cell, carcinoma; hepatocellular, hepatic cell; carcinoma, hepatocellular; carcinoma, Liver Cell Carcinoma, Primary Carcinoma of Liver Cells, Primary Carcinoma of the Liver Cells, Carcinoma of Liver Cells, Carcinoma of the Liver Cells, Carcinoma of liver, specified as primary, Carcinoma of liver cell
French HEPATOME, Carcinome du foie, Hépatome, Carcinome hépatique, CHC (Carcinome HépatoCellulaire), Carcinome hépato-cellulaire, Carcinome hépatocellulaire, Hépatocarcinome, Hépatome malin
Portuguese HEPATOMA, Carcinoma do fígado, Carcinomahepatocelular, Carcinoma Hepatocelular, Hepatoma
Spanish HEPATOMA, Carcinoma hepatocelular, Carcinoma de hígado, Carcinoma hepático, Liver carcinoma, (M)carcinoma hepatocelular, carcinoma de células hepáticas (clínico), carcinoma de células hepáticas (trastorno), carcinoma de células hepáticas, carcinoma hepatocelular (clínico), carcinoma hepatocelular, carcinoma hepatocítico (anomalía morfológica), carcinoma hepatocítico, carcinoma primario del hígado (trastorno), carcinoma primario del hígado, hepatocarcinoma, hepatoma, maligno, hepatoma, Hepatoma, Carcinoma Hepatocelular
Dutch carcinoom lever, carcinoom hepatocellulair, hepatoom, levercarcinoom, carcinoom van de lever, carcinoom; hepatocellulair, carcinoom; levercel, hepatocellulair; carcinoom, levercel; carcinoom, Carcinoom, hepatocellulair, Hepatocellulair carcinoom, Hepatoom, Levercelcarcinoom
German Karzinom, hepatozellulaer, Karzinom der Leber, Leberkarzinom, HEPATOM, Leberzellkarzinom, Hepatom, Hepatozelluläres Karzinom, Karzinom, hepatozelluläres
Italian Carcinoma del fegato, Epatoma, Carcinoma epatocellulare
Japanese 肝癌, ｶﾝｶﾞﾝ, ｶﾝｻｲﾎﾞｳｶﾞﾝ, 肝細胞癌, 肝癌(肝細胞癌), ヘパトーム, 原発性肝細胞がん, 原発性肝細胞癌, 肝細胞がん, 肝細胞がん-原発性, 肝細胞癌-原発性
Swedish Karcinom, hepatocellulärt
Czech karcinom hepatocelulární, Karcinom jater, Hepatom, Karcinom hepatocelulární
Finnish Pahanlaatuinen maksasolukasvain
Russian GEPATOMA, KARTSINOMA PECHENOCHNO-KLETOCHNAIA, ГЕПАТОМА, КАРЦИНОМА ПЕЧЕНОЧНО-КЛЕТОЧНАЯ
Korean 간세포 암종
Croatian KARCINOM, HEPATOCELULARNI
Polish Wątrobiak, Rak wątrobowokomórkowy
Hungarian Májcarcinoma, Hepatoma, Májrák, Hepatocellularis carcinoma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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