Gastroenterology Book

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Hepatocellular CarcinomaAka: 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
  9. Prevention
    1. Hepatitis B Vaccination for global immunity
  10. References
    1. Akriviadis (1998) Br J Surg 85(10):1319
    2. Ulmer (2000) Postgrad Med 107(5):117

Primary carcinoma of the liver cells (C0019204)

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 (NCI)(HEP-a-toe-SEL-yoo-ler kar-sin-O-ma) A type of adenocarcinoma, the most common type of liver tumor.
Definition (NCI)(hep-a-TOE-ma) A liver tumor.
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.
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. --2002
ConceptsNeoplastic Process (T191)
ICD9155.0
MSHD006528
EnglishCARCINOMA LIVER, CARCINOMA OF LIVER, Carcinoma of liver cell, Carcinoma of Liver Cells, Carcinoma of the Liver Cells, HCC, HCC - Hepatocellular carcinoma, Hepatic Carcinoma, Hepatocarcinoma, Hepatocellular Carcinoma, Hepatocellular Carcinomas, HEPATOMA, Hepatomas, LCC - Liver cell carcinoma, LIVER CARCINOMA, Liver cell carcinoma, Malignant hepatoma, Primary carcinoma of liver, Primary Carcinoma of Liver Cells, Primary carcinoma of the liver cells
Spanishcarcinoma de celulas hepaticas, carcinoma hepatocelular, carcinoma hepatocitico, carcinoma primario del higado, hepatocarcinoma, hepatoma
Parent ConceptsMalignant neoplasm of liver (C0345904), Adenocarcinoma (C0001418), Liver neoplasms (C0023903), Malignant Neoplasms (C0006826), Liver diseases (C0023895), Chronic liver disease NOS (C0341439), Liver and Intrahepatic Biliary Tract Carcinoma (C0279000), Common Carcinoma (C1333128), Primary malignant neoplasm of liver (C0024620), Liver tumor morphology (C0474812), Adenocarcinoma of liver (C0948680), Malignant adenomatous neoplasm - category (C1302750), Primary malignant neoplasm (C1306459)
SourcesAOD, COSTAR, CSP, CST, DXP, LCH, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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