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