Hepatocellular carcinoma appears frequently in patients with cirrhosis. Surveillance by biannual ultrasound is recommended for such patients because it allows diagnosis at an early stage, when effective therapies are feasible.
- A common cause of cancer world wide
- Highest incidence in Southeast Asia and sub-Saharan Africa.
- Not all patients have underlying cirrhosis first
- HBV or HCV infection
- Alcoholic cirrhosis
- nonalcoholic steatohepatitis
- Aflatoxin B exposure
- Primary biliary cirrhosis.
- Weight loss, anorexia, fever, pain
- Background of liver disease
- Lesion seen on 6 monthly screening (USS/AFP)
- FBC, U&E, LFTs, CRP
- USS: can help identify lesions
- Alpha fetoprotein
- Resection: The best candidates for resection are patients with a solitary tumour and preserved liver function.
- Liver transplantation: benefits patients who are not good candidates for surgical resection, and the best candidates are those within Milan criteria (solitary tumour =5 cm or up to three nodules =3 cm).
- Image-guided ablation is the most frequently used therapeutic strategy, but its efficacy is limited by the size of the tumour and its localisation.
- Chemoembolisation has survival benefit in asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread.
- Sorafenib, lenvatinib, which is non-inferior to sorafenib, and regorafenib increase survival and are the standard treatments in advanced hepatocellular carcinoma.