Hepatocellular Carcinoma

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.

About

• A common cause of cancer world wide
• Highest incidence in Southeast Asia and sub-Saharan Africa.
• Not all patients have underlying cirrhosis first

Risk factors

• HBV or HCV infection
• Alcoholic cirrhosis
• Haemochromatosis
• nonalcoholic steatohepatitis
• Aflatoxin B exposure
• Primary biliary cirrhosis.

Clinical

• Weight loss, anorexia, fever, pain
• Background of liver disease

Screening

• Lesion seen on 6 monthly screening (USS/AFP)

Investigations

• FBC, U&E, LFTs, CRP
• USS: can help identify lesions
• Alpha fetoprotein

Management

• 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.

References

• Hepatocellular Carcinoma Lancet