Hepatocellular Carcinoma

Epidemiology:

    • HCC occurs frequently with cirrhosis, especially when associated with viral hepatitis (HBV and HCV), alcoholic cirrhosis, alpha1AT deficiency, and hemochromatosis.

    • HCC is 5th most common CA in men and 9th most common CA in women worldwide.

    • 84% of 1° liver cancer in the US (mean age at Dx is 65).

Clinical features:

    • Clinical features are directly proportional to the stage of disease. Early disease is ASx, late-stage disease may present with RUQ abdominal pain, wt. loss, and hepatomegaly.

    • Suspect HCC in a well-controlled cirrhotic patient who develops manifestations of liver decompensation.

    • Surveillance of HCC (sensitive imaging study q6-12mo) normally indicated for Pts with cirrhosis. In Hep-B, surveillance should begin after age 40 and in those with family history of HCC even in the absence of cirrhosis.

Dxtic testing:

    • Alpha-fetoprotiens

    • Investigational markers for HCC: lens culinaris agglutinin-reactive alpha-fetoprotein, des-gamma-carboxyprothormbin (DCP), alpha-L-fucosidase, and glycipan-3 (GPC3).

    • Liver U/S, triple phase CT, and MRI are adequate and frequently used for detection of HCC.

    • Liver Bx in suspicious cases.

Tx:

    • Sorafenib is a small molecule that inhibits tumor cell proliferation and tumor angiogenesis and increases the rate of apoptosis in a wide range of tumor models.

    • In Pts with advance HCC, median survival and radiologic progression were nearly 3 months longer for Pts with sorafenib than for those given placebo

    • Alternative Tx for unresectable tumors: percutaneous alcohol or acetic acid inj, arterial chemoembolization, microwave coagulation therapy, or radiofrequency ablation.

    • These loco-regional therapies can be used as a bridge for liver transplantation in selected cases.

    • Surgery: hepatic resection is Tx of choice for noncirrhotic Pts. Liver transplantation is the treatment of choice for select cirrhotic patients (single HCC <5 cm up to three nodules <3 cm).

Outcome/prognosis: Early diagnosis is essential, as surgical resection and liver transplantation can improve long-term survival. Survival with no treatment remains very poor: 36% and 17% at 1 and 3 years respectively.