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.