Hepatocellular Carcinoma

Aka: Hepatocellular Carcinoma, Hepatoma

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