Loco regional treatment for hcc

1. Local-regional treatment of
Hepatocellular Carcinoma
DR. Farzana Rais
MCPS Diagnostic Radiology

2. Outline of Presentation
• Introduction
• Clinical presentation
• Risk Factors
• Local- regional Management

3. INTRODUCTION
• Primary malignancy of liver
• Occur predominantly in patients with CLD
• Fifth most common neoplasm in the world
• Third most common cause of cancer related
death
• Incidence is highest in Asia and Africa
• 5 year relative survival rate is 15%

4. Clinical Presentation
• Pruritus
• Jaundice
• Splenomegaly
• Variceal bleeding
• Cachexia
• Increase abdominal girth

5. Risk Factors
• Hepatitis B
20% cases of HCC are related with Hepatitis B
Increase risk of HCC 1000-fold
HCV infection
Common cause of HCC in japan and Europe
Life time risk 5%
30 cases of HCC in America related to HCV

6. Risk Factors continued
• Alcohol
• 30 % cases of HCC in America are related to
alcohol
• Increase risk 5 fold
• 50% of alcoholic may have subclinical HCC
at autopsy.

7. Risk Factor continued
• Autoimmune hepatitis
• Primary biliary cirrhosis
• Afla toxin
• Hemochromatosis
• Wilson disease

8. Screening NCCN
USG abdomen with or with out AFP:
every 6 month in patient with CLD due to following :
Hepatitis B or C
Alcohol
NAFLD
Genetic hemochromatosis
Alpha -1 Antitrypsin deficiency
Others causes

9. WORK UP
• CBC , LFTs, RFTs HBASG,ANTI HCV
• AFP
• TRIPHASIC CT /MRI
• CT CHEST
• BONE SCAN
• PET

10. NCCN biopsy may be consider
• When a lesion is suspicious for malignancy but
tri-phasic CT/MRI do not meet the imaging
criteria
• In patient who are not considered to be high
risk (don’t have cirrhosis ,chronic HBV and
history of HCC) CA19-9 or CEA is advised to
rule out intrahepatic cholangio carcinoma

12. BCLC STAGING
• Based on tumor size ,extend , liver function
and performance status
• Very usefull in deciding the potential
treatment options.

13. Work Up
• History and physical examination
• CBC,LFTS,RFTS ,PT/APTT, S. ELECTROLYTE
• HBsAg /anti-HBC ,Anti-HCV
• AFP >400 generally diagnostic
• USG 60% sensitive
• Triple-phasic CT 68 % sensitive and 93% specific
• MRI 81% sensitive and 85 %sepcific

14. Local-regional therapies
• Ablative procedure – Radiofrequency
ablation (RFA), Cryo-ablation,
percutaneous alcohol injection ,and
microwave / thermal ablation
• Arterially directed therapies-
– TAE,TACE ,DEB –TACE and RE with yttrium-90
• Radiation therapies- IMRT ,SBRT and
EBRT