1. HEPATOCELLULAR CARCINOMA

2. HISTORY
Usually male over 40 years old
Male : female = 3 :1
 Predisposing factors :
Hepatic cirrhosis (80%)
HBV & HCV
Eating a lot of stored food (alfa-toxin)
Androgenic steroids


3. HOW TO SUSPECT HCC IN LIVER CIRRHOSIS
Rapid deterioration of his condition
 Refractory ascites and encephalopathy
 Right hypo-chondrial pain or appearance of
local swealing


4. SYMPTOMS
Asymptomatic
Accidently discovery
during US or CT scan
Pain :
Dull aching pain in the
right hypo-chondrium

5. SIGNS
Low grade fever , cachexia , jaundice
 Liver is enlarged , hard irregular , nodular ,
tender
 Ascites may be present
 Occasionally murmur over the tumor
(mamoun sign) ??


6. METASTASIS
Lung
 Brain
 Bone
 LNs


7. PARA MALIGNANT $
Non-metastatic presentations
 Gynecomastia
 Hypercalcemia
 hypoglycemia


8. INVESTIGATIONS
Lab
•
•
•
•
alpha fetoprotein : increased up to
>500 ng/ml in 85% of cases
des-gamma carboxy prothrombin (sprcific
not sensitive)
serum ferritin
alkaline phosphatase

9. INVESTIGATIONS
Radiology
 abdominal US
 Abdominal CT scan
 MRI

10. INVESTIGATIONS
Liver biopsy :
better guide by US or CT
diagnostic but recently it is better avoided
as it may cause seeding of malignant cells

11. TREATMENT
Medical
• local or systemic cytotoxic drugs
(unsatisfactory)

12. TREATMENT
Hepatic artery manipulation
Embolization
Ligation
( in aim of ishemic necrosis of tumor)

13. TREATMENT
Surgical
• Surgical resection : localized tumor , non
cirrhotic liver
• Hepatic transplantation : patent hepatic
artery & portal vein , adecuate
cardiopulmonary & renal functions
(liver transplantation is the procedure of
choice in dealing with hepatocellular
carcinoma)

14. THANK YOU