STUDY PURPOSE ONLY FOR MEDICAL STUDENT AND MEDICAL OFFICER

1. HEPATOCELLULAR CARCINOMA

9. OutLine
 Introduction
 Causes
 PATHOPHYSIOLOGY
 The classic features
• Diagnosis
 Treatment
 Prevention

10. Definition
• Hepatocellular carcinoma (HCC) is the most frequent
primary solid tumor of the liver.
• Malignant neoplasm's of the liver that arise from
parenchyma cells are called HEPATOCELLULAR
CARCINOMA
• HCC is the sixth most common neoplasm and the
third leading cause of cancer-related death in the
world

11. • Almost 80% cases are due to underlying
liver cirrhosis (chronic HBV or HCV
infection)
• HCC is typically diagnosed late and the
median survival following diagnosis is
approximately 6-20 months

12. ETIOLOGY
Hepatitis B & C viruses –Chronic viral infection
Cirrhosis-excessive alcohol consumption
Ingestion of Aflatoxins contaminated food
Metabolic disease – Hemochromatosis
Androgenic steroids

14. PATHOPHYSIOLOGY
The exact PATHOPHYSIOLOGY IDIOPATHIC
The disease seems to occur in stages: Chronic liver
injury > cell death >regeneration> cellular
metabolic dysfunction> release of inflammatory
mediators> increase risk of transforming mutation
of hepatocytes > preneoplastic changes >
hepatocytes dysplasia can be seen then finaly result
HEPATOCELLULAR CARCINOMA

18. The classic features of Hcc
SYMPTOMS
1. Asymptomatic
2. RUQ pain
3. Weight loss.
4. Loss of appetite
5. Weakness.
6. Abdominal swelling.
7. Advanced – jaundice,
8. upper GI bleeding
SIGNS
1. Hepatomegaly
2. Ascites
3. Periumbilical collateral veins
4. Variceal bleeding
5. Easy bruising
6. Hepatic encephalopathy
7. Hypoglycemia
8. Shock

19. Diagnosis of Hcc
Physical Exam
Labs
Radiology
History

20. INVESTIGATIONS
Lab
1. Full blood count –FBC or CBC
2. Liver function test: -serum bilirubin -AST -ALT -
ALP -Prothrombin time -Serum albumin
3. Tumor markers:- AFP measurement

21. Imaging
1. Chest x-ray
2. abdomen Ultrasound
3. CT
4. MRI
5. Liver biopsy=- To confirm the diagnosis

22. MANAGEMENT
OF HCC
Non surgical
management
surgical
management

23. Important features that
guide treatment include
– Size
– Spread (stage)
– Involvement of liver vessels
– Presence of a tumor capsule
– Presence of extrahepatic metastases
– Vascularity

24. Non surgical management
Ablative
• -Ethanol injection
-Acetic acid injection -Thermal(cryotherapy)
Transarterial
-Embolization
-Chemoembolization
Systemic
-Chemotherapy
-Radiotherapy
-Imunotherapy

25. Non surgical management
1. Percutaneous ablation –
2. Alcohol injection –
3. Radiofrequency ablation
4. Transarterial remobilization and
chemoembolization

26. Chemotherapy
1. SORAFERIB – drug of choice in advance HCC
with good liver function
2. Sunitinib
3. Doxorubicin
4. Cisplatin
5. Fluorouracil
commonly used chemotherapeutic agents. o
Unfortunately HCC is relatively chemotherapy
resistant

27. Surgical management
1. Segmental or local resection
2. Lobectomy or partial hepatectomy
3. Extended lobectomy
4. Liver transplantation

28. Management summary

29. Prognosis after treatment
1. 5 year survival rate:- 30-40% after liver resection
2. 5year survival rate:- 75% in liver transplantation
3. 2 year survival rate :- 60% in transarterial
chemoembolization
CONCLUSION for Hcc is preventing and treating viral
hepatitis may help to reduce the risk of developing
liver cancer. Childhood hepatitis vaccination of
hepatitis B may reduce risk of it.Proper
nutrition,rest,good habits(avoid alcohol) and safer
practises makes a man healthy.

32. Thank you for your
attention