Hepatocellular carcinoma is one of the most common malignancies worldwide. Its incidence varies significantly between regions, from low rates in the United States and Africa to very high rates in parts of Asia. Major risk factors include chronic hepatitis B and C infections. Clinical features can include abdominal pain, weight loss, jaundice, and hepatomegaly. Diagnosis involves blood tests, ultrasound, CT scan, MRI and sometimes liver biopsy. High-risk groups are screened regularly through alpha-fetoprotein testing and ultrasound. Treatment options depend on the stage but may include surgical resection, ablation, chemotherapy, and transplantation.

1. Hepatocellular Carcinoma One of the most common malignancies Incidence: 1 M (annual) Ratio 4M:1F US: MR 1.9/100,000/year (low incidence) Africa: 5-20/100,000/year (moderate) Asia: 23-150/100,000/year (high) 09/20/10

2. Table 88-1 09/20/10

3. Etiologic Factors Hepatitis C Virus: US: 4M carriers  10%  cirrhosis  5%  HCC (20,000) Hepatitis B Virus: High association with HBeAg+ High HBVDNA viral load 09/20/10

4. Table 88-2 09/20/10

5. Clinical Features Abdominal pain Anorexia Weight loss Weakness Ascites Jaundice Hematemesis Bone pain asymptomatic Hepatomegaly Ascites Abdominal bruits Splenomegaly Muscle wasting Jaundice Dilated superf veins Palmar erythema edema 09/20/10

6. Paraneoplastic syndromes Hypoglycemia Erythrocytosis Hypercalcemia Hypercholesterolemia Dysfibrogenemia Carcinoid syndrome Gynecomastia, testicular atrophy Thrombocytopenia Leukopenia 09/20/10

7. Table 88-4 09/20/10

8. Laboratory Investigations Ultrasonography Alpha Feto Protein CT Scan MRI Others: Hep B, Hep C, HBV DNA Liver biopsy 09/20/10

9. HCC Screening High risk groups: cirrhosis, HBV, HCV, +Family history of HCC AFP determination Ultrasonography Biannual 09/20/10

10. Therapy Surgical resection Local ablation: RFA – heat; 3-4cm size Injection therapy: ethanol; 3x; 3 cm size Liver transplant Systemic chemotherapy Regional chemotherapy: TACE (doxorubicin, cisplatin) 09/20/10

11. Figure 88-1 09/20/10

12. Other tumors Cholangiocarcinoma: mucin-producing AdenoCA arising from bile ducts; acc to anatomic sites – intrahepatic, hilar, peripheral; Klatskin(CBD bifurcation); Asians Chlonorchis sinensis ( liver fluke); surgery for distal and hilar lesions Gall bladder CA: worse prognosis; 4F:1M; Calculous cholecystitis; surgery 09/20/10

13. Hepatic metastases Colon Pancreas breast 09/20/10

14. Benign tumors Hemangioma Adenoma Focal nodular hyperplasia Predominantly females 09/20/10