0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
948 Malignant Tumors of the Liver■HCC one of the most common malignancies worldwide
■HCC associated with cirrhosis in the majority of cases, particularly
chronic hepatitis B, chronic hepatitis C and hemochromatosis; the
rising incidence of HCC can be attributed to chronic HCV infec-
tion
■other conditions associated with HCC include hemochromatosis,
androgenic steroids, alpha-1-antitrypsin deficiency, etc.
Signs and Symptoms
■presentation is variable
■asymptomatic detection on screening with ultrasound and AFP
■abdominal pain or mass occurs in 60%
■weight loss common
■decompensation of previously-existing cirrhosis occurs in 20%
■perineoplastic manifestations include erythrocytosis, hypoglyce-
mia, and feminization
tests
Basic Tests: Blood:
■nonspecific: increased AST, ALT, alkaline phosphatase, bilirubin
■75% of patients with HCC have increased AFPImaging
■ultrasound and CT main imaging studies used for diagnosis
■screening ultrasound: HCC hyperdense lesions as small as 0.5–1 cm
■biphasic CT: useful to confirm the presence of HCC and assess for
additional lesions
■CT angiography: may be used as a confirmatory test to detect addi-
tional lesions
Biopsy
■liver biopsy may be required to confirm the diagnosis, particularly if
AFP level is normal.
■fibrolamellar HCC is a variant of HCC that is usually not associated
with cirrhosis and appears to have a better prognosis
differential diagnosis
■benign tumors, including FNH and hepatocellular adenoma
■isolated single metastatic lesion
management
What to Do First
■assess the security of the diagnosis, i.e., chronic HBV or HCV infec-
tion with (incr.) AFP and new lesion on screening ultrasound virtually
diagnostic