Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

260 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

is the first line of therapy; however, these tumors are very chemosensitive,

and neoadjuvant chemotherapy can render unresectable tumors operable.

Five-year survival after liver transplantation is excellent (83%).

Answer 20.3.15. The answer is B.

The NS5A protein product of HCV genome has been demonstrated to

inactivate p53 by sequestration. The hepatitis B x gene product has been

implicated in causing HCC because it is a transcriptional activator of

various cellular genes associated with growth control. The elevated serum

level of HBV DNA (a marker of higher levels of HBV replication) is

associated with a higher risk of HCC. The HBV genotype C is generally

thought to increase the risk of HCC because these individuals are likely to

remain seropositive for hepatitis B e antigen and thus have higher serum

levels of HBV DNA for a longer time.

Answer 20.3.16. The answer is D.

Hepatitis B virus is a DNA virus and it may become integrated within

the chromosomes of infected hepatocyte. On the other hand, hepatitis C

virus is an RNA virus without a DNA intermediate form, and therefore

cannot integrate into hepatocyte DNA.

Answer 20.3.17. The answer is A.

Old age, black race, lower platelet count, elevated serum alkaline phos-

phatase, elevated AST, presence of esophageal varices, and history of

smoking are the independent predictors for the development of HCC

in the setting of chronic hepatitis C infection.

Answer 20.3.18. The answer is D.

Presence of arterial hypervascularity, rapid enhancement during the arte-

rial phase of contrast administration, and washout during the later portal

venous and delayed phase are features characteristic of the appearance of

HCC on four-phase CT.

Answer 20.3.19. The answer is B.

The following groups should undergo surveillance for HCC.

Hepatitis B carrier—Asian men more than 40 years old, Asian women

more than 50 years old, Africans more than 20 years old, all cirrhotic

hepatitis B carriers, family history of HCC and patients with high hepatitis

B virus DNA with ongoing hepatic injury.

Nonhepatitis B cirrhosis—hepatitis C, alcoholic cirrhosis, genetic

hemochromatosis, and primary biliary cirrhosis

Tests that have been used for surveillance for HCC include serologic

tests (measurement of serum AFP) and radiologic tests (such as ultra-

sonography). Although the ideal surveillance interval is not known, a

surveillance interval of 6 to 12 months has been proposed based on esti-

mates of tumor doubling time.