Hepatocellular

carcinoma
Diagnosis, Treatment,
Prognosis + Quiz
Vinko Bubic
Mentor: A. mega Horvat
Diagnosis
Physical examination - enlarged, tender liver

Elevated serum alpha fetoprotein (normally :
40mg/l)

Elevated liver enzymes (ALT, AST, Alpha-1
antitrypsin, serum bilirubin, urine bilirubin...)
Diagnosis
CT

CT
Computed tomography - medical
imaging method employing tomography
(imaging by sections or sectioning)
Large series of two-dimensional X-ray
images taken around a single axis of
rotation, computer integration
Iodine dye through vein for better
visualisation (allergy)


MRI
Magnetic resonance imaging
The body - mainly composed of water molecules
Electromagnetic field causes protons to absorb
some of its energy
Scanner detects release of proton energy (tumor
tissue releases different frequency)
Greater contrast than CT
Modern 3T MRI
Biopsy
Definitive diagnosis of hepatocellular
carcinoma
Hyperchromatic, clear cells with large red
cytoplasm

Treatment
Liver transplatation (cadaver liver or live
donor lobe)

Surgical resection (best prognosis for
long-term survival, but possible in only
10-15% of cases)

Treatment

Percutaneus ethanol injection - small (< 3 cm)
solitary tumors

Transcatheter arterial chemoembolization
(TACE) - more than 3 cm and less than 4 cm in
diameter

Sealed source radiotherapy (brachytherapy) -
radioactive source is placed inside or next to
area requiring treatment


Prior to ethanol ablation After
Transcatheter arterial
chemoembolization

Other techniques
Radiofrequency ablation (RFA)
High intensity focused ultrasound (HIFU)
Chemotherapy (antiestrogen + tamoxifen)
Cryosurgery - destruction of abnormal
tissue using sub-zero temperatures

HIFU
Cryosurgery
Iceball
HCC complications

Gastrointestinal bleeding
Cachexy
Portal hypertension -> esophageal bleeding
Liver failure
Metastasis (lymph nodes around pancreas,
aorta, lungs, adrenal glands, bones)
Rupture of tumor -> abdominal bleeding
Prognosis
Usually poor outcome
Only 10 - 20% of hepatocellular
carcinomas can be removed completely
If not, disease usually deadly within 3 to 6
months
Quiz:
The definitive HCC diagnosis is
confirmed by:
a) spider nevus by inspection
b) auscultation
c) biopsy and microscopy
d) MRI
e) esophageal reflux


Ethanol:
a) dehydrates cells
b) hydrates cells and cracks them
c) activates IL-8
d) causes apoptosis
e) nothing from above

In cryotherapy, tumor is frozen by:
a) flucloxacillin
b) Iodine
c) liquid nitrogen
d) surgeons eye
e) cocaine

What did you eat today?
This maybe?

Thanks ! ! !
References:
http://www.cancer.gov/cancertopics/types/liver/
http://www.mayoclinic.com/health/liver-
cancer/DS00399
Medicinski leksikon, Leksikografski zavod
Miroslav Krlea, Zagreb 1992.
PATOLOGIJA, urednici Damjanov, Jukic, Nola,
izdanje 2007.