Liver & GIT
All of the following are important clinical manifest-tations of hepatocellular carcinoma except:
Physical Signs (H-18th Pg-778)
1. Hepatomegaly is the most common physical sign.
2. Abdominal bruits
4. Splenomegaly is mainly due to portal hypertension.
5. Weight loss and muscle wasting are common.
6. Fever is present
7. The signs of chronic liver disease may often be present, including jaundice, dilated abdominal veins, palmar erythema, gynecomastia, testicular atrophy, and peripheral edema.
8. Budd-Chiari syndrome can occur due to HCC invasion of the hepatic veins, with tense ascites and a large tender liver
Paraneoplastic syndromes In HCC include
i. Hypoglycemia ii. Erythrocytosis, iii.hypercalcemia,
iv. Hypercholesterolemia, v. Dysfibrinogenemia vi. Carcinoid syndrome,
vii. Increased thyroxine binding globulin
viii. Changes in secondary sex characteristic gynecomastia, testicular atrophy and precocious puberty),
ix. Porphyria cutaneatarda.
Prognosis: Unresectedhepatocellular carcinoma has a very poor prognosis. Patients rarely survive beyond 4 months after the diagnosis. The 5 year survival rate after curative resection is 35% to 50%.
Diagnosis of liver carcinoma
1. Elevated level of serum alpha-fetoproteins are seen in 50 - 75% cases.
Other causes of AFP
a. Livers: a. HCC
c. GIT tumours including Ca stomach
d. Non seminferous germ cell tumours of ovary / testes = chorio carcinoma, Embryonal carcinoma, Yolk sac tumours. Teratoma, Teratocarcinoma.
2. Liver scan
CT scans, ultrasound scans and MRI scans demonstrate the lesion in 80% patients.
3. Liver Biopsy: Most confirmation
The diagnosis can be established by percutaneous core biopsy or aspiration biopsy in most patients if the biopsy site is selected.
The acyclic retinoid polyphenic acid inhibits chemically induced hepatocarcinogenesis.
Treatment: (Pre operative high level of alpha Fetoprotein indicate Poor prognosis.)
1. HCC <2 cm: RFA ablation (Radiofrequency ablation), PEI (Local injection of ethanol into the tumor), or resection
2. HCC>2 cm, no vascular invasion: liver resection, RFA, or OLTX (Orthotopic liver transplant)
3. OLTX for patients with a single lesion ≤5cm or three of fewer nodules, each ≤ 3cm (Milan criteria).
4. Multiple unilobar tumors or tumor with vascular invasion: TACE (Trans arterial chemoembolization)
5. Drugs used in TACE are doxorubicin & cisplatin.
6. Bilobar tumors, no vascular invasion: TACE with OLTX for patients whose tumors have a response.