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Liver carcinoma

Major etiological associations for liver carcinoma are
  1. HBV and HCV infection, Cirrhosis.
  2. Chronic alcoholism
  3. Food contaminants (primarily aflatoxin’s derived from Aspergillus flavus)
  4. Hereditary tyrosinoses
  5. Hereditary hemochromatosis
  6. Anabolic steroids, OC
  7. Alpha-1 ATD, PBC, Glycogen storage diseased type I

Extra Edge Animal fat in Diet is not a causative factor of hepatoma.

Physical Signs (Ref. Hari. 18th ed., Pg-778)
  1. Hepatomegaly is the most common physical sign.
  2. Abdominal bruits
  3. Ascites
  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

Extra Edge Jaundice is a late feature in hepatoma

Paraneoplastic syndromes In HCC include
  1. Hypoglycemia
  2. Erythrocytosis,
  3. hypercalcemia, 
  4. Hypercholesterolemia,
  5. Dysfibrinogenemia
  6. Carcinoid syndrome, 
  7. Increased thyroxine binding globulin
  8. Changes in secondary sex characteristic gynecomastia, testicular atrophy and precocious puberty), 
  9. Porphyria cutanea tarda. 
Prognosis: Unresected hepatocellular 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%.


Extra Edge Hepatoma is common in Asians

Diagnosis of liver carcinoma
  1. Elevated level of serum alpha-fetoproteins are seen in 50 - 75% cases.
    Other causes of ↑ AFP
    1. Livers:
      1. HCC
      2. Hepatoblastoma
    2. GIT tumours including Ca stomach
    3. Non seminferous germ cell tumours of ovary / testes, chorio carcinoma, Embryonal carcinoma, Yolk sac tumours. Teratoma, Teratocarcinoma.
    4. Hepatitis
  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 polyprenoic 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) 
    OLTX for patients with a single lesion ≤ 5cm or three of fewer nodules, each ≤ 3cm (Milan criteria).
  3. Multiple unilobar tumors or tumor with vascular invasion: TACE (Trans arterial chemoembolization)
    Drugs used in TACE are doxorubicin & cisplatin.
  4. Bilobar tumors, no vascular invasion: TACE with OLTX for patients whose tumors have a response.
Fibrolamellar carcinoma:
The fibrolamellar variant of the HCC is associated with a more favorable prognosis. It arises in otherwise healthy young adults and may be discovered while still amenable to surgical resection. It is a distinctive variant of hepatocellular carcinoma. 
  1. It is seen in young adults (20-40 yrs. of age)
  2. It is more common in females.
  3. Clinical Feature: Fever, Wight Loss, Enlarge liver, ↑ LFT.
  4. It Metastasis to lungs & Lymph node.
  5. It has better prognosis
  6. It has no association with HBV or cirrhosis
  7. It is grossly encapsulated mass (i.e. It is not a diffuse lesion).
  8. AFP elevation is not seen in Fibrolamellar Ca
    ↑ S. neurotensin level.
  9. Treatment surgery

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