Liver cancer: Difference between revisions

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'''Hepatocellular carcinoma''' (<abbr>HCC</abbr>) is the most common primary malignant tumor of the liver. It’s mostly a disease of older men. In almost all cases it develops in an already [[Cirrhosis|cirrhotic]] liver, so the risk factors for HCC are the same as those for cirrhosis.
<section begin="radiology" />'''Hepatocellular carcinoma''' (<abbr>HCC</abbr>) is the most common primary malignant tumor of the liver. It’s mostly a disease of older men. In almost all cases it develops in an already [[Cirrhosis|cirrhotic]] liver, so the risk factors for HCC are the same as those for cirrhosis.<section end="radiology" />


The incidence of HCC is increasing. Due to the long asymptomatic period, most cases are irresectable at presentation. This gives it a poor prognosis, with a 5-year survival of 30 – 50%.
The incidence of HCC is increasing. Due to the long asymptomatic period, most cases are irresectable at presentation. This gives it a poor prognosis, with a 5-year survival of 30 – 50%.
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== Clinical features ==
== Clinical features ==
The tumour itself is usually asymptomatic, but the patient usually has symptoms from the underlying disease ([[cirrhosis]] or [[hepatitis]]), like [[ascites]] and [[jaundice]]. [[Constitutional cancer symptom|Constitutional cancer symptoms]] like weight loss, weakness, abdominal pain may be present but may also be caused by the underlying disease.
The tumour itself is usually asymptomatic, but the patient usually has symptoms from the underlying disease ([[cirrhosis]] or [[hepatitis]]), like [[ascites]] and [[jaundice]]. [[Constitutional cancer symptom|Constitutional cancer symptoms]] like weight loss, weakness, abdominal pain may be present but may also be caused by the underlying disease.
 
<section begin="radiology" />
== Diagnosis and evaluation ==
== Diagnosis and evaluation ==
Patients at high risk for <abbr>HCC</abbr> (cirrhosis of any cause, chronic hep B) should be screened regularly for HCC. Screening involves measuring abdominal [[ultrasound]] and [[AFP]] levels. Focal lesions in a cirrhotic liver are primary liver cancer until proven otherwise. AFP is elevated only in 50% of cases, in which case the level correlates with the tumour size.
Patients at high risk for <abbr>HCC</abbr> (cirrhosis of any cause, chronic hep B) should be screened regularly for HCC. Screening involves measuring abdominal [[ultrasound]] and [[AFP]] levels. Focal lesions in a cirrhotic liver are primary liver cancer until proven otherwise. AFP is elevated only in 50% of cases, in which case the level correlates with the tumour size.


Contrast [[CT]] or [[MR]] confirms the diagnosis and shows extrahepatic spread. Typical features on imaging include early contrast uptake, “washout”, and vascular spread.
Contrast [[CT]] or [[MR]] confirms the diagnosis and shows any extrahepatic spread. Typical features on imaging include early contrast uptake, “washout”, and vascular spread.<section end="radiology" />


[[Liver biopsy]] is often not needed as the definitive diagnosis can be made with imaging, and biopsy carries a risk of bleeding and tumour spread.
[[Liver biopsy]] is often not needed as the definitive diagnosis can be made with imaging, and biopsy carries a risk of bleeding and tumour spread.