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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. | ||