Shot overview of HCC

1. Hepatocellular Carcinoma
Dr Shatdal Chaudhary

2. Incidence
• One of most common malignancy world wide
• Annual 1 million case
• M:F 4:1
• Mean Age 56 ± 13
• Associated with
– cirrhosis 81%
– No cirrhosis 19%

3. • Etiology
– Cirrhosis from any cause
– Hep B&C chronic infection
– Chronic ethanol consumption
– NASH/NAFLD
– Mycotoxin- Alfatoxin B1

4. • Unusual
– Pri biliay cirrhosis
– Hemachromatosis
– Α1 Antitrypsin def
– Glycogen storage disorder
– Wilson disease

5. C/F
• Symptoms (%)
– Abdominal pain 40
– Weight loss 24
– Appetite loss 11
– Weakness 15
– Jaundice 5
– Cirrhosis Symptoms 18
– No Symptoms 24

6. Physical Signs
• Hepatomegaly 50-90%
• Ascites 30-60%
• Splenomegaly
• Abdominal bruit
• Fever 10-50%
• Signs of cirrhosis

7. • Paraneoplastic syndromes
– Hypoglycemis
– Erytherocytosis
– Hypercalcemia
– Hypercholesterolemia
– Dysfibrogenemia
– Carcinoid synd
– Chage in sexual characteristic

8. Staging
• Okuda Classification + -
– Tumor extent ≥50% <50%
– Ascites + -
– Albumin ≤3(g/L) >3
– Bilirubin ≥3 <3
• Stage 1 all-
• Stage 2 1/2 +
• Stage 3 3/4 +

9. CLIP staging
• 0 1 2
• Tumor number single multiple -
• Tumor extent <50 <50 >50
• Child Pugh score A B C
• AFP <400 >400 -
• Portal vein thromb No Yes -
• CLIP 0, CLIP1, CLIP2, CLIP3.

10. Investigation
• USG- Liver mass with hyper vascularity
Portal vein thrombosis
• Helical CT Scan
• Serological assay
– AFP 50%
– AFP-L3 80%
– DCP/PIVKA-2
• USG guided Core Liver Biopsy/FNAC

11. Treatment
Treatment option
• Surgery: Resection/ Liver Transplant
• Local Ablative therapies
– Cryosurgery
– Radiofrequency Ablation
– Percutaneous ethanol injection

12. • Regional Therapies
– Transarterial chemotherapy
– Transarterial embolization
– Transarterial chemoembolization
– Transarterial radiotherapy
• Conformal External-Beam radiation
• Chemotherapy
• Immunotherapy

13. Stages 1 and 2 HCC
• Surgical resection/RFA/ Local injection
– Child A, Noncirrhotic, No Metastasis, Single lesion
– Child B, C – Orthotopic liver trasplant
– Percutaneous ethanol injection

14. Stages 3 and 4
• Poor prognosis
• If no meastasis – transplant
• Chemotherapy
– Doxorubicin
– Cisplatin
– Mitomycin C
– Oral Sorefenib