hepatocellular carcinoma (HCC) by Essa Khan (2517)

hcc

1. Epidemiology Accounts for 5.4% of all cancers Incidence greater in Asia and sub-Saharan Africa Incidence in western countries is due to increased prevalence of HCV Male to female ratio ranges from 1:3 to 1:8 Also known as hepatoma Arise from hepatocytes Primary tumor less common than secondary

2. Risk factors Major Aflatoxin Alcohol HBV HCV Cirrhosis Minor Hemochromatosis Smoking Metabolic disorders Wilson disease Alpha 1 antitrypsin

3. Hepatocellular carcinoma aflatoxin HBV or HCV HCV ALCOHOL TP53 inactivation inflammation cirrhosis inflammation Oxidative stress Necrosis regeneration Continuous proliferation Mutation of genes Genomic instability Genomic instability

4. pathogenesis Mostly arise from premalignant lesion i.e. dysplasia that are often found in cirrhosis Which is then followed by driver mutation any of: TP53 Beta catenin Or inactivation of TP53

5. Morphology Gross Unifocal Multifocal diffuse Microscopic May be well differentiated or poor differentiated or intermediate between them. Thick trabeculae Nest of pleomorphic cells Necrosis may be present

6. Normal Cancerous

7. Clinical manifestation Variable and often manifests late Abdominal pain 2. weight loss 3. asthenia 4. low grade fever anorexia Diagnosis Proper history taking Physical examination: abdominal mass, gynecomastia, palmar erythema, caput medusae, ascites, rough hardened texture of liver, hepatic bruit, jaundice Investigation: CBC, LFT’s, abdominal USG,CT scan, CXR, alpha fetoprotein Treatment Chemotherapy: Doxorubicin and 5 fluorouracil Surgical: Resection or liver transplant Transcatheter arterial embolization (TAE or TACE)

8. Thanks