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"HEPATOCELLULAR CARCINOMA (HCC)"

December 23, 2020 Edit this post

This is the most common liver primary occurring mostly in patients with chronic liver disease and cirrhosis. AFP is the tumour marker , and ...

This is the most common liver primary occurring mostly in patients with chronic liver disease and cirrhosis. AFP is the tumour marker, and gross elevation is diagnostic. The tumour derives its blood supply from the hepatic artery and often invades the portal vein. The most frequent site of metastasis is the lungs. Surgical resection and liver transplant are the only options for cure.
US

•  Hyper- or hypo-echoic liver lesions—solitary, multifocal or diffuse.
•  May show arterial vascularity.
•  Heterogeneous reflectivity due to areas of necrosis.
•  Smaller lesions are typically of homogeneous low reflectivity.
•  Check the patency of the portal vein.

CT 
•  Ill-defined and low-density (can be isodense) lesions.
•  10% have calcifications.
•  May contain fat.
•  Invasion of the portal vein is typical, look for an enlarged portal vein.
•  Encapsulated low-density mass pre-contrast.
•  Rapid arterial enhancement with washout in the venous phase.
MRI
•  Marked enhancement in the arterial phase (20 seconds); there may be peripheral enhancement in the venous phase (60 seconds) due to pseudocapsule.
•  Lesion is high signal on a T2* post-superparamagnetic iron oxide.
INTERVENTION

•  Thermal ablation/transarterial chemoembolisation (TACE) should only be performed in Child-Pugh score A or B patients.
•  Thermal ablation is used for small tumours that are not amenable to surgery to give local control and increase life expectancy.
•  Thermal ablation may also be used to control tumours in patients waiting for a transplant.
•  TACE may be used for large, unresectable tumours.
•  Can be combined—TACE to reduce tumour volume, followed by ablation.
•  TACE after ablation may also decrease recurrence.

Hepatocellular carcinoma, axial CT images of the liver. (a) The arterial phase scan shows a small enhancing lesion in the right lobe. (b) The venous phase scan shows the lesion to washout.

 

 

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