liver cell carcinoma
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hepatocellular carcinoma (HCC),[MIM*114550]
Malignant tumor of the liver that develops in the setting of chronic liver disease or cirrhosis. Hepatocellular carcinoma is derived from hepatocytes that are transformed into adenocarcinoma. Up to 60% of patients with HCC have elevated serum alpha fetoprotein levels. Tumor has a poor long-term prognosis unless treated surgically by resection or liver transplantation. Noninvasive imaging (e.g., MRI or CT scan) may distinguish hepatomas from other benign tumors such as hemangiomas.
hepatocellular carcinomaA primary liver cancer that arises in hepatocytes (liver cells).
Incidence increased (1.6/105 from 1980 to 4.9/105 from 2005), primarily in middle- to older-aged (age 40–60) patients; black patients are 2-fold more common than whites; male:female ratio is 3:1.
Abdominal pain, weight loss, weakness, anorexia, vomiting, jaundice, hepatomegaly, ascites, splenomegaly, wasting, fever; paraneoplastic changes include increased cholesterol, polycythaemia and sex-discordant changes in hormone levels.
• HBV+ carries a 7-fold increased risk; HCV-ness carries a 4-fold increased risk.
• Mycotoxin (e.g., aflatoxin B1 in stored grains, drinking water).
• 3-year risk for HCC is 12.5% in patients with cirrhosis; 4% in patients with chronic liver disease; others include alcohol consumption, autoimmune chronic active hepatitis and cryptogenic cirrhosis.
• Metabolic diseases—Haemochromatosis, glycogen storage diseases, Wilson’s disease, galactosemia.
• Environmental conditions, such as excessive exposure to thorotrast (an obsolete radiocontrast medium), androgenic steroids, PVC (polyvinylchloride).
AFP, HepPAR, PIVKA II (protein induced by the absence of vitamin K), biopsy, hepatitis serology, LFTs, CBC, coagulation profile.
5-year postoperative recurrence is 80%, reflects adequacy of surgical margins, detected by AFP.