1 / 12

Hepatocellular Carcinoma from the ACC to Med E

Hepatocellular Carcinoma from the ACC to Med E. Paul M. Johnson Department of Internal Medicine University of North Carolina Hospitals February 12, 2010. Overview. Incidence Diagnosis Treatment Surveillance. HCC: A growing problem…. Incidence: 4.1/100K in US male to female ratio 3:1

grace-guy
Download Presentation

Hepatocellular Carcinoma from the ACC to Med E

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hepatocellular Carcinomafrom the ACC to Med E Paul M. Johnson Department of Internal Medicine University of North Carolina Hospitals February 12, 2010

  2. Overview • Incidence • Diagnosis • Treatment • Surveillance

  3. HCC: A growing problem… • Incidence: 4.1/100K in US • male to female ratio 3:1 • much higher risk abroad • mortality rate = incidence Above: Average yearly, age-adjusted incidence of HCC in US. Left: Cumulative incidence of HCC among veteran patients between 1985 and 1990. Gastroenterology 2004; 127: S27

  4. Who gets HCC in the US? • Hep C: 2-8% annual incidence • Hep B: 0.5% annual incidence • Cirrhosis due to other causes • EtOH, and others (Wilson’s, α1AT-def, hemochromatosis, NASH) Gastroenterology 2004; 127: S27-234

  5. Diagnosis • History • wt loss, early satiety = advanced mass • Physical Exam • decompensation of cirrhosis • ascites, jaundice, splenomegaly • bruit over liver? • paraneoplastic • Labs • nonspecific, but indicative of liver disease • Alpha-fetoprotein • sensitivity/spec is poor • Imaging • key point: U/S, CT, and MRI all work well • Biopsy • not always needed • risk of seeding (2.5 % in one review) Gut 2008; 57: 1592-6

  6. Treatment of HCC Resectable or not Transplantable or not Small, local disease or severe disease If small and local, can pursue RFA, TACE (chemoembo), or PEA If severe disease, pursue systemic therapy Sorafenib vs. clinical trails A simplified approach to treatment of HCC. Am J Med 2007; 120: 194-202

  7. A word on surveillance…. There is no definitive evidence that screening for HCC improves survival* USPSTF and ACS do not have guidelines for screening for HCC, but the AASLD does.

  8. …however, look for HCC when… Surveillance Plan for HCC Alpha-fetoprotein at cutoff 20 ng/mL, 60% sens, 80% spec inadequate Ultrasound sens 65-80%, spec 90% Interval 6-12 months, but no data Use ultrasound to screen at 6-12 month intervals (level II evidence) Hepatology 2005; 42: 1208-1233

  9. Diagnosis Hepatology 2005; 42: 1208-1233

  10. Key Points • HCC is increasing in incidence. • Screen selected patients with ultrasound q 6 months. • Select HBV carriers, HCV and others patients with cirrhosis • If the patient is symptomatic with HCC on presentation, the 5-year survival is 10%. Lancet 2003; 62: 1907-1917.

  11. References • Wands, JR.Prevention of Hepatocellular Carcinoma. NEJM 2004; 351: 1567. • Parikh, S, and Hyman, D. Hepatocellular Cancer: A Guide for the Internist. Am J Med 2007; 120: 194-202. • El-Seag, HB. Hepatocellular Carcinoma: Recent Trends in the United States. Gastroenterology 2004; 127: S27-234. • Bruix, J, Sherman, M. Management of Hepatocellular Carcinoma. AASLD Guideline. Hepatology 2005; 42: 1208-1233. • Silva, AU, Hegab, B. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut 2008; 57: 1592-6. • Llover, JM, Burroughs, A. Hepatocellular carcinoma. Lancet 2003; 62: 1907-1917. • Schwartz, JM, Carithers, RL. Hepatocellular carcinoma. www.uptodate.com. Accessed 2/11/2010.

More Related