Diagnosis of HCC

1. Diagnosis of HCC • History & PE • Serologic Assays • Radiology • Pathologic Diagnosis

2. Diagnosis of HCC: Hx & PE • History • Evaluating positive predisposing factors • History of hepatitis or jaundice • Blood transfusion • Use of intravenous drugs • Family history of HCC or hepatitis • Social history • Job descriptions/ industrial exposure to carcinogenic drugs • Contraceptive hormones Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA

3. Diagnosis of HCC: Hx & PE • Physical Examination • Assessing stigmata of underlying liver disease • Jaundice • Ascites • Peripheral edema • Spider nevi • Palmarerythema • Weight loss • Evaluation of abdomen • Hepatic size • Masses or ascites • Hepatic nodularity • Tenderness • Splenomegaly Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA

4. Diagnosis of HCC: Serologic Assays • AFP (α- fetoprotein) • DCP (des-γ-carboxy prothrombin) • CEA, Vitamin B12, AFP, Ferritin, PIVKA-2 antimitochondrial Ab • Standard liver function tests (PT, PTT, albumin,transaminases, γ-glutamyl transpeptidase, alkaline phosphatase) • Hepatitis A, B, C serology Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA

5. Diagnosis of HCC: Radiology • US • Excellent screening tool • Findings: • Hypervascularity of the tumor mass • Thrombosis by tumor invasion of normal portal veins • Echogenic masses Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA Novelline, R. Squire’s Fundamentals of Radiology 6th edition.Harvard University Press

6. Diagnosis of HCC: Radiology • CT (Helical/ Triphasic) • To determine tumor size and extent and presence of portal vein invasion • Accurately localizes the tumor and determine whether resection is possible • Findings: • Portal vein invasion is detected as an obstruction and expansion of the vessel • Liver tumors tend to have ill-defined margins and sometimes necrotic centers and calcification Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA Novelline, R. Squire’s Fundamentals of Radiology 6th edition.Harvard University Press

7. Diagnosis of HCC: Radiology • MRI - indicated if CT is inconclusive - can provide detailed information of the mass - Findings: - mass will typically be hypo-intense or iso- intense on a T1 weighted image - brighten markedly with T2 weighting Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA Novelline, R. Squire’s Fundamentals of Radiology 6th edition.Harvard University Press

8. Diagnosis of HCC: Pathologic Diagnosis • Histologic proof of the presence of HCC • Core liver biopsy of the mass under ultrasound guidance • Bleeding risk is increased compared to other cancers because: • Tumors are hypervascular • Px often have thrombocytopenia & decreased clotting factors * For patients suspected of having portal vein involvement, a core biopsy of the portal vein may also be indicated Fauci et.al. Harrison’s principles of Internal Medicine 2008 17th edition. McGraw-Hill USA