Hepatocellular carcinoma

Risk factor- HBV, HCV, nitrosamine, aflatoxin, senecio alkaloid, alcohol, metabolic syndrome, DM, iron overload, obesity, Alpha-1 antitrypsin deficiency, AIP, gallstone, cholecystectomy, red meat

Protective factor- Statin, aspirin, NSAID, white meat

CT- Arterial phase(early enhance, hyperdense), Venous phase(early washout, hypodense)

Systemic effect and paraneoplastic syndrome- Painful gynecomastia, hypercalcemia, hypoglycemia, hyperlipidemia, hyperthyroidism, pseudo-porphyria

Presentation- Abdominal pain, weight loss, early satiety, palpable mass, tumor rupture, 

Paraneoplastic syndrome- Hypoglycemia, erythrocytosis, hypercalcemia, diarrhea

Metastasis(>5cm, large vessel invasion)- Lung, bone, adrenal gland

Okuda staging system


Yes(1)No(0)
Tumor mass>=50% of liver<50% of liver
Ascitesyesno
Albumin<=3>3
Bilirubin>=3< 3

Stage I-0, Stage II-1~2, Stage III-3~4

CLIP score


012
Child-PughABC
Tumor morphologysingle & <50%multiple & <50%multiple & >50%
AFP<400>=400
Portal vein thrombosisnoyes

BCLC staging

StagePSTTumor stageOkuda stageChild-PughTreatment
00single<2cmIAAblation=resection
A0single<5cm or 3 <3cmIA-BSingle- Resection > transplantation >ablationMultiple- Transplantation >ablation
B0single>5cm or multiple >3cmI~IIA-BChemoembolization(TACE)(Doxorubicin/ Adriamycin, Lipidol)
C1~2vessel invasion or extrahepatic invasionI~IIA-BSystemic therapy(Sorafenib)
D3~4#anyIII#C#BSC
RFAMore complication than PEI
PEIInjection of ethanol and acetic acid, less pain
TAELipidol and Gelform
TACELipidol and Gelform + Adriamycin
SIRTY-90

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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