Hepatocellular Carcinoma
- Rare in developed countries
- Malignant
- Slow growing
- One of the most common cancers in parts of Africa
- usual cause Hep B or C
- aflatoxin also implicated
- parasitic infestations
- Age 40-60 in developed countries, 20-40 in developing where common
Aetiological factors
Identifiable in nearly all cases
- Pre-existing infection with Hepatitis B & particularly C
- alcoholic cirrhosis
- 25% patients with cirrhosis >5 years develop HCC
- haemochromatosis
- chronic active Hepatitis
- aflatoxins
Pathology
- Often arise multicentrically
- may be bile-stained
Presentation
- Anorexia
- Weight loss
- abdominal pain
- distension
- stigmata of cirrhosis
Examination
- Liver mass usually palpable
Investigation
- Ultrasound
- CT
- a-fetoprotein
- Laparoscopy
- Needle biopsy
Treatment
- Isolated lesions occasionally amenable to resection, often recur
- Transplantation now abandoned due to inevitable recurrence
- Stenting if biliary obstruction occurs
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