Diagnosis of HCC History & PE Serologic Assays Radiology Pathologic Diagnosis

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

Diagnosis of HCC: Hx & PE Physical Examination Assessing stigmata of underlying liver disease Jaundice Ascites Peripheral edema Spider nevi Palmar erythema 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

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

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

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

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

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