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 th edition. McGraw-Hill USA

3. 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 th 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 th edition. McGraw-Hill USA

5. Diagnosis of HCC: RadiologyUS
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 th 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 th 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 th 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 th edition. McGraw-Hill USA