Hepatocellular carcinoma

• One of the most common cancers worldwide
• Metastatic disease more common than primary hepatic cancer
• Risk factors: cirrhosis (alcohol, HCV, nonalcoholic steatohepatitis), chronic hepatitis B, aflatoxins

Signs and Symptoms

• RUQ tenderness, abdominal distention, signs of chronic liver disease (jaundice, easy bruising, coagulopathy)
• Tender liver
• Liver enlargement

Investigation

• Bloods: abnormal LFT, ↑ α-fetoprotein (AFP)
• Liver ultrasound and CT
• Liver biopsy

Management

• Partial hepatectomy: for preserved synthetic function + feasibility
• Orthotopic liver transplant: Milan criteria: single lesion < 5 cm or 3 lesions < 3 cm
• Non-surgical treatments: transarterial chemoembolization, radiofrequency ablation, sorafenib for advanced metastatic disease
• AFP levels, serial imaging (US and CT) for monitoring