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 USANovelline, 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 USANovelline, 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 USANovelline, 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:(1) Tumors are hypervascular(2) 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