Chapter 088. Hepatocellular Carcinoma (Part 9)

Table 88-6 Some Novel Medical Treatments for Hepatocellular CarcinomaEGF receptor antibodyErlotinib, GefitinibKinase antagonists, SorafenibVitamin KIL-2131I – ethiodol (Lipiodol)131I – Ferritin90Yttrium microspheres166HolmiumThree-dimensional conformal radiationProton beam high-dose radiotherapyAnti-angiogenesis strategies, BevacizumabNote: EGF, epidermal growth factor; IL, interleukin.SummaryMost Common Modes of Patient Presentation1.A patient with known history of hepatitis, jaundice, orcirrhosis, with an abnormality on ultrasound or CT scan, or rising AFP or DCP (PIVKA-2)2.A patient with an abnormal liver function test as part of aroutine examination3.Radiologic workup for liver transplant for cirrhosis4. fever.Symptoms of HCC including cachexia, abdominal pain, orHistory and Physical Examination1. disorientationClinical jaundice, asthenia, itching (scratches),...
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Chapter 088. Hepatocellular Carcinoma (Part 9) Chapter 088. Hepatocellular Carcinoma (Part 9) Table 88-6 Some Novel Medical Treatments for HepatocellularCarcinoma EGF receptor antibody Erlotinib, Gefitinib Kinase antagonists, Sorafenib Vitamin KIL-2131 I – ethiodol (Lipiodol)131 I – Ferritin90 Yttrium microspheres166 HolmiumThree-dimensional conformal radiationProton beam high-dose radiotherapyAnti-angiogenesis strategies, BevacizumabNote: EGF, epidermal growth factor; IL, interleukin.SummaryMost Common Modes of Patient Presentation 1. A patient with known history of hepatitis, jaundice, orcirrhosis, with an abnormality on ultrasound or CT scan, or rising AFP orDCP (PIVKA-2) 2. A patient with an abnormal liver function test as part of aroutine examination 3. Radiologic workup for liver transplant for cirrhosis 4. Symptoms of HCC including cachexia, abdominal pain, orfever.History and Physical Examination 1. Clinical jaundice, asthenia, itching (scratches), tremors, ordisorientation 2. Hepatomegaly, splenomegaly, ascites, peripheral edema, skinsigns of liver failure.Clinical Evaluation 1. Blood tests: full blood count (splenomegaly), liver functiontests, ammonia levels, electrolytes, α-fetoprotein and DCP (PIVKA-2), Ca2+ 2+ and Mg ; hepatitis B and C serology (and quantitative HBV DNA orHCV RNA, if either is positive); neurotensin (specific for fibrolamellarHCC) 2. Triphasic dynamic helical (spiral) CT scan of liver (ifinadequate, then follow with an MRI); chest CT scan; upper and lowergastrointestinal endoscopy (for varices, bleeding, ulcers); and brain scan(only if symptoms suggest) 3. A core biopsy: of the tumor and separately of the underlyingliver.Therapy(See also Fig. 88-1) 1. HCC < 2 cm: RFA ablation, PEI, or resection 2. HCC > 2 cm, no vascular invasion: liver resection, RFA, orOLTX 3. Multiple unilobar tumors or tumor with vascular invasion:TACE 4. Bilobar tumors, no vascular invasion: TACE with OLTX forpatients whose tumors have a responseExtrahepatic HCC or elevated bilirubin: Phase I and II studies.