Hepatocellular Carcinoma Lecture Notes

Hepatocellular Carcinoma Overview

  • A primary cancer originating in the liver, distinguished from secondary liver cancers (metastases).
  • Often associated with cirrhosis and hepatitis.
  • Male to female ratio is approximately 4:1.

Anatomic Features of the Liver

  • Liver is the largest internal organ and gland in the human body.
  • Measures 12-15 cm coronally and 15-20 cm transversely in adults.
  • Weighs approximately 1500 grams, accounting for 2.5% of total body weight.
  • The liver has a smooth diaphragmatic surface, with indentations on the visceral surface due to anatomical relations with adjacent organs.

Anatomy and Relations

  • The liver is divided into major lobes:
    • Right lobe
    • Left lobe
  • Accessory lobes include:
    • Caudate lobe
    • Quadrate lobe
  • Anterior to liver: Diaphragm, abdominal wall, stomach, and pleura.
  • Posterior to liver: Esophagus, right kidney, gallbladder, and inferior vena cava (IVC).
  • Falciform ligament connects the liver to the anterior abdominal wall.

Blood Supply and Nerve Supply

  • Receives blood from:
    • Hepatic Portal Vein (70%): Nutrient-rich, oxygen-poor blood from the gastrointestinal tract.
    • Hepatic Arteries (30%): Oxygen-rich blood supply to the liver.
  • Nerve supply comes from the autonomic nervous system:
    • Parasympathetic via vagus nerve
    • Sympathetic from the coeliac plexus

Symptoms of Hepatocellular Carcinoma

  • Common symptoms include:
    • Abdominal pain
    • Weight loss
    • Weakness
    • Abdominal fullness/swelling
    • Jaundice
    • Nausea

Signs During Physical Examination

  • Signs include:
    • Hepatomegaly (50-90% of patients)
    • Ascites (30-60% of patients)
    • Splenomegaly
    • Spider angiomas
    • Obstructive jaundice

Risk Factors for Hepatocellular Carcinoma

  • Chronic Viral Hepatitis: Risks associated with Hepatitis B and C.
  • Alcohol Abuse: Leading cause of cirrhosis, increasing cancer risk.
  • Obesity: Non-alcoholic fatty liver disease can lead to cirrhosis and cancer.
  • Aflatoxins: Produced by fungi contaminating certain foods.

Diagnosis

  • Diagnostic methods include:
    • Imaging techniques: Ultrasound, CT, MRI.
    • Alpha-Fetoprotein (AFP): Blood test for tumor marker elevation.
    • Liver biopsy for histological grading if diagnosis is uncertain.

Treatment Options

  • Surgery: Removal of cancerous tissue or liver transplant for early-stage cancer.
  • Ablation Techniques: Destruction of cancer cells using heat or cold.
  • Chemotherapy or Radiation: Direct delivery techniques to treat cancer.
  • Targeted Drug Therapy: Focuses on specific cancer weaknesses.
  • Immunotherapy: Utilizes the body's immune response against cancer.
  • Clinical Trials: Opportunity to test new therapies under investigation.

Conclusion

  • Hepatocellular carcinoma is a significant global health issue with rising incidence rates linked to hepatitis infections and lifestyle factors. Understanding its risk factors, symptoms, diagnosis, and treatment modalities is crucial for management and prevention.