59 yo man with prior treated HCV presents with new diagnosis HCC and extensive PVT
Dr. Catherine Lucero | Morning Report | 08/22/2016 | video
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Thrombocytopenia - sensitive finding for cirrhosis, indicates portal hypertension and splenomegaly leading to platelet sequestration
Posted 08/22/16 09:01:30 AM by Anna Krigel
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HCV screening - all adults born between 1945 and 1965 must be screened once for HCV (using HCV Ab)
- If positive - treat for HCV with novel therapies
- If not treated - HCV takes 20-30 years to progress to cirrhosis
- ETOH, HBV, and HIV can accelerate course of progression to cirrhosis
Posted 08/22/16 09:14:08 AM by Anna Krigel
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AASLD guidelines recommend screening for HCC in all patients with cirrhosis, starting when the diagnosis is made, with liver ultrasound every 6 months
- AFP has poor sensitivity and specificity, thus it should never be used alone for HCC screening
- AFP in combination with ultrasound for HCC screening is also not recommended by the AASLD (not cost effective, increases false-positives)
Posted 08/22/16 09:31:14 AM by Anna Krigel
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- First decide if resectable or unresectable
- If unresectable, decide if liver transplant candidate using Milan Criteria
- Single lesion less than or equal to 5cm
- Up to 3 lesions less than 3cm
- No evidence of vascular invasion
- No regional or nodal or extrahepatic distant metastases
- If not a transplant candidate, can attempt down-staging with TACE, stereotactic radiotherapy, etc.
- If extrahepatic metastases, management likely palliative but can do systemic therapy with sorafenib
Posted 08/22/16 09:50:57 AM by Anna Krigel
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For further reading...
Posted 08/22/16 09:56:34 AM by Anna Krigel
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