• 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

• 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

• 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

• Treatment of HCC
  • 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

• For further reading...

  Milan Criteria
  Sorafenib in Advanced Hepatocellular Carcinoma (SHARP trial)
  
  

  Posted 08/22/16 09:56:34 AM by Anna Krigel

Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.