INCTR

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Hepatocellular Carcinoma Imaging
Treatment
Ali N Khan FRCS, FRCP, FRCR
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Hepatocellular carcinoma is the most common liver
malignancy

It has considerable variability in incidence
worldwide.
80 of HCC arise on the background of cirrhosis.
Non-cirrhotics catching up
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Presentation

• Most discovered on cross sectional imaging US
• Cirrhosis surveillance
• Small numbers have non-specific symptoms

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Atypical presentations
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Obstructive jaundice
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PUO
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Adrenal mass?
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• Imaging Options
• No one imaging has been shown to be superior
• US
• CT
• MRI
• Angiography
• NM

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Liver Biopsy Think
first, then dont do it! Converts
loco-regional disease into systemic

• Do only if inoperable
• Do only if markers negative
• Never biopsy hepatomas or haemangiomas
• Biopsy FNH adenomas useless
• If operable laparoscopy IOUS
• If operable the liver remnant is most important

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EASL monothematic conference Non-invasive
diagnostic criteria for HCC in Cirrhosis

• Lesions gt than 2 cm with arterialisation as shown
  by two coincident imaging techniques
• Or
• Focal lesion gt 2 cm associated with alpha FP gt
  400 ng ml-1

Bruix J, et al J Hepatol 2001
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Options

• Surgery 30 operable, NMGH experience only 3
  operable (143 patients)

• Multicentric disease

• Systemic chemotherapy not effective

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So what is the alternative?
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Ablative procedures

• Chemoembolization/Drug eluting bead embolisation
• Alcohol ablation
• Cryosurgery
• Radio-frequency ablation
• Laser ablation
• Microwave ablation

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The detection rate by MRI 63, by US 67, by CT
50, by DSA 74, and by Lipiodol-CT 93.
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Poppy seed oil used as vehicle to deliver
chemotherapeutic agents
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Chemotherapeutic agents

• Doxorubicin
• Mitomycin
• Cisplatin
• Epirubicin
• 5-FU

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PVA
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ChemoembolizationRational

• Dual blood supply
• Lipiodol concentrated by HCC
• Selective placement of a catheter
• Embolisation with an emulsion of anticancer drug
  Lipiodol
• Sealing the embolisation with particulate
  material

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