What is the pathophysiology of hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) primarily arises in a cirrhotic liver, where repeated inflammation and fibrinogenesis predispose the liver to dysplasia and malignant transformation.

What is HCC and CCA?

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a relatively rare primary liver carcinoma that has both a hepatocellular carcinoma (HCC) component and cholangiocarcinoma (CCA) component in the same tumor nodule [1].

Why does HCC increase AFP?

AFP levels may be elevated because of production by the tumor or by regenerating hepatocytes. Therefore, AFP levels are also frequently elevated in chronic active hepatitis C (levels of 200-300 ng/mL are not uncommon), but in those patients the levels tend to fluctuate and do not progressively increase.

Where does hepatocellular carcinoma arise from?

Hepatocellular carcinoma (HCC), or liver cancer, occurs when a tumor grows on the liver. It is responsible for over 12,000 deaths per year in the United States, making it one of the most serious cancers in adults.

What is hepatocellular carcinoma PDF?

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver and occurs predominantly in patients with underlying chronic liver disease and cirrhosis. It is considered as the second leading cause of cancer-related death worldwide with over 500,000 people affected.

Is HCC and cholangiocarcinoma the same?

Whereas hepatocellular carcinomas develop by malignant transformation of hepatocytes, cholangiocarcinomas arise from the small intrahepatic bile duct epithelium. The UICC-TNM classification of malignant liver tumors is applied for both tumor entities. 70-80% of hepatocellular carcinoma occur in cirrhotic liver.

What is hepatocellular cholangiocarcinoma?

Summary. Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a tumour that exhibits both hepatocytic and biliary differentiation. Classical risk factors for hepatocellular carcinoma (HCC) seem to also predispose patients to the development of cHCC-CCA.

Is AFP elevated in HCC?

The alpha-fetoprotein (AFP) in serum is currently available diagnostic marker for HCC discovery. As for patients with chronic liver disease, a sustained increase in AFP serum level was shown to be one of the risk factors of HCC and has been used to help identify high-risk subgroup of chronic liver disease [12].

Should AFP or any biomarkers be used for HCC surveillance?

AFP is the most commonly studied biomarker for HCC, with the available studies including a phase 5 biomarker trial assessing the impact of AFP on survival of patients with HCC [1]. In general, AFP level is positively associated with tumor size, restricting its utility in detecting smaller HCC tumors.

What cell type is hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) This type of liver cancer develops from the main liver cells called hepatocytes. It’s more common in people with cirrhosis. Cirrhosis means scarring of the liver due to previous damage. For example, damage from the hepatitis B or C virus, or long term alcohol drinking.

How does aflatoxin causes hepatocellular carcinoma?

AFB1 is a genotoxic hepatocarcinogen that presumptively causes cancer by inducing DNA adducts, leading to genetic changes in the target cells, which then cause DNA strand breakage, DNA base damage and oxidative damage that may ultimately lead to cancer.

Is hepatocellular carcinoma an adenocarcinoma?

A type of adenocarcinoma and the most common type of liver tumor.

What is differentiated hepatocellular carcinoma?

Well-differentiated HCC is defined by the presence of malignant cells that resemble normal hepatocytes with minimal nuclear atypia and the absence of naked nuclei in the smears, that is, the plasma membrane of the neoplastic hepatocytes can survive the force of smearing.

Is hepatocellular carcinoma primary or secondary?

Hepatocellular carcinoma is also called hepatoma or HCC. It’s the most common type of primary liver cancer. Because of this, the information in this primary liver cancer section is mostly about hepatocellular carcinoma. This type of liver cancer develops from the main liver cells called hepatocytes.

Is HCC benign?

Most cancerous tumors in the liver are metastatic. Types of malignant liver cancer tumors include: Hepatocellular carcinoma or hepatocellular cancer Known as HCC, this is the most common form of liver cancer in adults. It is also sometimes called hepatoma.

What is the difference between hepatocellular carcinoma and cholangiocarcinoma?

Whereas hepatocellular carcinomas develop by malignant transformation of hepatocytes, cholangiocarcinomas arise from the small intrahepatic bile duct epithelium. The UICC-TNM classification of malignant liver tumors is applied for both tumor entities.

What is the ICD 10 code for hepatocellular carcinoma?

C22. 0 – Liver cell carcinoma. ICD-10-CM.

How sensitive is AFP for HCC?

Alpha-fetoprotein (AFP) is the most widely used serum marker for screening and initial diagnosis of HCC in clinical practice. However, the sensitivity of AFP is only about 60% at a cut-off value of 20 ng/mL, and the specificity is low [8,9,10].

What level of AFP is diagnostic of HCC?

AFP >400–500 ng/ml is considered diagnostic for HCC, although fewer than half of patients may generate levels that high 39.

How does aflatoxin occur?

People can be exposed to aflatoxins by eating contaminated plant products (such as peanuts) or by consuming meat or dairy products from animals that ate contaminated feed. Farmers and other agricultural workers may be exposed by inhaling dust generated during the handling and processing of contaminated crops and feeds.

Is aflatoxin a direct carcinogen?

Examples of direct-acting carcinogens include alkyl or aryl epoxides, nitrosoureas, nitrosamides, and certain sulfonate and sulfate esters. Examples of indirect-acting carcinogens include polycyclic aromatic hydrocarbons, aromatic amines, alkyl nitrosamines, or aflatoxin B1.

Where does HCC metastasis to?

The extrahepatic metastasis occurs in one-third of patients with HCC and it is associated with a poor prognosis. The most common sites of extrahepatic metastasis are lung, regional lymph nodes, bone, adrenal glands, and peritoneum/omentum.

Is hepatocellular carcinoma well differentiated?

Confirmatory diagnosis may require a tissue sample for histological evaluation. The histologic appearance of HCC ranges from well differentiated (with individual hepatocytes appearing nearly identical to normal hepatocytes) to poorly differentiated tumors consisting of large multinucleate anaplastic giant tumor cells.

What are the stages of hepatocellular carcinoma?

Based on these variables, patients are classified into three stages (I: not advanced; II: moderately advanced; III: very advanced) with different outcomes [Table 2]. Okuda staging system was accepted and widely used as an improved classification system for HCC.