- Diagnosis of Hepatocellular Carcinoma

B98401002
A.

Screening for hepatocellular carcinoma should be performed on:

I.

Cirrhotic patients with

(1) Child-Pugh stage A and B
(2) Child-Pugh stage C awaiting liver transplant

II.

Non-cirrhotic patients without cirrhosis

(1) HBV (+) with active hepatitis or HCC family history
(2) Chronic hepatitis C and advanced liver fibrosis

B.

Diagnostic algorithm from European Association for the Study of the Liver
Journal of Hepatology 2012 vol. 56 j 908943

C. The patient we discussed today has a recurrent HCC detected by regular

follow-up of serum alpha lipoprotein and contrast CT scan.

Radiologic hallmarks
of HCC (arterial
hypervascularity and
venous/late phase
wash out)

Discussion
APASL Guidelines for HCC (Hepatol Int 2010; 4: 439-474)

AFP is generated from fetal yolk sac and fetal liver. It decline to < 10 ng/dl within 300
days of birth. Serum elevations thereafter suggest underlying pathology which may be
malignant. Any tumor arising from organs derived from the same endodermal lining as
the hepatic diverticulum can be associated with elevations in serum AFP levels,
including cancers of the stomach, pancreas, and biliary tree. Pregnancy and
nonseminomatous germ-cell tumors must also be considered. Chronic hepatitis or
cirrhosis raise AFP in 20% and 40% of patients, respectively, and tend to fluctuate in
parallel with underlying inflammatory activity.
Kashyap R, et al. Clinical significance of elevated alpha-fetoprotein in adults and children. Dig Dis Sci.
2001;46:170913.
Johnson PJ. The role of serum alpha-fetoprotein estimation in the diagnosis and management of
hepatocellular carcinoma. Clin Liver Dis. 2001;5:14559.

On MRI, HCC appears as a high intensity pattern on T2-weighted images, and a low
intensity pattern on T1-weighted images.