Tumor Hati

 Tumor jinak Hemangioma, fibroma

 Tumor ganas
– Primer
 Karsinoma hepatoseluler (Hepatoma)

 Kolangiokarsinoma

 Sarkoma

– Sekunder
 Metastase dari tumor ganas saluran cerna

 Metastase dari tumor ganas paru

 Metastase Ca mammae

 Metastase tumor genitalia

 Metastase limfoma
Table. Risk Factors for Hepatocellular
Carcinoma in Humans

Major
Chronic HBV infection
Chronic HCV infection
Repeated exposure to aflatoxin 1.
Cirrhosis 
Minor
Oral contraceptive steroids
Cigarette smoking
Hereditary hemochromatosis
Wilson disease
1- Antitrypsin deficiency
Type 1 hereditary tyrosinemia
Glycogen storage disease (types 1 and 2)

Hypercitrullinemia
Ataxia telangiectasia
Membranous obstruction of the inferior vena cava
Table. Factors Influencing Screening for
Hepatocellular Carcinoma
CONSIDER
RISK SCREENING ?
FACTORS High Moderate Low Yes No

HBV carriage
Early onset +
Later onset +
Chronic HCV + +
infection +
Hereditary +
hemochromatosis +
Membranous +
obstruction of +
the inferior vena
cava (in black
Africans and
Japanese) +
Cirrhosis of most
other causes + +
 Tumor Hati
Gambaran klinik
 Keluhan
– Nyeri, benjolan diperut kanan atas atau ditengah, pembesaran
perut, gejala gagal hati , gejala konstitusional
 Pemeriksaan fisik
– Anemi,ikterus,
– Hepatomegali berbenjol,nyeri tekan,bruit
– Gejala sirosis hati
 Labor
– Seromarker : HBs Ag, Anti HCV
– Petanda tumor : Alfa Feto Protein (AFP), CEA, PIV K, Ca 19-9
 Imajing : USG, CT, MRI
 PA : Biopsi guide USG/CT, Laparoskopi
Table. Prevalence of Clinical Features of
Hepatocellular Carcinoma

PREVALENCE PREVALENCE
SYMPTOMS (%) PHYSICAL SIGNS (%)

Abdominal pain 59 - 95 Hepatomegaly 54 - 98

Weight loss 34 - 71 Hepatic bruit 6 - 25

Weakness 22 - 53 Ascites 35 - 61
28 - 43 Splenomegaly 27 - 42
Abdominal swelling
Jaundice 4 - 35
Nonspecific
25 - 28 Wasting 25 - 41
Gastrointestinal symptoms
5 - 26 Fever 11 - 54
Jaundice
Table. Paraneoplastic Syndromes Associated with
Hepatocellular Carcinoma

Hypoglycemia
Polycythemia (erythrocytosis)
Hypercalcemia
Sexual changes: Isosexual precocity, gynecomastia, feminization
Systemic arterial hypertension
Watery diarrhea syndrome
Porphyria
Carcinoid syndrome
Osteoporosis
Hypertrophic osteoarthropathy
Thyrotoxicosis
Thrombophlebitis migrans
Polymyositis
Neuropathy
Cutaneous markers: Pityriasis rotunda, Leser-trelat sign,
dermatomyositis, pemphigus foliaceus
 Table. Tumor Markers of Hepatocellular Carcinoma*
SENSITIVITY SPECIFICITY DISADVANTAGES
(%) (%) ADVANTAGES
Alpha-fetoprotein Inhigh-incidence 90 Relatively quick and Relatively
populations, easy to measure, expensive
80-90; in low- most extensively
incidence studied
population, 50-70
Easy and quick to Far more

DES- -carboxy
prothrombin
58 - 91 84 measure expensive
than -FP
Easy and quick to
75 70 - 90 measure; relatively 
-1-fucosidase inexpensive
Relatively easy and Expensive
60 quick to measure
96
Isoenzymes

of -glutamyl
transferase

Note that sensitivity and specificity vary both with the population under study and
the absolute level of the marker. Thus, the specificity of a markedly elevated alpha-
fetoprotein in high-risk patients greatly exceeds the sensitifity of mildly elevated
levels in cirrhosis-free patients.
Table. Treatment Options for Hepatocellular
Carcinoma

Surgical resection: Offers best chance for cure, but seldom is

possible when disease is symptomatic. May be technically
difficult. High recurrence rate after resection.
Liver transplantation : May be succesful in selected patients
Requires transfer to a transplant center and, posto-
peratively, lifelong immunosuppression. High recurrence
rate. Expensiveeus
Alcohol injection : Palliative for small (usually multiple) tumors
that cannot be resected. May be difficult to decide if all the
malignant cells have been destroyed. Procedure may
facilitate spread of the tumor.
Chemoembolization : May shrink selected large tumors to the
point where they may become resectable. Effect is palliative
for localized but unresectable tumors.
Chemotherapy : Palliative only; can be used as an adjunct to
surgical resection or transplantation. Drug toxicity is
frequent.
 Terapi Tumor Hati
Bergantung ukuran /stage tumor dan
penyakit yang mendasarinya
 Tumor < 2cm Reseksi atau transplant
 Tumor 2 – 5 cm Injeksi etanol
Radiofrequensi ablasi
 Tumor > 5 cm Embolisasi transarterial
Ablasi dengan radiofrequensi
 Stadium sangat lanjut  Tender Love and Care (TLC)

Prognosis
 Bergantung ukuran dan jumlah nodul, ada/tidak adanya sirosis dan
VHB atau VHC
 Umumnya ad malam