Cause:Chronic hep B or hep C (Ann IM 1991;115:644) and many other causes of cirrhosis including hemachromatosis
Pathophys:Hepatitis causes hepatoma by viral genome incorporation into liver cell DNA
Increasing incidence associated w hep C in Japan (Nejm 1993;328:1797, 1802) and in US 3/100 000 (Ann IM 2003;139:817; Nejm 1999;340:745)
Polycythemia, gynecomastia due to HCG production, hypercalcemia due to increased PTH (Nejm 1970;282:704), dysfibrinogenemia bleeding, 2nd primary hepatoma in 45% at 3 yr (Nejm 1996;334:1561)
Lab:
Chem:Alkaline phos elevated more than bilirubin
-Fetoprotein/protein ratio increased (a nonfunctioning fibrinogen—Nejm 1978;299:221); 50% false neg, 1% false pos (Nejm 1968;278:984), r/o embryonal cell testicular and gastric cancers (Nejm 1971;285:1058), and low level elevations in ataxia telangiectasia
Hem:Polycythemia (10%)
Xray:Hepatic mass by ultrasound, CT, or MRI; hot by gallium
Rx:
Prevent by screening hep C and B cirrhotics w -fetoprotein levels (questionable benefit, 50% specif, 90% sens—Ann IM 2003;139:46), vit K2 (menaquinone) 45 mg po qd (Jama 2004;292:358), and ultrasounds? (Nejm 1991;325:675)
Surgical lobectomy sometimes possible (Nejm 1994;331:1547) followed by interferon rx if hep C caused (Ann IM 2001;134:963), or total hepatectomy w liver transplant (Ann IM 1998;129:643; Nejm 1996;334:693)
Percutaneous ethanol injection of tumor, or surgical extirpation w f/u vit A analog po qd decreases rate of 2nd primary tumors (Nejm 1996;334:1561)
Chemoembolization no help? (Nejm 2008;299:1669)