VA AM Report 10.31: Belated Halloween blog

Happy belated Halloween. Picked up this humdinger of a fun fact on the Wikipedia: Halloween is a fusion, like other Christian holidays, of pagan/pre-Christian beliefs originating from the British Isles and then incorporating Christian beliefs over time. Much like the Mexican Dia de Muertos it was a pagan celebration of long dead ancestors, and turned into an evening holiday preceding All Saint’s Day which falls on November 1st. The more you know.

Something else that’s scary? hepatocellular carcinoma!

What is it? Kind of self-explanatory, a cancer arising from hepatocytes. BUT, the teaching point is while 75-85% of HCC is associated with underlying cirrhosis, it can arise in the absence of cirrhosis, classically with chronic HBV or NASH but even in patients without chronic viral infection. There’s an association with aflatoxins (on peanuts and stuff) and HCC, in addition to other environmental toxins (cigarettes for instance)

Who gets it? As above, usually folks w/ underlying liver dz, cirrhosis, or chronic viral infection. Higher rates in SE Asia, which interestingly go down when comparing migrants to Hawaii and then even further among migrants to the US, suggesting environmental causes as important.

How does it present? Most common symptom is abdominal pain, can get swelling too either from portal hypertension and ascites or just rapid tumor growth. Occasionally necrosis of the tumor and bleeding can lead to rapid death. Most common sign is hepatomegaly, ascites less frequently. In some cases the tumor can directly invade the portal vein, IVC, and cause ascites as well.

#LTpearl: A normal hgb in a cirrhotic should make you think of an EPO secreting HCC.

Screening? Patients w/ cirrhosis or chronic HBV should be screened at least every 6 months with imaging: CT, u/s, MRI all feasible, plus/minus AFP which by itself is an insufficient screening test by itself.

Treatment? I’ve included this nice algorithm including all treatment options.kas_ch111_f002

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