Q) Which of the following is true about screening in hepatocellular carcinoma
a) Alpha feto protein should be done 6 monthly
b) Ultrasound abdomen should be done 6 monthly
c) Candidates for liver transplant should be screened every 3 months
d) Nodules more than 2 cm should be followed up more regularly
In a cirrhotic liver tumors can develop any time and a stringent screening protocol has to be followed. Earlier ultrasound of liver and alpha feto protein were both used as tumor markers. However in 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.
The screening recommendation is not for those patients with severe Read More ...
Q) What is true about trans arterial chemoebolization (TACE) for liver tumors
a) Arterio portal shunt is not an issue in TACE
b) Hypervascular liver tumors can be effectively managed with TACE
c) Extent of tumor necrosis is in the tune of 20-40%
d) TACE is almost at par with resection for cure in HCC
Explanation is for premium members
Arterio portal shunting is important to be evaluated in TACE because if too much shunting is present blood will be directed from hepatic artery to portal vein which can eventually lead to bleeding from varices. A large shunt should be embolized 1st before TACE in HCC.
Liver tumors are extensively supplied by hepatic artery. The type of tumor can also determine the blood supply to the lesion. Encapsular nodular tumor is extensively supplied by hepatic artery where as well differentiated and infiltrating
edge of HCC is supplied by portal vein or both portal vein and hepatic artery. Doxorubicin is the most common chemotherapeutic drug which is mixed with lipiodol.
When lipiodol is injected in hepatic artery, it is preferentially accumulated in tumor and not in liver parenchyma. Read More ...