Hepatocellular carcinoma

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Hepatocellular carcinoma



Hepatocellular carcinoma


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USMLE® Step 1 questions

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High Yield Notes

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Hepatocellular carcinoma

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USMLE® Step 1 style questions USMLE

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A 67-year-old man comes to the clinic due to worsening fatigue and abdominal distension. The patient has lost 11 pounds in the last 2 months with minimal change in appetite. Past medical history is notable for chronic liver disease due to hepatitis B infection that was diagnosed 15 years ago. His most recent colonoscopy 1 year ago showed no abnormalities. His temperature is 37.0°C (98.6°F), pulse is 85/min, and blood pressure is 154/89 mm Hg. Physical examination reveals temporal wasting and scleral icterus. Palmar erythema and multiple spider angiomas are present. The abdomen is distended with shifting dullness to percussion. There is 2+ pitting edema of the lower extremities. Ultrasound shows a single homogenous liver mass with irregular borders. Which of the following best describes the tumor marker that is likely elevated in this patient?

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hepatocellular carcinoma p. 401


in hepatocellular carcinoma p. 401


liver cancer/tumors p. 401


hepatocellular carcinoma p. 401

Fatty liver disease

hepatocellular carcinoma and p. 401

Hemochromatosis p. 404

hepatocellular carcinoma and p. 401

Hepatitis C (HCV)

hepatocellular carcinoma and p. 401


hepatocellular carcinoma p. 401

Jaundice p. 402

hepatocellular carcinoma p. 401

Metastases p. 401

liver cancer p. 401

Polycythemia/vera p. 441

hepatocellular carcinoma p. 401


Content Reviewers

As opposed to benign hepatic tumors, malignant hepatic tumors are cancerous, very severe, and are actually now the third leading cause of cancer deaths worldwide.

With these malignant liver cells or hepatocytes, just like malignant cells in other cancers, they develop some mutation that causes them to replicate at way higher rates and form these masses of cells that continue to grow and potentially spread to other tissues.

This would be a primary hepatic tumor, since it starts in the liver. It’s totally possible, though, for liver tumor to develop as a metastasis from another primary cancer, in which case it would not be hepatocellular carcinoma, but a carcinoma from somewhere else, and this is actually more common than primary liver tumors themselves.

The most common sources of the tumor cells that got to the liver but started somewhere else are the colon, pancreas, lung and breast.

What exactly causes the mutation in the hepatocyte though?

Well the mechanism isn’t fully understood and can probably be caused by a lot of different things, most importantly though, things that put the liver in a constant cycle of damage and repair are the biggest culprits.

If the liver cells are constantly being forced to repair, this raises the chances of genetic mistakes or mutations, potentially leading to carcinogenesis or development of cancer cells.

Examples might be any disease that leads to cirrhosis and scarring of the liver tissue, which can include alcoholic hepatitis and cirrhosis, hereditary hemochromatosis, primary biliary cirrhosis, alpha-1 antitrypsin deficiency, and others.

The most common risk factor, the ones that have been linked the most with hepatocellular carcinoma are the hepatitis B and hepatitis C viruses, both of which can become chronic or long-lasting.

In this case, these cells are at greater risk because of the constant state of infection and immune cell attack, leading to constant damage and repair.


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