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home - Liver - Miscellaneous - HCC Treament Written by Dr Sebastian Zeki

Recognises the importance of sepsis as a complication
Aware of the differential diagnosis and management of sepsis and its
possible sequelae

Knows the appropriate use of the appropriate antibiotics and their
complications Aware of prevention of nosocomial infection

Understands the principles and practice of diagnosis and treatment of

Prepared to involve and liaise with specialist sepsis support



Knows the importance of clinical nutrition and its disturbances in
patients with acute and chronic liver disease

Appreciates indications for enteral or parenteral support and
understanding of limitations of these interventions

Shows ability to make careful nutritional assessment
Can liaise with nutritional support team where appropriate


Understands prognostic scoring systems including Child - Pugh
MELD UKELD Maddrey and disease-specific scoring systems where
they exist

Builds the use of accredited quantitative scoring systems into routine
clinical liver practice clinical colleagues and junior staff

Shows consistent application of evidence-based in the
evaluation of liver disease and the determination of prognosis

HCC Treament

Median survival 3 months5-year survival less than 3 cm - 50% If AFP very raised (>4,000 and positive HbSAgORAFP >400 and -ve HbSAg ANDmass seen If AFP not conclusive and mass seen, biopsy (up to 30% HCC have normal AFP If resectable If non resectable due to hepatic reserve or tumour location then consider for tranplantation If due to extensive disease or poor candidate consider localised therapy if single lesion <5cm or systemic if multiple and <4 lesionsChemoembolizationAblationChemotherapy with radioRadiotherapy alone Otherwise consider systemic therapy:Sorafenib Criteria for transplantation:The patient is not a resection candidate.The tumour is >6cm or 2-3 tumours >3cm each.There is no macrovascular involvement.There is no extrahepatic tumour spread.The patient has Child-Pugh C liver disease. If AFP very raised and no mass seen 3 monthly surveillance Resect and monitor every 3/12 If mets then consider sorafenib Ablation or embolization options:Radiofrequency.Alcohol.Cryotherapy.Microwave.Chemoembolization.Radioembolization.Bland embolization. If non-resectable Treatment of HCC Consider bridging RFA prior to tranplantation.Dont give adjuvant chemo as risk of HCC recur-rence and HCV proliferation Written by Dr Sebastian Zeki