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How is HCC Diagnosed?

In patients with cirrhosis, HCC can be diagnosed with AASLD image criteria including early arterial enhancement, venous wash out, capsule formation, and increasing in size over time on a triple phase CT scan or MRI test. HCC can also be diagnosed with a biopsy of the tumor.

The Multidisciplinary Treatment Team

A newly diagnosed HCC will be managed by a multidisciplinary team that usually includes a hepatologist who manages liver disease, liver surgeons who perform liver resection or transplant, a medical oncologist who provides patients with medication (systemic therapy) by mouth or via vein or treat HCC, an interventional radiologist who provides treatment direct into the liver such as TACE (transarterial chemoembolization). The first and most important question to be addressed by the team is if the patient has curative treatment options. For patients without curative treatment options, palliative treatment may prolong the patient’s life and quality of life.

 

Liver Cancer - Managing Possible Liver Failure

HCC patients may develop liver failure. The common symptoms of liver failure include the development of ascites (swelling of the belly), lower extremity swelling, jaundice (the skin and eyes turn yellow) and hepatic encephalopathy (sluggish, forgetful, confusion, etc). Patients who develop these symptoms should alert their physician for diagnosis and treatment of liver failure.

Managing Nivolumab for the Treatment of HCC

Currently two immune checkpoints (nivolumab approved in 2017, pembrolizumab approved in 2018) are approved for advanced HCC. A patient may develop immune mediated side effects that can be treated with steroid or other immune suppressant. A patient usually starts with a high dose steroid that may be tapered off in several weeks when the symptoms improve or resolve. Please contact your doctor if you develop any symptoms after you start this type of treatment.

Second Line Treatment of HCC

Currently we have four treatments (Regorafenib, Nivolumab, Pembrolizumab, Cabozantinib) approved for patients who have received one line of prior therapy for advanced HCC. Regorafenib and Cabozantinib are oral, multi-kinase inhibitors, approved by FDA for prolongation of survival in patients who have had prior therapy for advanced HCC. Nivolumab and Pembrolizumab are two immune checkpoint inhibitors that are FDA approved for durable anti-cancer response in a subset of patients with advanced HCC.

Treatment for Advanced-Staged HCC

The treatment for advanced stage HCC is changing with the FDA approval of multiple treatments over the last few years. Currently we have two treatment options (Sorafenib or Lenvatinib) for patients who have been untreated for advanced HCC. Four treatment options (Regorafenib, Nivolumab, Pembrolizumab, Cabozantinib) are approved for patients who have received one line of prior therapy for advanced HCC.

Side Effects of Oral Liver Cancer Treatments

The common side effects of oral treatment (sorafenib, lenvatinib, regorafenib or cabozantinib) for advance HCC are fatigue, diarrhea, increase in blood pressure, hand and foot reaction. Most of the symptoms will improve and resolve in days to weeks after the medication is discontinued. Communicate with your doctor when you have any of the symptoms to adjust the treatment.

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