It is the most common malignant tumor; Occur after the age of 50 year and incidence is more common in male patient; In 80% of cases it occur under the background of chronic hepatic disease while in another 20% it occur in normal background; The common causes of chronic hepatic disease in these patients are Alcohol, Hepatitis B & C infection and Steatohepatitis
Hepatocellular Cancer or Hepatic Cancer can be one of the reason for decompensation in patients of cirrhosis; Otherwise these patients present with features like ascites/ jaundice and when investigated are found to have Cancer
Pain right upper abdomen along with anorexia and weight loss are common
Imaging modality of choice for diagnosis of Hepatocellular Carcinoma is triple phase CT abdomen which reveals typical feature of HCC that is arterial enhancement and portal venous phase washout; Tumor marker is alpha-fetoprotein; Typical feature on CT along with raised alpha-fetoprotein is sufficient for diagnosis of hepatic Cancer; FNAC is not done because of risk of seedling of needle tract
Surgical resection is the treatment of choice; When Hepatic Cancer occur under the background of cirrhosis and if it comes under the criteria of transplant and if donor is available it should be the treatment of choice
If Surgical resection is not possible or patient is not fit for surgery then there are various non-surgical methods available which should be done according to the criteria fulfilled
The most common lesion seen on ultrasound is hemangioma; Whenever in doubt of the diagnosis triple phase CT abdomen should be done to confirm it; Patient symptoms should not be related to hemangioma because it is seen on ultrasound until and unless other pathologies is ruled out, It is a benign condition and usually does not require any intervention; Only large symptomatic hemangiomas require intervention.
It is generally of two types one is pyogenic and other is Amoebic, Most commonly patients present with fever and right-sided upper abdomen pain; Ultrasound abdomen is the first investigation in pain abdomen which will suggest the diagnosis, it will tell number and size of the abscess, whenever in doubt triple phase CT abdomen should be done because many times other hepatic pathology may be misdiagnosed , Once diagnosed appropriate antibiotics should be started, At initial stage abscess are solidified so Percutaneous drainage will not be effective, so in case of large abscess once it is liquified PCD can be done, Sometimes patient present with features of ruptured hepatic abscess such as diffuse pain abdomen, high grade fever in these cases Laparoscopic peritoneal lavage with abscess drainage should be done.