OCT 14, 2020 1:15 PM SGT

Update on Screening for Hepatocellular Carcinoma (HCC)

C.E. Credits: P.A.C.E. CE Florida CE
  • Gastrointestinal Oncology, Clinical Trials - Warren Alpert Medical School of Brown University

      After earning his Medical degree from Damascus University in Damascus Syria, Dr. Almhanna received his Master in Public Health (MPH) Degree at the Case Western Reserve University in Cleveland Ohio. After completing his internal Medicine Residency in Michigan, he underwent fellowship training in Hematology and Medical Oncology from Cleveland Clinic Foundation in Cleveland, Ohio. In 2008, he was appointed Assistant Professor of Medicine at Wayne States University, then he was recruited to Moffitt Cancer Center in 2010 where he took the helped building and developing esophageal and gastric cancer working team. He served on the National Comprehensive Cancer Network, esophageal and gastric cancer panel between 2014-2017. His research has involved clinical and translational investigations in gastrointestinal tumors. Currently he is an associate professor at The Warren Alpert Medical School of Brown University and working at the lifespan Cancer institute with several talented oncologists to help strengthen the gastrointestinal research portfolio in the GI oncology department. He has been the lead investigator on several multicentral trials and developed his own investigator initiated treatment.


    Hepatocellular carcinoma (HCC) is a primary liver malignancy that typically develops in the setting of chronic liver disease. It is the 4th leading cause of cancer Worldwide with a five-year survival of only 18%. The diagnosis of HCC can be difficult and often requires several imaging modalities and biopsies. It is important for tumors to be detected when they are < 2cm in size for an early diagnosis, prevention of stage progression and ultimately a favorable outcome. Surveillance plays a key role in early diagnosis while ultrasound and CT technologies scans have limitations. The tumor markers AFP, AFP-L3 and PIVKA may be useful in early diagnose of HCC. It has been shown that combining the use of the three markers improves sensitivity significantly and has the potential to change the outcome of patients with HCC. Practice guidelines for HCC are discussed for US (AASLD), Asia (APASL) and Japan (JSH). Several models that combine clinical features and HCC biomarkers in order to predict HCC are discussed: GALAD, MoRAL, ASAP. Integrating these biomarkers in HCC treatment pathways as a surrogate for treatment response or disease recurrence is extremely important for early diagnosis and change of outcome.

    Learning Objectives:

    • Understand the challenge and clinical unmet needs when it comes to HCC screening
    • Understand the difference between using multi analytic panel approach vs one assay and how it impacts the accuracy of the results

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