Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia

Sarah Ng; Justin Chin; Sudhakar Rao; Nick Kontorinis; James Anderson; Suresh Navadgi; Jee Kong; Adam Doyle; Wendy Cheng

doi:doi:10.11648/j.ijg.20180201.14

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Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia

Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, Suresh Navadgi, Jee Kong, Adam Doyle, Wendy Cheng

Published in International Journal of Gastroenterology (Volume 2, Issue 1)

Received: 15 September 2018 Accepted: 8 October 2018 Published: 7 November 2018

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Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.

Published in	International Journal of Gastroenterology (Volume 2, Issue 1)
DOI	10.11648/j.ijg.20180201.14
Page(s)	18-23
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Ruptured Hepatocellular Carcinoma, Trans-Arterial Chemoembolisation, Trans-Arterial Embolisation

References

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APA Style

Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. (2018). Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. International Journal of Gastroenterology, 2(1), 18-23. https://doi.org/10.11648/j.ijg.20180201.14

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ACS Style

Sarah Ng; Justin Chin; Sudhakar Rao; Nick Kontorinis; James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int. J. Gastroenterol. 2018, 2(1), 18-23. doi: 10.11648/j.ijg.20180201.14

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AMA Style

Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int J Gastroenterol. 2018;2(1):18-23. doi: 10.11648/j.ijg.20180201.14

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@article{10.11648/j.ijg.20180201.14,
  author = {Sarah Ng and Justin Chin and Sudhakar Rao and Nick Kontorinis and James Anderson and Suresh Navadgi and Jee Kong and Adam Doyle and Wendy Cheng},
  title = {Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia},
  journal = {International Journal of Gastroenterology},
  volume = {2},
  number = {1},
  pages = {18-23},
  doi = {10.11648/j.ijg.20180201.14},
  url = {https://doi.org/10.11648/j.ijg.20180201.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20180201.14},
  abstract = {Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.},
 year = {2018}
}

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TY  - JOUR
T1  - Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia
AU  - Sarah Ng
AU  - Justin Chin
AU  - Sudhakar Rao
AU  - Nick Kontorinis
AU  - James Anderson
AU  - Suresh Navadgi
AU  - Jee Kong
AU  - Adam Doyle
AU  - Wendy Cheng
Y1  - 2018/11/07
PY  - 2018
N1  - https://doi.org/10.11648/j.ijg.20180201.14
DO  - 10.11648/j.ijg.20180201.14
T2  - International Journal of Gastroenterology
JF  - International Journal of Gastroenterology
JO  - International Journal of Gastroenterology
SP  - 18
EP  - 23
PB  - Science Publishing Group
SN  - 2640-169X
UR  - https://doi.org/10.11648/j.ijg.20180201.14
AB  - Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.
VL  - 2
IS  - 1
ER  -

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Author Information

Sarah Ng

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Justin Chin

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Sudhakar Rao

Department of General Surgery, Royal Perth Hospital, Perth, Australia
Nick Kontorinis

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
James Anderson

Department of Radiology, Royal Perth Hospital, Perth, Australia
Suresh Navadgi

Department of General Surgery, Royal Perth Hospital, Perth, Australia
Jee Kong

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Adam Doyle

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Wendy Cheng

Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

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APA Style

Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. (2018). Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. International Journal of Gastroenterology, 2(1), 18-23. https://doi.org/10.11648/j.ijg.20180201.14

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ACS Style

Sarah Ng; Justin Chin; Sudhakar Rao; Nick Kontorinis; James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int. J. Gastroenterol. 2018, 2(1), 18-23. doi: 10.11648/j.ijg.20180201.14

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AMA Style

Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int J Gastroenterol. 2018;2(1):18-23. doi: 10.11648/j.ijg.20180201.14

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@article{10.11648/j.ijg.20180201.14,
  author = {Sarah Ng and Justin Chin and Sudhakar Rao and Nick Kontorinis and James Anderson and Suresh Navadgi and Jee Kong and Adam Doyle and Wendy Cheng},
  title = {Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia},
  journal = {International Journal of Gastroenterology},
  volume = {2},
  number = {1},
  pages = {18-23},
  doi = {10.11648/j.ijg.20180201.14},
  url = {https://doi.org/10.11648/j.ijg.20180201.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20180201.14},
  abstract = {Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia
AU  - Sarah Ng
AU  - Justin Chin
AU  - Sudhakar Rao
AU  - Nick Kontorinis
AU  - James Anderson
AU  - Suresh Navadgi
AU  - Jee Kong
AU  - Adam Doyle
AU  - Wendy Cheng
Y1  - 2018/11/07
PY  - 2018
N1  - https://doi.org/10.11648/j.ijg.20180201.14
DO  - 10.11648/j.ijg.20180201.14
T2  - International Journal of Gastroenterology
JF  - International Journal of Gastroenterology
JO  - International Journal of Gastroenterology
SP  - 18
EP  - 23
PB  - Science Publishing Group
SN  - 2640-169X
UR  - https://doi.org/10.11648/j.ijg.20180201.14
AB  - Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.
VL  - 2
IS  - 1
ER  -

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