True about carcinoma liver -

Answer is 'a' i.e. AFP increased in 70% cases; 'b' i.e. Resection possible in few cases only; 'c' i.e. USG guided biopsy is good for diagnosis g/1 are found in about 70 to 80% of patients with HCC. Lower levels may be found in patients * with large metastases from gastric or colonic tumors and in some patients with acute or chronic hepatitis. High levels of serum AFP (> 500 to 1000 gg/1) in an adult with liver disease and without an obvious gastrointestinal tumor strongly suggest HCC."- Harrison 16/e [Harrison 17/e writes about AFP:- "Fetoprotein (AFP) is a serum tumor marker in HCC; however, it is only increased in about half of U.S. patients." A rising level suggests progression of the tumor or recurrence after hepatic resection or embolization therapies. * The presence of an aerially enhancing liver mass > 2 cm with an AFP > 400 ng/ml (or 400 ,ug/L) is highly * suggestive of HCC. Percutaneous liver biopsy under U/S or CT guidance can be diagnostic, but the sample should be drawn with caution as these tumors tend to be vascular. Thorotrast (colloidal thoriune dioxide) is an angiographic medium that was used in 1930s. It emits high levels of long-lasting radiation. It has been associated with - hepatic fibrosis - hepatocellular carcinoma - cholangiosarcoma and - ngiosarcoma About Aflatoxin Harrison writes- "Probably the best-studied and most potent ubiquitous natural chemical carcinogen is a product of the Aspergillus fungus, called atlatoxin B1. This mold and aflatoxin product can be found in stored grains in hot, humid places, where peanuts and rice are stored in unrefrigerated conditions. Aflatoxin contamination of foodstuffs correlates well with incidence rates in Africa and to some extent in China." Because of multicentricity, bilobar involvement, poal vein invasion, and lymphatic metastasis only 15-20% of hepatocellular carcinomas are resectable.