Differential Diagnosis
- Single most likely diagnosis
- Hepatocellular carcinoma (HCC): Elevated AFP is a common tumor marker for HCC, and elevated CEA can also be seen in some cases. Jaundice is a possible symptom due to liver dysfunction or bile duct obstruction. The absence of stiffness on elastography does not rule out HCC, as it can be variable.
- Other Likely diagnoses
- Cholangiocarcinoma: This cancer of the bile duct can cause jaundice and elevated tumor markers like CEA. While AFP is less commonly elevated, it can occur. Elastography findings may not be specific.
- Metastatic colorectal cancer to the liver: Elevated CEA is a common finding, and while AFP is less typical, it can be elevated in some cases. Jaundice can occur due to liver involvement or bile duct obstruction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pancreatic cancer: Although less likely given the tumor marker profile, pancreatic cancer can cause jaundice and has a poor prognosis if missed. It's essential to consider it, especially if there are other suggestive symptoms or imaging findings.
- Intrahepatic cholangiocarcinoma with metastasis: Similar to cholangiocarcinoma, but with a focus on intrahepatic origin and potential for metastasis, which could explain the elevated tumor markers and jaundice.
- Rare diagnoses
- Hepatoblastoma: A rare liver cancer that can occur in adults, although it's more common in children. It can cause elevated AFP and, less commonly, CEA. Jaundice can be a symptom.
- Embryonal carcinoma of the liver: An extremely rare tumor that can cause elevated AFP and, occasionally, CEA. Jaundice and other liver dysfunction symptoms can occur.