14. Primary and secondary liver tumors (symptoms, diagnosis, treatment)

Question 1

Primary types

Answer 1

HCC - Hepatocellular carcinoma

IH-CCC - Intrahepatic choleangiocellular carcinoma

Question 2

HCC causes

Answer 2

• 90% have cirrhosis (need regular control every 6 months: US, AFP)
• HBV, HCV, Aspergillus flavus

Question 3

HCC surgical treatment

Answer 3

Liver transplant

Question 4

HCC Milan criteria

Answer 4

Criteria set for considering liver transplants with CURATIVE intent

Solitary <5cm or max. 3 multiple <3cm

Question 5

HCC non-surgical treatment

Answer 5

Chemotherapy +/- tumor ablation (RFA) +/-

chemo)embolization (TACE

Question 6

IH-CCC

Answer 6

• Infiltrative, fast growing, poor prognosis
• LTX: bad result, often recurrent
• Should be resected

Question 7

Secondary

Answer 7

CLM - Colorectal liver metastasis

NCLM - non-colorectal liver metastasis

Question 8

NCLM reccomended resections

Answer 8

Neuroendocrine, breast, endometrial cancers

Question 9

NCLM not reccomended resections

Answer 9

cardia, esophagus, lung, head and neck

Question 10

Resectability is based on…

Answer 10

• Enough liver volume and function after resection
• Future liver remnant (FLR) with good circulation and biliary drainage
• Total liver function

Question 11

FLR

Answer 11

• Measure with CT-volumetry or SPECT/CT
• 20 - 25% FLR is enough in normal liver
• 40% for cirrhosis patients

Question 12

How to increase FLR

Answer 12

Hypertrophy through portail vein occlusion techniques

Question 13

Prevention of intraop. bleeding

Answer 13

• ischemic preconditioning (less IRI)

- Pringle (intermittent clamping)

Question 14

How much ischemia can a liver tolerate?

Answer 14

> 40 minutes of ischemia = irreversible damage