3: Liver Tumours

Question 1

What % of liver tumours are metastatic

Answer 1

90

Question 2

What % of liver tumours are primary

Answer 2

10

Question 3

What is a primary liver tumour also referred to as

Answer 3

Hepatocellular carcinoma

Question 4

What age-group are the majority of hepatocellular carcinomas

Answer 4

> 70

Question 5

In which gender are hepatocellular carcinomas more common

Answer 5

Males

Question 6

In general, what causes HCC

Answer 6

Liver cirrhosis

Question 7

What is the most common cause of hepatocellular carcinoma

Answer 7

Hepatitis

Question 8

What are 3 other causes of hepatocellular carcinoma

Answer 8

Alcoholic liver disease
Alfatoxin exposure
Primary biliary cirrhosis

Question 9

What is the main risk factors for hepatocellular carcinoma

Answer 9

Hepatitis B infection
Hepatitis C infection
Alcoholism 
FH
Smoking

Question 10

What is the main clinical presentation of hepatocellular carcinoma

Answer 10

Liver Cirrhosis:

• Lethargy
• Weight loss

A dull RUQ pain has been described but is uncommon

Question 11

How will late stage hepatocellular carcinoma present

Answer 11

Liver failure

Question 12

On examination, how will the liver feel on palpation

Answer 12

Enlarged, irregular, tender and craggy

Question 13

What blood tests are ordered for hepatocellular carcinoma

Answer 13

FBC
LFT
AFP

Question 14

How will LFTs present in hepatocellular carcinoma if due to alcoholic liver disease

Answer 14

AST : ALT >2

Question 15

How will LFTs present if hepatocellular carcinoma is due to viral hepatitis

Answer 15

AST : ALT = 1

Question 16

How will coagulation studies present in hepatocellular carcinoma

Answer 16

Raised PT and APTT

Question 17

How will FBC present in hepatocellular carcinoma

Answer 17

Thrombocytopenia

Question 18

What is the tumour marker for hepatocellular carcinoma

Answer 18

AFP (alpha fetoprotein)

Question 19

What is AFP used for

Answer 19

Monitor response to treatment

Question 20

What is first-line imaging for HCC

Answer 20

USS

Question 21

If a mass >2cm is found on USS with raised AFP what does it mean

Answer 21

Diagnostic for HCC

Question 22

If HCC what other imaging is performed

Answer 22

CT

MRI Liver

Question 23

What staging system is used for HCC

Answer 23

Barcelona Clinic Liver Cancer Scoring System (BCLC)

Question 24

What scoring systems are used to predict mortality from cirrhosis

Answer 24

Child-pugh

MELD (Model for end-stage liver disease)

Question 25

What is the only curative option for HCC

Answer 25

Surgical resection

Question 26

When is surgical resection indicated

Answer 26

If patients do not have cirrhosis

Question 27

What criteria is used to assess whether patients should receive transplantation

Answer 27

MILAN

Question 28

What are three potential non-surgical approaches to manage HCC

Answer 28

• Image-guided ablation
• Alcohol ablation
• Trans-arterial chemoembolisation

Question 29

Why is the liver a common site of metastases

Answer 29

GI drains through portal system to the liver

Question 30

what is a mnemonic to remember cancers that metastasise to the liver

Answer 30

LPBBS

Question 31

What cancers metastsise to the liver

Answer 31

Lung
Pancreas
Breast 
Bowel
Stomach

Question 32

What are the symptoms of liver abscess

Answer 32

Fever, Rigors, RUQ pain

Question 33

How are live abscesses managed

Answer 33

CT guided aspiration

Antibiotics