3: Liver Tumours Flashcards
What % of liver tumours are metastatic
90
What % of liver tumours are primary
10
What is a primary liver tumour also referred to as
Hepatocellular carcinoma
What age-group are the majority of hepatocellular carcinomas
> 70
In which gender are hepatocellular carcinomas more common
Males
In general, what causes HCC
Liver cirrhosis
What is the most common cause of hepatocellular carcinoma
Hepatitis
What are 3 other causes of hepatocellular carcinoma
Alcoholic liver disease
Alfatoxin exposure
Primary biliary cirrhosis
What is the main risk factors for hepatocellular carcinoma
Hepatitis B infection Hepatitis C infection Alcoholism FH Smoking
What is the main clinical presentation of hepatocellular carcinoma
Liver Cirrhosis:
- Lethargy
- Weight loss
A dull RUQ pain has been described but is uncommon
How will late stage hepatocellular carcinoma present
Liver failure
On examination, how will the liver feel on palpation
Enlarged, irregular, tender and craggy
What blood tests are ordered for hepatocellular carcinoma
FBC
LFT
AFP
How will LFTs present in hepatocellular carcinoma if due to alcoholic liver disease
AST : ALT >2
How will LFTs present if hepatocellular carcinoma is due to viral hepatitis
AST : ALT = 1
How will coagulation studies present in hepatocellular carcinoma
Raised PT and APTT
How will FBC present in hepatocellular carcinoma
Thrombocytopenia
What is the tumour marker for hepatocellular carcinoma
AFP (alpha fetoprotein)
What is AFP used for
Monitor response to treatment
What is first-line imaging for HCC
USS
If a mass >2cm is found on USS with raised AFP what does it mean
Diagnostic for HCC
If HCC what other imaging is performed
CT
MRI Liver
What staging system is used for HCC
Barcelona Clinic Liver Cancer Scoring System (BCLC)
What scoring systems are used to predict mortality from cirrhosis
Child-pugh
MELD (Model for end-stage liver disease)
What is the only curative option for HCC
Surgical resection
When is surgical resection indicated
If patients do not have cirrhosis
What criteria is used to assess whether patients should receive transplantation
MILAN
What are three potential non-surgical approaches to manage HCC
- Image-guided ablation
- Alcohol ablation
- Trans-arterial chemoembolisation
Why is the liver a common site of metastases
GI drains through portal system to the liver
what is a mnemonic to remember cancers that metastasise to the liver
LPBBS
What cancers metastsise to the liver
Lung Pancreas Breast Bowel Stomach
What are the symptoms of liver abscess
Fever, Rigors, RUQ pain
How are live abscesses managed
CT guided aspiration
Antibiotics
