60a Liver tumours + biliary Flashcards
What are the risk factors for hepatocellular carcinoma? (5)
Cirrhosis. Male >> Female. Alcohol. Obesity. Viral hepatitis.
How are cirrhotic patients monitored? (2)
Why?
6 month ultrasound scan.
Raised alpha feto-protein. (very large to secrete this).
HCC usually too large once symptomatic to treat.
What are the macroscopic features of hepatocellular carcinoma? (3)
Expansile soft nodules (green due to bile).
Often multifocal if cirrhosis.
Often involves portal vein.
What is the diagnostic microscopic feature of hepatocellular carcinoma?
Bile production.
How is hepatocellular carcinoma treated, criteria? (3)
Surgery (if non-cirrhotic, small, peripheral).
Transplant (1 tumour under 5cm or 3 under 3cm).
If not: ablation, embolisation, chemo.
What is the TNM staging for hepatocellular carcinoma?
- no vascular invasion.
- tumours invade vasculature, or multiple tumours less than 5cm.
3a. Multiple, anymore than 5cm.
3b. Anything involving major branch of hepatic or portal vein. - Invades other organs (other than gall bladder), or perforates visceral peritoneum.
What is the prognosis of hepatocellular carcinoma?
Less than 1 year unless spotted early.
Which is more common, 1o liver cancer or mets?
Mets.
Which cancers metastasise to the liver? (1, 5)
Few large nodules - large bowel.
Multi nodular: Lung, Pancreas, Breast, Stomach, Melanoma
What is a cholangiocarcinoma?
Adenocarcinoma arising from bile ducts.
How does intrahepatic cholangiocarcinoma behave? (3).
Risk factors?
Peripheral, mass forming, presets late.
Cirrhosis.
How does perihilar cholangiocarcinoma behave?
Risk factors? (2)
In large ducts: causes obstructive jaundice early.
Primary sclerosing cholangitis, Liver flukes.
What does bile contain? (6)
Bile salts Phospholipids Cholesterol Bilirubin Calcium salts Mucin
Who do gallstones occur in?
female, obesity, diabetes
“fair, fat, female, forty”
What are the main types of gallstones? (3)
Appearance?
Cholesterol – yellow, opalescent,
Pigment – small black, in haemolytic anaemia
Mixed stones (most common)
What are the complications of gallstones? (7)
Cholecystitis Mucocele Increased gallbladder cancer risk. Jaundice Cholangitis and liver abscesses Pancreatitis. Gallstone ileum (entered into gut through fistulous connection with the gallbladder)
What is cholecystitis?
Inflammation of the gall bladder.
Cause of acute cholecystitis?
Features? (4)
Complications? (2)
Stone blocks duct, 2o infection.
Large, swollen, congested, ulcerated.
Empyema + rupture.
Cause of chronic cholecystitis?
Histological features? (2)
Small gall stones.
Fibrosis, Rokitansky Aschoff sinuses.
What are the indications for a cholecystectomy? (4)
Pain.
Gallstones.
Pancreatitis.
Gall bladder polyp (rare).
