77. Liver Tumours

Question 1

What are the different types of tumours you might find in the liver?

Answer 1

Metastasis
Malignant primaries (HCC, cholangiocarcinoma, hepatoblastoma)
Benign tumours (haemangioma, adenoma, fibroma)

Question 2

Where is the likely site of a primary in liver metastasis?

Answer 2

Stomach, lung, colon (men)

Breast, colon, stomach, uterus (woman)

Pancreas, leukaemia, lymphoma, carcinoid tumours (rare)

Question 3

Describe the malignant primary tumours you might see in the liver?

Answer 3

Hepatocellular carcinoma- primary hepatocytes neoplasia, caused by Hep B

Cholangiocarcinoma-biliary tree cancer,

Angiosarcoma- blood/lymph vessel cancer

Hepatoblastoma- typically presents in kids

Gastrointestinal stroma tumour- sarcomas (soft tissue cancer)

Question 4

Discuss the benign tumours you would typically see in the liver?

Answer 4

Cysts

Heamoangioma-dont biopsy, don’t need treatment

Adenoma- (epithelial)

Focal modular hyperplasia

Fibroma- connective tissue

Benign GIST- e.g. Leiomyoma

Question 5

What symptoms and signs would make you consider a liver cancer?

Answer 5

Fever, malaise, anorexia, weight loss, RUQ pain
Jaundice is late except in cholangiocarcinoma
Intraperitoneal heamorrhage (tumour rupture)
Helatomgelay
Decompensated liver disease (ascites, reduced clotting)

Question 6

How do investigate a suspected liver tumour?

Answer 6

Bloods: FBC, clotting, LFT, hepatitislmserology, a-fetoprotein

USS/CT- identify lesions, guide biopsy and staging, find primary.
MRI- distinguish malignant from benign

Liver biopsy- May achieve histological diagnosis

Question 7

How do you treat liver metastasis?

Answer 7

Mostly palliative

Certain tumours may respond to chemo (lymphomas, germ cell tumours)

Some tumours may be able to be resected (e.g. colorectal mets)

Question 8

Heamobilia is a late stage symptom of hepatocellular carcinoma. It should always be considered when Quincke’s triad is observed. What is quincke’s triad?

Answer 8

Right upper quadrant pain
Upper GI heamorrhage
Jaundice

Question 9

What causes hepatocellular carcinoma?

Answer 9

Hep B, Hep C
Cirrhosis
NAFLD
Anabolic steroids
Alfatoxins (mould)

Question 10

What is the treatment for HCC?

Answer 10

Resection fo tumours <3cm
Liver transplant
TACE
Sorafenib (kinase inhibitor)

Question 11

What causes cholangiocarcinoma?

Answer 11

Flukes (works)
PSC
Biliary cysts
HBV,HCV

Question 12

What is the prognosis and treatment for cholangiocarcinoma

Answer 12

As most people present late with raised ALP and, bilirubin and general fatigue not a lot can be done.

Surgery is rarely an option and typically involves major hepatectomy, extrahepatic bile duct excision and caudate lobe resection

Prognosis 5 months