EXAM #3: HEPATOBILIARY MALIGNANCY Flashcards
How many segments is the liver divided into? How are these segments devised?
8, based on vascular supply
List the benign liver lesions.
1) Focal Nodular Hyperplasia
2) Simple Cyst
3) Hemangioma*
4) Adenoma
*Most common
What are Liver Adenomas?
Benign glanduar liver tumor
What are Liver Adenomas associated with?
Oral contraceptives–regress with contraceptive cessation
What is the greatest risk with a Hepatic Adenoma?
Rupture especially during pregnancy
*Also can transform to liver metastasis
What are the buzzwords for describing FNH?
Nodular hyperplasia with a “CENTRAL SCAR”
What imaging study is best for visualizing FNH?
CT Scan, specifically in the “arterial phase”
What is a Hemangioma?
Blood filled space
What is a “Giant Hemangioma?”
Hemangioma that is greater than 5cm
What are the two primary liver cancers?
1) Hepatocellular carcinoma
2) Cholangiocarcinoma (bile duct cancer)
Note that sometimes HCC is called Hepatoma*
Where is HCC common?
Worldwide (non-US and Europe) b/c of endemic viral hepatitis
What are the risk factors for HCC?
1) Viral hepatitis (HBV and HCV)
2) Anything causing cirrhosis
- Alcoholism
- Hemochromatosis
- Wilson’s Disease
- Alpha-1 antitrypsin def.
- NAFLD
3) Aflatoxin
What are the subtypes of HCC?
- Solitary
- Diffuse
- Fibrolamellar
What is unique about Fibrolamellar HCC?
Best prognosis
Commonly seen in women younger than 35
What is a Hepatoblastoma?
Childhood primary liver cancer– neoplastic proliferation of fetal liver cells
What tumor marker is associated with Hepatoblastoma?
Alpha-fetoprotein
How does HCC present?
- Hepatosplenomegaly
- Ascites
- Abdominal pain
- Weight loss
Typically in males over 60 w/ underlying cirrhosis
What is the classic diagnostic study for HCC?
Serum alpha-fetoprotein
What can you do if you’re unsure that a mass is HCC?
Percutaneous liver biopsy
What are the surgical procedures for HCC?
1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant
What are the challenges of liver surgery?
1) Dual blood supply (hepatic a. and portal vein)
2) Hepatic reserve
3) Coagulopathy
What is a Child Pugh Score?
Measure of hepatic reserve
What is the scale used for the Child Pugh Score?
Class A, B, or C
A= good risk
B= moderate risk
C= poor risk
B and C normally don’t get resected
What makes a good surgical candidate for surgical live resection?
1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Less than 3 cm tumor size
What are the alternative local therapies for patients that are poor surgical candidates?
1) Cryosurgery
2) Microwave ablation
3) Radiofrequency ablation
4) Ethanol injection
5) Acetic acid injection
What blood supply feeds most of the tumor tissue? Normal liver?
Hepatic artery= tumor
Portal circulation= normal
What are the treatment modalities that will use the hepatic a. to treat un-resectable HCC?
1) Embolization
2) Radiation therapy
What drug is specifically used as a chemotherapy for HCC?
Sorafenib
Note that this is commonly given via the hepatic a.
What is the MOA of Sorafenib?
1) Blocks angiogenesis
2) Targets HCC surface proteins
What are the three classifications of Cholangiocarcinoma?
1) Intrahepatic
2) Perihilar*
3) Distal
*Perihilar is most common
What are the risk factors for Cholangiocarcinoma?
1) PSC i.e. UC
2) Liver flukes
3) Congenital malformations i.e. “Choledochal cyst”
What is the only known cure for Cholangiocarcinoma?
Surgery
What is the clinical presentation for a Cholangiocarcinoma?
1) Constitutional sx. associated with all cancer
2) Painless jaundice
3) Biliary tract obstruction
What is the PE sign associated with a palpable Gallbladder?
Courvoisier’s sign
What lab studies assist in the diagnosis of Cholangiocarcinoma?
1) Liver fxn tests
2) CEA
3) CA 19-9
What imaging studies are used to diagnose Cholangiocarcinoma?
1) ERCP
2) CT/MRI with cholangiography
3) US
What surgery is used to treat a perihilar Cholangiocarcinoma?
Roux en Y Hepaticojejunostomy
What surgery is used to treat a distal Cholangiocarcinoma?
Whipple Procedure
What procedure is used for most cases of Cholangiocarcinoma?
- Most are unresectable b/c of late disease presentation*
- Palliative biliary decompression
How does Gallbaldder cancer compare to Cholangiocarcinoma?
Much more aggressive/ poor prognosis
What is the typical patient with Gallbladder cancer?
Elderly women without liver disese
- Urban areas
- Chilean women
What is the classic imaging finding associated with Gallbladder cancer?
Porcelain gallbladder i.e. calcification of the gallbladder
What stage of GB cancer has the best prognosis?
T1a–incidentally found on lap chole for other pathology
