FN: Liver Tumours

Question 1

Pathology

Answer 1

􏰀 90% of liver tumours are 2O metastases
􏰁 1O in men: stomach, lung, colon
􏰁 1O in women: breast, colon, stomach, uterus
􏰁 Less common: pancreas, leukaemia, lymphoma
􏰀 90% of primary tumours are HCC.
􏰀 Benign tumours: haemangiomas, adenomas, cysts

Question 2

symptoms

Answer 2

􏰀 Benign tumours are usually asymptomatic
􏰀 Systemic: fever, malaise, wt. loss, anorexia
􏰀 RUQ pain: stretching of Glisson’s capsule
􏰀 Jaundice is often late, except in cholangiocarcinoma
􏰀 May rupture → intraperitoneal haemorrhage

Question 3

signs

Answer 3

􏰀 Hepatomegaly: smooth or hard and irregular
􏰀 Signs of chronic liver disease
􏰀 Abdominal mass
􏰀 Hepatic bruit (HCC)

Question 4

Ix

Answer 4

􏰀 Bloods: LFTs, hepatitis serology, AFP
􏰀 Imaging:
􏰁 US or CT / MRI ± guided diagnostic biopsy
􏰁 ERCP + biopsy in suspected cholangiocarcinoma
􏰀 Biopsy (seeding may occur along tract)
􏰀 Find primary: e.g. colonoscopy, mammography

Question 5

Liver MEts

Answer 5

􏰀 Rx and prognosis vary ̄c type and extent of 1O
􏰀 Small, solitary CRC mets may be resectable
􏰀 Advanced disease 􏰄 prognosis: < 6mo

Question 6

HCC

Answer 6

􏰀 Rare in West, common in China and sub-Saharan Africa

Question 7

Causes of HCC

Answer 7

􏰀 Viral hepatitis
􏰀 Cirrhosis: EtOH, HH, PBC
􏰀 Aflatoxins (produced by Aspergillus)

Question 8

Mx of HCC

Answer 8

􏰀 Resection of solitary tumours improves prognosis (13 → 59%), but 50% have recurrence.
Also: chemo, percutaneous ablation and embolization

Question 9

cholangiocarcinoma

Answer 9

biliary tree malignancy (10% of liver primary tumours)

Question 10

Causes of cholangiocarcinoma

Answer 10

􏰀 Flukes (Clonorchis)
􏰀 PSC
􏰀 Congenital biliary cysts
􏰀 UC

Question 11

Cholangiocarcinoma presentation

Answer 11

􏰀 Fever, malaise
􏰀 Abdominal pain, ascites, jaundice
􏰀 ↑BR, ↑↑ALP

Question 12

Mx of cholangiocarcinoma

Answer 12

􏰀 30% resectable

􏰀 Palliative stenting: percutaneous or ERCP