Gastroenterology 10 - Liver Cancer

Question 1

2 primary liver cancers

Answer 1

hepatocellular carcinoma

cholangiocarcinoma

Question 2

what screening is done if a secondary liver cancer is found?

Answer 2

whole body CT scan
thorough Hx + exam of skin + breasts

not uncommon to be unable to find primary

Question 3

main risk factor for hepatocellular carcinoma

Answer 3

liver cirrhosis

(chronic viral hepatitis, alcohol, fatty disease, etc)

are screened

Question 4

what cancer is associated with Primary Sclerosing Cholangitis?

Answer 4

cholangiocarcinoma

however only accounts for 1/10 of this cancer

usually over 50s instead

Question 5

6 features in presentation of liver cancer

Answer 5

weight loss
abdo pain
anorexia
nausea+vom
jaundice
itching 

often asymptomatic

Question 6

2 differentials for painless jaundice

Answer 6

pancreatic cancer
cholangiocarcinoma

share ca19-9 marker

Question 7

tests for liver cancer x5

Answer 7

alpha fetoprotein 
CA19-9
liver ultrasound
CT+MRI for staging 
ERCP for biopsies etc

Question 8

treating HCC

Answer 8

poor prognosis
kinase inhibitors may prolong life

main hope is catching early and excising fully

Question 9

treating cholangiocarcinoma

Answer 9

very poor prognosis

ERCP can place a stent for symptomatic relief from cholestasis

Question 10

2 benign tumours you may find in the liver

Answer 10

haemangiocarcinoma

focal nodular hyperplasia (related to oestrogen - COCP, women)