heepatobillary malignancies Flashcards
what are the malignant liver lesions ?
hepatocellular carcinoma
cholangiocarcinoma
what is one of the most important risk factors for HCC ?
cirrhosis
how can primary prevention of HCC be achieved ?
HBV vaccination
how can progression to cirrhosis and HCC be prevented ?
antiviral treatment in patients with chronic Hep BB
adoption of healthy lifestyle measure to reduce the incidence of NAFLD
what is the interval in which screening for HCC should be performed in high risk populations ?
every 6 months
how is a diagnosis of HCC madee ?
in cirrhotic patients it should be based on non invasive criteria with no need for histopathology
in non cirrhotic patients diagnosis should be confirmed by biopsy
what are the non invasive criteria that should be used for diagnosis of HCC in cirrhotic patients ?
multiphasic CT
MRI
contrast enhanced US
what is seen in multiphasic CT of HCC ?
there are 4 phases associated -
non enhanced
arterial - hyperenhancement of the lesion
portal venous - washout of the lesion
equilibrium
what staging system is used for HCC in cirrhotic liver ?
BCLC
what does the BCLC system show ?
very early stage - single nodule less than 2 cm
early - single or multiple / 2-3 cm nodules
intermediate - multinodular/ unresectable
advanced - portal invasion, extrahepatic spread
Terminal - non transplantable HCC
what iis the management for each stage in the BCLC ?
1 - ablation or resection
2- if solitary nodule then resect , can’t resect transplant , if multiple nodules transplant, if can’t transplant perform ablation
3- chemoembolization
4- systemic therapy
5- best supportive care
what is cholangiocarcinoma divided into ?
intrahepatic and extrahepatic
why is the survival rate low for cholangiocarcinoma ?
because the diagnosis is usually made at an advanced stage
what are the risk factors for cholangiocarcinoma ?
primary sclerosing cholangitis
smoking and alcohol
older agee
liver fluke infestation
caroli’s disease
choledochal cyst
bile duct adenoma
chronic intrahepatic stones
chemical agents ( vinyl chloride)
cirrhosis
which serum marker can be used to identify ICCA ?
Ca 19-9
what are the associated findings of CCA ?
hepatic capsular retraction
vascular encasement
dilatation of the peripheral ducts
what is the standard therapy for unresectable CCA ?
combination chemotherapy with gemcitabine plus cisplatin
what is the most common benign primary lesion of the liver ?
cavernous hemangioma
what age and gender are hepatocellular adenomas common in ?
younger women especially those taking OCPs
what are the key features of cavernous hepatic hemangiomas ?
patient with a normal healthy liver, a hyperechoic lesion is very likely to be a liver hemangioma
in multiphasic CT - It shows nodular peripheral enhancement followed by central enhancement in delayed phases and tending to homogenization in the equilibrium phase
what is a common misconception about hepatic hemangioma ?
OCPs and pregnancy are a contraindication
they are not
what is the management for hepatic hemangioma ?
conservative management
what is the gold standard for the diagnosis of focal nodular hyperplasia ?
MRI - to visualize the central scar
what is the management for focal nodular hyperplasia ?
conservative
what is the association of sex hormones and hepatocellular adenoma ?
associated with prolonged OCP use in women
and associated with androgenic steroids in men
why must hepatocellular adenomas be watched more carefully out of all the benign lesions ?
carry a significant risk of haemorrhage and malignant transformation
why is there an increasing prevalence of hepatocellular adenoma ?
associated with rising prevalence of obesity and metabolic syndrome
how is HCA diagnosed ?
MRI and liver biopsy
what type of mutation is associated with a higher risk of malignant transformation in HCA ?
beta catenin
what is thee most appropriate management for HCA ?
1- discontinue OCPs and advisee to lose weight
2- resection irrespective of size is recommended in men and patient with beta cateeniin mutation
3- resection is also indicated wiith lesions larger than 5 cm
what is the best route of management for a bleeding HCA with haemodynamic instability ?
embolizattionn
when should reassessment of lesions less than 5 cm occur ?
at 1 year with annual imaging
