Hepatobiliary Flashcards
Treatment for locally advanced, unresectable gallbladder or cholangiocarcinoma cancer?
Chemoradiation with a fluoropyrimidine or systemic chemo (cis/gem for example). Cis/gem increased OS from 8.3 mos for gem alone to 11.7 mos.
What are the absolute contraindications for surgery in gallbladder cancer?
Liver metastasis, peritoneal metastases, involvement of N2 nodes (celiac, peripancreatic, periduodenal, or superior mesenteric nodes) malignant ascites, extensive involvement of the hepatoduodenal ligament, and encasement or occlusion of major vessels. Direct involvement of colon, duodenum, or liver does not represent an absolute contraindication.
The ABC-02 trial randomized patients with unresectable cancers of the gallbladder, bile ducts, or ampulla to cis/gem or gem alone. What are the results?
OS: 11.7 mos for cis/gem vs. 8.1 mos for gem.
What are the risk factors for cholangiocarcinoma?
Smoking, HBV, HCV, diabetes, alcohol, cirrhosis. Also primary sclerosing cholangitis, choledochal cysts.
What are the risk factors for hepatocellular carcinoma?
Hep B and C, alcoholism, autoimmune hepatitis, primary biliary cirrhosis, androgenic steroids, aflatoxins, tobacco, nitrosylated compounds, thorotrast, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease, porphyria, glycogen storage disease
T or F: AFP-L3% is a more reliable indicator of HCC than total AFP.
True
What is the general approach to early stage or intermediate stage HCC?
Surgical resection. If unresectable, hepatic arterial infusions of chemo, chemoembolization, alcohol injection, radiofrequency ablation. RFA is probably more effective than other locally percutaneous ablative techniques. Liver transplantation is the best therapy for unresectable HCC.
What is the treatment for advanced HCC?
Sorafenib (anti-VEGFR and Raf): OS 10.7 mos vs. 7.9 mos for placebo in the SHARP trial. Sorafenib is better than sunitinib.
How many gallbladder cancers are incidentally found after cholecystectomy?
50% of gallbladder cancers. If lap chole, need re-resection of adjacent liver segment and lymphadenectomy unless stage I.
