Hepatobiliary CA Flashcards
The majority of liver CA are what?
Mets from other organs
The falciform ligament separates what parts of the liver?
lobes 2 and 3
What is the most common benign condition of the liver that is mistaken for hepatocellular CA? What are the other three?
Focal nodular hyperplasia
Simple cysts
Hemangiomas
Adenomas
What type of drugs are associated with liver adenomas? What are the cells that are found within these lesions?
Oral contraceptives
Only Hepatocytes
How often are liver adenomas symptomatic?
50% of the time
Which gender usually gets FNH?
Women
How do you diagnose FNH? What is the characteristic finding?
Characteristic CT findings (macroscopic central scar)
What are the cell types within FNH?
Hepatocytes
Scar
Biliary tract
True or false: focal nodular hyperplasia is not seen well on ultrasound
True
What is the most common benign primary tumor of the liver? What are they? What is the treatment?
Hemangioma
Endothelium lined, blood filled spaces
Unless really big (greater than 5 cm), nothing
What is the most common primary malignant tumor of the liver?
Hepatocellular CA
Why is HCC common in other countries? Why is there a rise in the US?
Viral hepatitis B
Rise in Hep C in US
What are the risk factors for HCC? (gender, infx, liver conditions)
Male Aflatoxin Hepatitis Cirrhosis Liver diseases
What are aflatoxins?
Toxins produced by aspergillus species, and is commonly on food products
What are the three forms of hepatocellular CA?
Solitary
Diffuse
Fibrolamellar
What is hepatoblastoma?
Childhood liver cancer of blastomas
In whom is the fibrolamellar HCC more common? Why do these have a better outcome?
women younger than 35
Does not cause cirrhosis or does not completely affect the liver
What is the protein that is followed with HCC? What is this used for?
Alpha-fetoprotein
Not used for screening–follow pt levels after a surgical resection
In whom is HCC common?
males above 60 yo
What is the best way to diagnose hepatocellular CA?
Imaging
What is the most common surgery for liver cancer? Are transplants common for liver cancer?
Lobectomy
Transplant rare–usually used for other diseases
What are the three challenges of liver surgery?
- Dual blood supply
- Hepatic reserve (need enough)
- Coagulopathy
What is the measurement of hepatic reserve? What is measured for this score? What is class A?
Child-Pugh score (lower is better)
- Encephalopathy
- Ascites
- Albumin
- PT
- Bili
6 points or less is class A
What are the optimal characteristics for liver resection?
Solitary tumors without major vascular invasion
How good is the survival rate after a liver surgery for HCC? Recurrence rate?
50% live 5 years
70%
How is radiofrequency performed?
Microwave ablation percutaneously
What are the three general types of embolization for liver CA?
Arterial embolization
Chemoembolization
Radioembolization
What is the chemo agent for HCC? MOA?
Sorafenib
Blocks tumors from forming new blood vessels, and slows the growth by binding surface proteins
What are the three classifications of intrahepatic cholangiocarcinomas?
Intrahepatic
Perihilar
Distal
How is intrahepatic cholangiocarcinoma treated?
Like primary liver CA
Where are the majority of cholangio CAs? What age?
Perihilar region
Greater than 65 yo
True or false: most pts with cholangiocarcinoma have no known risk factors
True
What are the risk factors for cholangiocarcinoma? (infx, autoimmune)
Chinese liver fluke
Sclerosing cholangitis
What is the ab that is elevated with primary biliary cirrhosis?
AMA
What is the antibody that is elevated with Primary sclerosing cholangitis?
pANCA
Which gallbladder cancer is associated with UC?
Primary sclerosing cholangitis
What are the ssx of bile duct carcinoma?
Biliary tract obstructive ssx
What are the markers for bile duct carcinomas? (2)
CA19-9 or CEA
What are the ways to diagnose cholangiocarcinoma?
ERCP and imaging
What is the treatment for cholangiocarcinoma?
Surgical excision
Biliary decompression/relief of obstruction
What is the reconstruction surgery that is used to treat cholangiocarcinoma? How effective is this?
Roux-en-y (hepaticojejunostomy)
Still really poor outcomes
Is radiation effective for cholangiocarcinoma? Chemo?
Not really–increase survival by 2 months
Chemo ineffective
What is the survival rate like with late cholangiocarcinoma?
Really poor
What is the classic patient for gallbladder CA? Survival rates?
elderly women without liver disease (chilean women in particular)
Really low survival rates
What are the characteristics of gallbladder cancer?
Aggressive and metastasizes quickly
Who is the classic patient for HCC?
elderly man with liver disease
What is a porcelain gallbladder?
Calcification of the gallbladder d/t gallbladder cancer
Gallstones are present in what percent of gallbladder cancer pts? Why is this significant?
75-98%
Not necessarily significant, since a lot of people have gallstones
What is the only stage of gallbladder cancer that has an excellent prognosis?
T1a (cancer limited to mucosa and lamina propria)
What percent of patients with Primary sclerosing cholangitis develop cholangiocarcinoma?
10-36%
What is Courvoisier’s sign?
Palpable gallbladder
What is T1b gallbladder CA?
CA into the muscularis mucosa
