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Gastrointestinal > Hepatobiliary CA > Flashcards

Hepatobiliary CA Flashcards

1
Q

The majority of liver CA are what?

A

Mets from other organs

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2
Q

The falciform ligament separates what parts of the liver?

A

lobes 2 and 3

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3
Q

What is the most common benign condition of the liver that is mistaken for hepatocellular CA? What are the other three?

A

Focal nodular hyperplasia

Simple cysts
Hemangiomas
Adenomas

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4
Q

What type of drugs are associated with liver adenomas? What are the cells that are found within these lesions?

A

Oral contraceptives

Only Hepatocytes

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5
Q

How often are liver adenomas symptomatic?

A

50% of the time

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6
Q

Which gender usually gets FNH?

A

Women

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7
Q

How do you diagnose FNH? What is the characteristic finding?

A

Characteristic CT findings (macroscopic central scar)

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8
Q

What are the cell types within FNH?

A

Hepatocytes
Scar
Biliary tract

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9
Q

True or false: focal nodular hyperplasia is not seen well on ultrasound

A

True

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10
Q

What is the most common benign primary tumor of the liver? What are they? What is the treatment?

A

Hemangioma

Endothelium lined, blood filled spaces

Unless really big (greater than 5 cm), nothing

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11
Q

What is the most common primary malignant tumor of the liver?

A

Hepatocellular CA

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12
Q

Why is HCC common in other countries? Why is there a rise in the US?

A

Viral hepatitis B

Rise in Hep C in US

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13
Q

What are the risk factors for HCC? (gender, infx, liver conditions)

A 
Male
Aflatoxin
Hepatitis
Cirrhosis
Liver diseases
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14
Q

What are aflatoxins?

A

Toxins produced by aspergillus species, and is commonly on food products

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15
Q

What are the three forms of hepatocellular CA?

A

Solitary
Diffuse
Fibrolamellar

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16
Q

What is hepatoblastoma?

A

Childhood liver cancer of blastomas

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17
Q

In whom is the fibrolamellar HCC more common? Why do these have a better outcome?

A

women younger than 35

Does not cause cirrhosis or does not completely affect the liver

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18
Q

What is the protein that is followed with HCC? What is this used for?

A

Alpha-fetoprotein

Not used for screening–follow pt levels after a surgical resection

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19
Q

In whom is HCC common?

A

males above 60 yo

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20
Q

What is the best way to diagnose hepatocellular CA?

A

Imaging

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21
Q

What is the most common surgery for liver cancer? Are transplants common for liver cancer?

A

Lobectomy

Transplant rare–usually used for other diseases

22
Q

What are the three challenges of liver surgery?

A
  1. Dual blood supply
  2. Hepatic reserve (need enough)
  3. Coagulopathy
23
Q

What is the measurement of hepatic reserve? What is measured for this score? What is class A?

A

Child-Pugh score (lower is better)

  • Encephalopathy
  • Ascites
  • Albumin
  • PT
  • Bili

6 points or less is class A

24
Q

What are the optimal characteristics for liver resection?

A

Solitary tumors without major vascular invasion

25
Q

How good is the survival rate after a liver surgery for HCC? Recurrence rate?

A

50% live 5 years

70%

26
Q

How is radiofrequency performed?

A

Microwave ablation percutaneously

27
Q

What are the three general types of embolization for liver CA?

A

Arterial embolization
Chemoembolization
Radioembolization

28
Q

What is the chemo agent for HCC? MOA?

A

Sorafenib

Blocks tumors from forming new blood vessels, and slows the growth by binding surface proteins

29
Q

What are the three classifications of intrahepatic cholangiocarcinomas?

A

Intrahepatic
Perihilar
Distal

30
Q

How is intrahepatic cholangiocarcinoma treated?

A

Like primary liver CA

31
Q

Where are the majority of cholangio CAs? What age?

A

Perihilar region

Greater than 65 yo

32
Q

True or false: most pts with cholangiocarcinoma have no known risk factors

A

True

33
Q

What are the risk factors for cholangiocarcinoma? (infx, autoimmune)

A

Chinese liver fluke

Sclerosing cholangitis

34
Q

What is the ab that is elevated with primary biliary cirrhosis?

A

AMA

35
Q

What is the antibody that is elevated with Primary sclerosing cholangitis?

A

pANCA

36
Q

Which gallbladder cancer is associated with UC?

A

Primary sclerosing cholangitis

37
Q

What are the ssx of bile duct carcinoma?

A

Biliary tract obstructive ssx

38
Q

What are the markers for bile duct carcinomas? (2)

A

CA19-9 or CEA

39
Q

What are the ways to diagnose cholangiocarcinoma?

A

ERCP and imaging

40
Q

What is the treatment for cholangiocarcinoma?

A

Surgical excision

Biliary decompression/relief of obstruction

41
Q

What is the reconstruction surgery that is used to treat cholangiocarcinoma? How effective is this?

A

Roux-en-y (hepaticojejunostomy)

Still really poor outcomes

42
Q

Is radiation effective for cholangiocarcinoma? Chemo?

A

Not really–increase survival by 2 months

Chemo ineffective

43
Q

What is the survival rate like with late cholangiocarcinoma?

A

Really poor

44
Q

What is the classic patient for gallbladder CA? Survival rates?

A

elderly women without liver disease (chilean women in particular)

Really low survival rates

45
Q

What are the characteristics of gallbladder cancer?

A

Aggressive and metastasizes quickly

46
Q

Who is the classic patient for HCC?

A

elderly man with liver disease

47
Q

What is a porcelain gallbladder?

A

Calcification of the gallbladder d/t gallbladder cancer

48
Q

Gallstones are present in what percent of gallbladder cancer pts? Why is this significant?

A

75-98%

Not necessarily significant, since a lot of people have gallstones

49
Q

What is the only stage of gallbladder cancer that has an excellent prognosis?

A

T1a (cancer limited to mucosa and lamina propria)

50
Q

What percent of patients with Primary sclerosing cholangitis develop cholangiocarcinoma?

A

10-36%

51
Q

What is Courvoisier’s sign?

A

Palpable gallbladder

52
Q

What is T1b gallbladder CA?

A

CA into the muscularis mucosa

Gastrointestinal (42 decks)

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