Hepatobiliary cancers: liver and pancreas Flashcards
What is primary liver cancer?
Primary liver cancer is cancer that originates in the liver.
What are the 2 types of primary liver maligant tumours?
- Hepatocellular carcinoma (HCC) - 80%
- Cholangiocarcinoma - 20%
What are the 2 types of primary liver benign tumours?
- Haemangioma
- Hepatic adenoma
Define hepatocellular carcinoma.
The most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis.
Give 3 risk factors for HCC.
- Carriers of HBV and HCV (higher risk)
- Liver cirrhosis due to Alcohol
- Liver cirrhosis due to NAFLD
- Liver cirrhosis due to other chronic liver diseases e.g. haemochromatosis
- Males (90%)
Explain the pathophysiology of HCC.
- Arises from the liver parenchyma.
- Tumour is either single or occurs as multiple nodules throughout the liver.
- Consists of cells resembling hepatocytes.
- Metastasises via the hepatic or portal veins to the lymph nodes, bones and lungs.
Give 4 liver-related symptoms for HCC.
- Jaundice
- Ascites
- HE
- Pruritus (itching)
Give 4 non-specific symptoms for HCC.
- Weight Loss
- Fatigue
- Weakness
- Nausea + vomiting
Investigations for HCC diagnosis.
- 1st Line: Abdominal Ultrasound
- CT to confirm (GOLD STANDARD)
- Serum Alpha-Fetoprotein (AFP) = tumour marker for HCC
Management of HCC.
Poor Prognosis
1. Surgical resection of tumour/isoalted lesion
2. Liver Transplant (if isolated to the liver) = only chance for cure
Define cholangiocarcinoma.
AKA bile duct cancer - cancer of the biliary tree:
A type of cancer that forms in the bile ducts.
Give 4 risk factors for cholangiocarcinoma.
- Associated with infestation with parasitic worms (flukes) e.g. Clonorchis
sinensis - Biliary cysts
- Chronic Viral Hep B/C
- Liver cirrhosis
- Inflammatory bowel disease e.g. UC and Crohn’s
Briefly describe the pathophysiology of cholangiocarcinomas.
Arise from biliary tree – usually adenocarcinomas.
Usually slow-growing.
Give 3 signs of clinical presentation for cholangiocarcinoma.
Signs of cholecstasis:
1. Jaundice
2. Pale Stools
3. Dark Urine
4. Pruritus
5. Courvoisier’s Sign
Give 3 non-specific symptoms for cholangiocarcinoma.
- Weight Loss
- Fatigue
- Weakness
- Nausea + vomiting
Investigations for cholangiocarcinoma.
- 1st line – Abdominal Ultrasound and CT
- ERCP – used to take biopsies - Gold Standard
- CA19-9 – Tumour marker for Cholangiocarcinoma
- LFTs – raised bilirubin and ALP
Management of cholangiocarcinoma.
- Surgical resection is rarely possible and patients die within 6 months.
- Liver transplant is contraindicated.
- ERCP used to place a stent in the blocked duct = relieves symptoms.
What is the most common benign tumour in the liver?
Haemangioma
What is the most common liver tumour?
A secondary (metastatic) tumour
Define pancreatic cancer.
Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass.
These cancerous cells have the ability to invade other parts of the body.
The most common one is pancreatic adenocarcinomas.
Give 3 risk factors for pancreatic cancer.
- Smoking (associated with a 2-fold risk increase)
- T2DM
- Obesity
- Excess alcohol intake
- Chronic pancreatitis
- Genetic mutation predisposing to pancreatic cancer
- Presence of PRSS-1 mutation
- Fx
- Old age - 60+
Pathophysiology of pancreatic adenocarcinomas.
Adenocarcinoma typically in the head of the pancreas and can compress bile ducts.
Give 4 key signs of pancreatic cancer.
- Obstructive/Painless Jaundice
- Pale stools
- Dark urine
- Generalised itching (pruritus)
Also:
5. Weight loss
6. Worsening of T2DM (or new onset)
7. Can get epigastric pain that radiates to back (body and tail)
Which 2 named signs can be observed for pancreatic cancer?
- Courvoisier’s Sign
- Palpable gallbladder + jaundice = not due to gallstones
- The cause is usually cholangiocarcinoma or pancreatic cancer. - Trousseau’s sign of malignancy
- Refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic adenocarcinoma
- Thrombophlebitis is where blood vessels become inflamed with an associated blood clot (thrombus) in that area.
- Migratory refers to the thrombophlebitis reoccurring in different locations over time.
Investigations for pancreatic cancer.
- Abdominal Ultrasound
- CT of pancreas / CT TAP
- Identifies mass and helps with staging of cancer
- GOLD STANDARD - Tumour marker – CA19-9
- Not diagnostic but helps with monitoring progression
Management for pancreatic cancer.
- Management will be decided at a hepatobiliary (HPB) MDT meeting.
- Surgery to remove tumour
- Total pancreatectomy
- Distal pancreatectomy
- Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)
- Radical pancreaticoduodenectomy (Whipple procedure) - Palliative treatment:
- Stents inserted to relieve the biliary obstruction
- Surgery to improve symptoms (e.g., bypassing the biliary obstruction)
- Palliative chemotherapy (to improve symptoms and extend life)
- Palliative radiotherapy (to improve symptoms and extend life)
- End of life care with symptom control
