Hepatobiliary Malignancies

Question 1

What is the most common source of liver cancer?

Answer 1

Metastasis from other organs.

Question 2

Which lobes does the falciform ligament run between?

Answer 2

Between2/3 and 4.

Question 3

What are the main functions of the liver?

Answer 3

Glycogen storage
Bile production
Coagulation factors
Blood filter

Question 4

What are the different Benign Liver Lesions

Answer 4

FNH-Focal Nodular Hyperplasia
Simple Cyst
Hemangioma
Adenoma

Question 5

What is the defining feature of Focal Nodular Hyperplasia?

Answer 5

Nodular hyperplastic parenchyma with one or more macroscopic central scars.

Question 6

What are the traits of Liver Cell Adenoma?

Answer 6

Rare proliferation of Benign hepatocytes
symptomatic 1/2 the time
Risk of rupture or malignant proliferation

Question 7

What are the traits of Hemangiomas?

Answer 7

Most common benign tumor of the liver;
microscopically, Endothelium lined, blood filled spaces;
>5cm are termed giant hemangiomas

Question 8

What is the type of liver cancer that develops from hepatocytes?

Answer 8

Hepatocellular Carcinoma

Question 9

What is cancer that develops within the intrahepatic bile ducts?

Answer 9

Cholangiocarcinoma

Question 10

What are the risk factors for HCC?

Answer 10

Males 
Aflatoxin
Hep B/C
Cirrhosis
Hemochromatosis
Wilson's disease
alpha 1 Anti Trypsin deficiency
NASH, Non-alcoholic Steatohepatitis

Question 11

What is the main cause of NASH?

Answer 11

Obesity

Question 12

What is the leading cause of cirrhosis?

Answer 12

Alcohol abuse

Question 13

What is the leading cause of Primary Billiary cirrhosis?

Answer 13

Autoimmune disease

Question 14

What are Aflatoxins?

Answer 14

Cancer causing substance that is produced from fungi. more common in warmer and tropical climates.

Question 15

What are the main types of HCC?

Answer 15

Hepatocellular: Solitary, diffuse, and fibrolamellar

Cholangiocarcinoma, and Hepabtoblastoma

Question 16

What is the tumor marker for HCC?

Answer 16

Alpha feto-protein(AFP)

Can monitor recurrence of tumors.

Question 17

What are surgical treatments for Liver Cancer?

Answer 17

Wedge Resection
Lobectomy
Trisegmentectomy
Liver Transplant-Rare

Question 18

What are the challenges of liver surgery?

Answer 18

Dual blood supply
Hepatic Reserve
Coagulopathy-removing the ability for the liver to produce clotting factors. Can be very bloody surgeries!

Question 19

What does the Pugh Score tell you?

Answer 19

Risk of adverse events in surgery.

Question 20

What defines an optimal tumor resection candidate?

Answer 20

Solitary tumors without major vascular invasion

Question 21

Which vessels are closed in Liver embolization treatment?

Answer 21

Hepatic arteries.

Question 22

What is the role of Sorafenib in Liver cancer therapy?

Answer 22

It is a targeted therapy that blocks tumors from forming new blood vessels. Targets surface proteins

Question 23

Where is the most common location of CholangioCA?

Answer 23

Perihilar Region (Branch ing point between ducts)

Question 24

What is the clinical presentation of CholangioCA?

Answer 24

Signs of Biliary Tract obstruction.

Painless Jaundice. Pruritis

Question 25

What is the Role of ERCP in CholangioCA?

Answer 25

Collect biopsies in Bile Duct, Stent, direct imaging.

Question 26

What procedure is used if there is distal location of cholangioCA?

Answer 26

Whipple Procedure

Question 27

What are palliative options for Cholangio CA?

Answer 27

Biliary Decompression/ relief of obstruction
Radiation
Chemotherapy

Question 28

In what demographic is Gallbladder cancer most common?

Answer 28

Leading cause of death in Chilean Women.
Rare in North America.
More common in Women

Question 29

What is a pocelain Gallbladder?

Answer 29

Calcification of the wall of the Gall Bladder

Question 30

What group of people does the best with Gallbladder cancer treatment?

Answer 30

T1a= cancer limited to mucosa and lamina propria.