Hepatobilliary Neoplasia Flashcards
The most common neoplasms of the liver are:
Metastatic tumors
The most common tumor sites that metastasize to the liver are?
Colon, Stomach, Pancrea, Breast, Lung
Cancer sometimes penetrates benign liver
Hepatocellular carcinoma prognosis?
Its bad, less than 5%
Hepatocellular carcinoma is what>
Malignant epithelial neoplasm of the liver composed of cells resembling hepatocytes to a greater or lesser degree
Epidemiology of hepatocellular carcinoma?
3x more common in males, 3x more common in asian americans
Hepatocellular carcinoma is most common in pts with what?
Viral hepatitis
Pts with hepatocellular carcinoma present with what?
Jaundice, encephalopathy, ascites, bleeding, mild-moderate abdominal pain, wt. loss, diarrhea, bone pain
What are the useful predictors of prognosis for hepatocellular carcinoma?
Size
Differentiation
Invasion and Metastasis
Presence or Absence of Cirrhosis
Why is biopsy a risky procedure in HCC?
Because many Hepatocellular carcinomas are highly vascularized. You can get a massive hemorrhage if you’re not careful
Most common HCC histologic patterns?
Microtrabecular and macrotrabecular
Major serum protein marker for hepatocellular carcinoma
alpha-fetoprotein
Whats the problem with alpha fetoprotein being the major marker?
It is also elevated in acute or chronic liver injury, gonadal tumors, pregnancy, and some gastric cancers
Over 20 the specificity is 91%
Over 200 the specificity is 99%
What is the mainstay treatment for liver cancer?
Surgical resection
Surgical resection is problematic however because most pts are not eligible due to tumor extent or underlying liver dysfunction
ok
What are some other treatments for liver cancer?
Inject ethanol into the tumor…pretty awesome
Hepatic adenomas are most common in what kinds of pts
Those who have taken or are taking anabolic steroids, androgenic steroids, or estrogenic steroids
BIRTH CONTROL
Are hepatic adenomas malignant?
nope…they go away when you stop taking the drug
Note that hepatic adenomas may expand during pregnancy because of the increase in estrogen levels…tehy are estrogen sensitive. This increases the possibility of rupture and intraperitoneal hemorrhage.
The tumors will regress as soon as the pregnancy is over though
Most common benign tumor in the liver
Hemangioma
Hemangioma histo>
blood filled vascular space
Hepatoblastoma
Rare malignant epithelial neoplasm in children
Cholangiocarcinoma
Malignant epithelial neoplasm with Biliary differentiation
Cholangiocarcinoma epidemiology
more common in males
Ages 50-70
Cholangiocarcinoma strongly associated with what other condition
Primary sclerosing cholangitis
Extrahepatic cholangiocarcinoma at the bifurcation of the hepatic bile duct is called?
Klatskin tumor
KRAS mutation in what percent of intrahepatic tumors?
Extrahepatic
50%
15% extrahepatic
appearance of cholangiocarcinoma?
tan-white (no bile made)
cholangiocarcinoma spreads mostly via what route?
Lymph
Cholangiocarcinoma histo
abnormal tubular structures embedded in a dense fibrous matrix
Extrahepatic cholangiocarcinoma symptoms
Pruritis, RUQ pain, wt loss, Jaundice, clay colored stool and dark urine,
Lab: high bilirubin
highalk phos
Entrahepatic cholangiocarcinoma symptoms
dull RUQ pain and wt loss
Lab: bilirubin may be normal or a little high
alk phos will be high
Cholangiocarcinoma prognosis
Bad
Gall Bladder carcinoma more common in who
Its really rare overall but most common in females, hispanics, native americans
Risk factors of gall bladder cancer?
gall stones
Liver mets have what appearance
multiple, rounded, potentially hemorrhagic or necrotic
Liver mets often allow surprisingly normal function of the liver due to regeneration capacity
ok
