Hepatology: Cancer

Question 1

What is the most common type of liver tumour?

Answer 1

Secondary metastatic tumours

Question 2

Where is the typical origin of liver metastases?

Answer 2

Breast, lung or GI tract

Question 3

Where is hepatocellular carcinoma (HCC) common?

Answer 3

China and Africa

Question 4

How does HCC present?

Answer 4

1) Fatigue
2) Reduce appetite
3) RUQ pain
4) Weight loss
5) Jaundice
6) Ascites
7) Haemobilia
8) Hepatomegaly (RUQ mass)

Question 5

What is the leading cause of HCC?

Answer 5

Hepatitis B

Question 6

What are risk factors for HCC?

Answer 6

1) Hepatitis B
2) Hepatitis C
3) Autoimmune hepatitis
4) Cirrhosis - alcohol, hereditary haemochromatosis, primary biliary cholangitis
5) NAFLD
6) Family history
7) Diabetes
8) Obesity
9) Clonorchis sinensis

Question 7

How do you diagnose HCC?

Answer 7

4 phase CT abdo pelvis + MRI + liver biopsy

Question 8

Which tumour marker is raised in HCC?

Answer 8

AFP

Question 9

What are treatment options for HCC?

Answer 9

1) Hepatic resection
2) Liver transplantation
3) Radiofrequency ablation

Question 10

What is cholangiocarcinoma?

Answer 10

Biliary tree cancer

Question 11

What is cholangiocarcinoma?

Answer 11

Biliary tree cancer

Question 12

What are risk factors for cholangiocarcinoma?

Answer 12

1) Clonorchis sinensis - parasites (eastern Asia)
2) Primary sclerosing cholangitis
3) Biliary cysts
4) Caroli’s disease
5) Hepatitis B + C
6) Diabetes
7) Biliary-enteric drainage surgery

Question 13

How does cholangiocarcinoma present?

Answer 13

1) Fever
2) Abdominal pain ± ascites
3) Malaise
4) Raised bilirubin
5) Raised ALP

Question 14

What can be used to prevent hepatocellular carcinoma?

Answer 14

Hepatitis B vaccination

Question 15

What can be used to improve QOL in cholangiocarcinoma?

Answer 15

Stenting

Question 16

What tumour marker is positive in cholangiocarcinoma?

Answer 16

CA19-9

Question 17

What is the genetic inheritance of Gilbert’s syndrome?

Answer 17

Autosomal recessive

Question 18

What causes Gilbert’s syndrome?

Answer 18

Decreased activity of the enzyme that conjugates bilirubin with glucuronic acid owing to a mutation in the UGT1A1 gene

Question 19

Which gene is mutated in Gilbert’s syndrome?

Answer 19

UGT1A1 gene

Question 20

What are the clinical features of Gilbert’s syndrome?

Answer 20

Intermittent mild jaundice in relation to stress, fasting, infection or exercise

Question 21

What do blood tests show in Gilbert’s syndrome?

Answer 21

Mildly increased bilirubin but normal FBC

Question 22

What is ascites?

Answer 22

Accumulation of fluid within the peritoneal cavity

Question 23

What causes ascites in cirrhosis?

Answer 23

Portal hypertension causing increased hydrostatic pressure leading to transudation of fluid

Question 24

How is the serum ascites albumin gradient (SAAG) calculated?

Answer 24

Subtracting the albumin concentration of the ascitic fluid from the serum albumin concentration

Question 25

What are causes of a high SAAG > 1.1?

Answer 25

1) Cirrhosis
2) Heart failure
3) Budd Chiari syndrome
4) Constrictive pericarditis
5) Hepatic failure
A high SAAG (>1.1g/dL) suggests that the cause of the ascites is due to raised portal pressure. Raised hydrostatic pressure forces water into the peritoneal cavity whilst albumin remains within the vessels, thus resulting in a higher difference in the albumin concentration between the serum and ascitic fluid

Question 26

What are causes of a low SAAG < 1.1?

Answer 26

Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome