Hepatology: Cancer Flashcards
What is the most common type of liver tumour?
Secondary metastatic tumours
Where is the typical origin of liver metastases?
Breast, lung or GI tract
Where is hepatocellular carcinoma (HCC) common?
China and Africa
How does HCC present?
1) Fatigue
2) Reduce appetite
3) RUQ pain
4) Weight loss
5) Jaundice
6) Ascites
7) Haemobilia
8) Hepatomegaly (RUQ mass)
What is the leading cause of HCC?
Hepatitis B
What are risk factors for HCC?
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
How do you diagnose HCC?
4 phase CT abdo pelvis + MRI + liver biopsy
Which tumour marker is raised in HCC?
AFP
What are treatment options for HCC?
1) Hepatic resection
2) Liver transplantation
3) Radiofrequency ablation
What is cholangiocarcinoma?
Biliary tree cancer
What is cholangiocarcinoma?
Biliary tree cancer
What are risk factors for cholangiocarcinoma?
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
How does cholangiocarcinoma present?
1) Fever
2) Abdominal pain ± ascites
3) Malaise
4) Raised bilirubin
5) Raised ALP
What can be used to prevent hepatocellular carcinoma?
Hepatitis B vaccination
What can be used to improve QOL in cholangiocarcinoma?
Stenting
What tumour marker is positive in cholangiocarcinoma?
CA19-9
What is the genetic inheritance of Gilbert’s syndrome?
Autosomal recessive
What causes Gilbert’s syndrome?
Decreased activity of the enzyme that conjugates bilirubin with glucuronic acid owing to a mutation in the UGT1A1 gene
Which gene is mutated in Gilbert’s syndrome?
UGT1A1 gene
What are the clinical features of Gilbert’s syndrome?
Intermittent mild jaundice in relation to stress, fasting, infection or exercise
What do blood tests show in Gilbert’s syndrome?
Mildly increased bilirubin but normal FBC
What is ascites?
Accumulation of fluid within the peritoneal cavity
What causes ascites in cirrhosis?
Portal hypertension causing increased hydrostatic pressure leading to transudation of fluid
How is the serum ascites albumin gradient (SAAG) calculated?
Subtracting the albumin concentration of the ascitic fluid from the serum albumin concentration
What are causes of a high SAAG > 1.1?
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
What are causes of a low SAAG < 1.1?
Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome
