Liver Flashcards
epidemiology
18th most common in UK, 6th most common in the world
38% increase by 2035
8th most common death
1/58 males diagnosed
1/122 females diagnosed
aetiology
liver cirrhosis
obesity
smoking
long term infections: Hep B/C
liver flukes: parasites in contaminated food/water
what is the most common pathology
hepatic cell carcinoma (85%)
what are the other pathology types
cholangiosarcoma of bile duct
angiosarcoma - vascular cancer
hepatoblastoma
liver mets from other primary sites
diagnosis
active surveillance: high risk patients with hep B/C
CT/MRI
US
blood tests: raised LFT may indicate something other than liver cancer
biopsy
what are the spread types
local/primary and lymphatics
what is the primary spread
mets in other lobes
multiple in the liver
lung/live from blood
gall bladder
what is the ;lymphatic spread
hepatic
coeliac
para-aortic
what staging is used
BCLC = Barcelona Clinic Liver Cancer
what does the BCLC look at
performance status: fitness level, child Pugh score (liver function), and number and size of the tumours
what does the staging system determine
the treatment most suitable/ advised treatment route
RFA
Radio-frequency ablation, high RF waves are used
PEI
Percutaneous Ethanol Injection
when is surgery the treatment
early stages
are high doses required
yes, they are necessary for killing the tumour
presentation
jaundice: yellow pigmented skin, white spots in the eyes due to excess bilirubicin in the blood
abdominal pain
vomiting
weight-loss is RARE
physical lump
uncontrolled fever (jaundice or functional issue)
ascites: build up of fluid in the peritoneum, could be confused with bloating
shoulder pain, due to the nerves being trapped
what is the dose for RT for single centres
66Gy in 33
what is SIRT
selective internal radiotherapy
injects radioactive beads into the tumour
what types of RT can be given
TACE + RT
SABR/SBRT [most common, takes 45 minutes], VMAT is RARE
what is the predominant dose for RT
54Gy in 30
what is the survival rate
63-76%
what does TACE stand for
Trans Arterial Chemo Emobilisation
what is TACE
high dose of chemo (doxorubicin/cisplatin) are injected into the tumour injected, the contrast which is used to highlight the vessels is injected into the femoral artery, making it less systemic. This reduces the blood supply to the tumour, causing it to be starved of O2 and nutrients required for growth.
why is TACE normally before RT
RT can shrink the vessels making it more difficult for TACE to work
