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Pelvis and Abdomen: R&O > Liver > Flashcards

Liver Flashcards

1
Q

epidemiology

A

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

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2
Q

aetiology

A

liver cirrhosis
obesity
smoking
long term infections: Hep B/C
liver flukes: parasites in contaminated food/water

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3
Q

what is the most common pathology

A

hepatic cell carcinoma (85%)

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4
Q

what are the other pathology types

A

cholangiosarcoma of bile duct
angiosarcoma - vascular cancer
hepatoblastoma
liver mets from other primary sites

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5
Q

diagnosis

A

active surveillance: high risk patients with hep B/C
CT/MRI
US
blood tests: raised LFT may indicate something other than liver cancer
biopsy

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6
Q

what are the spread types

A

local/primary and lymphatics

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7
Q

what is the primary spread

A

mets in other lobes
multiple in the liver
lung/live from blood
gall bladder

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8
Q

what is the ;lymphatic spread

A

hepatic
coeliac
para-aortic

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9
Q

what staging is used

A

BCLC = Barcelona Clinic Liver Cancer

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10
Q

what does the BCLC look at

A

performance status: fitness level, child Pugh score (liver function), and number and size of the tumours

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11
Q

what does the staging system determine

A

the treatment most suitable/ advised treatment route

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12
Q

RFA

A

Radio-frequency ablation, high RF waves are used

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13
Q

PEI

A

Percutaneous Ethanol Injection

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14
Q

when is surgery the treatment

A

early stages

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15
Q

are high doses required

A

yes, they are necessary for killing the tumour

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16
Q

presentation

A

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

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17
Q

what is the dose for RT for single centres

A

66Gy in 33

18
Q

what is SIRT

A

selective internal radiotherapy
injects radioactive beads into the tumour

19
Q

what types of RT can be given

A

TACE + RT
SABR/SBRT [most common, takes 45 minutes], VMAT is RARE

20
Q

what is the predominant dose for RT

A

54Gy in 30

21
Q

what is the survival rate

A

63-76%

22
Q

what does TACE stand for

A

Trans Arterial Chemo Emobilisation

23
Q

what is TACE

A

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.

24
Q

why is TACE normally before RT

A

RT can shrink the vessels making it more difficult for TACE to work

25
Q

Inclusion criteria for TACE

A

1-3 mets
unsuitable for surgery
curative intent (LE>6months)
max size of met is <6cm
class A CPS

26
Q

exclusion criteria for TACE

A

hepatitis or liver failure
previous RT to liver

27
Q

what is SABR

A

Stereo Ablative RT
short dose regimes with high doses in less fractions, for patients unsuitable for treatment via surgery, early stages with no distant mets

28
Q

types of doses for SABR

A

40-60Gy in 3 (alternate days)
50-60Gy in 5 fractions (alternate or daily)
30-60Gy in 10 fractions (TV doesn’t meet SABR eligibility)

29
Q

what is the palliative RT

A

20Gy in 5 or 30Gy in 10
ant and post field

30
Q

where are mets found

A

colorectal
lung
stomach
breast
prostate
pancreas
skin
oesophagus

31
Q

breathing immobilisation techniques

A

SGRT
Exhale hold
Metronome - control breathing in and out
Compression belt, abdominal bridge, thermoplastic

32
Q

what is the issue with irradiating the liver

A

you might irradiate the skin or duodenum

33
Q

what happens during tumour lysis

A

the body goes into overdrive, risk of sepsis
uncontrolled fever and immune response

34
Q

what does bigger mets lead to

A

bigger cell death and bigger issues

35
Q

what does velindre do

A

wing board
free breathing
full inhale and exhale = ITV
CBCT- 10 min later, CBCT again to check no inter fraction motion of day 0
0 tol

36
Q

what do other centres do

A

breath-hold/ exhale
Vacfix on wing board
4DCT on CBCT software
FFF for high dose rate

37
Q

what are the RT side effects and complications

A

skin
nausea
diarrhoea
loss of appetite
fatigue
radiation induced liver damage: low Childs Pugh score
SABR daily toxicity scoring

38
Q

what’s the survival if mets are treated with SABR

A

70-100%

39
Q

what happens with late presentation

A

poor prognosis

40
Q

what does active surveillance allow for?

A

early detection of liver mets

Pelvis and Abdomen: R&O (22 decks)

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