Liver & Biliary Neoplasms Flashcards
what is the most common benign liver neoplasm? what is it associated with?
cavernous hemangioma
oral contraceptive pills
what symptoms will a patient with a benign liver neoplasm present with? (2)
RUQ pain
+/- palpable RUQ mass
what imaging is preferred for a benign liver neoplasm?
multiphase CT/MRI
in which patients is surgical resection of a benign neoplasm done? (3)
symptomatic lesion
tumor > 5cm
rapidly enlarging tumor
when can benign liver adenomas regress?
when OCPs are stopped
malignant neoplasms that form from the liver’s normal hepatocytes
hepatocellular carcinoma
what is the most common risk factor for hepatocellular carcinoma?
cirrhosis
a patient presents with cachexia, bitemporal wasting, fatigue, ascites +/- blood, palpable liver enlargement and auscultation of bruit over tumor within the liver. Dx?
hepatocellular carcinoma
what labs will be found in a patient with hepatocellular carcinoma? (4)
leukocytosis
anemia
elevated liver enzymes
elevated alpha-fetoprotein
what is the marker for hepatocellular carcinoma?
alpha-fetoprotein
what will be present if a patient has hepatocellular carcinoma with viral load or antibodies?
concurrent hepatitis
what imaging is used to determine location and vascularity of hepatocellular carcinoma?
CT / MRI
what imaging is used to diagnose hepatocellular carcinoma?
multiphasic CT or MRI with contrast
what gives a definitive diagnosis of hepatocellular carcinoma?
liver biopsy
what is the protocol of imaging if a hepatocellular lesion is <1cm? (2)
US q 3 months
biopsy if lesion enlarges
what is the treatment for hepatocellular carcinoma that offers the best prognosis for patients with early HCC?
hepatic resection + liver transplant
what are 2 palliative treatments for HCC in patients who are non-surgical candidates? (2)
radiofrequency ablation
sorafenib
in which patients should we screen for HCC? (2)
chronic HBV
cirrhosis due to HBV, HBV, or alcohol
what is the surveillance method for HCC?
U/S + alpha-fetoprotein q 6 months
what is the most common neoplasm of the pancreas? and which part of the pancreas?
pancreatic adenocarcinoma
head
a pancreatic adenocarcinoma is most symptomatic if it’s located where in the pancreas?
head
in which patients should we suspect pancreatic cancer?
middle-age or older patients with weight loss and/or painless jaundice
what indicates advanced disease beyond the pancreatic cancer?
pain
a patient presents with diarrhea, migratory thrombophlebitis, weight loss, satiety, and silver stools (thomas sign). Dx?
pancreatic cancer
what are 2 clinical signs that would indicate pancreatic cancer?
Courvoisier sign (palpable nontender gallbladder)
sister mary joseph nodule (hard periumbilical nodule d/t mets to abdominal wall)
what labs will be present in a patient with pancreatic cancer? (5)
mild anemia
CA19-9
+ FOB test
+/- DM/hyperglycemia
+/- elevated amylase/lipase
what will indicate biliary obstruction in a patient with pancreatic cancer?
elevated LFTs
what is elevated with neuroendocrine tumors in a patient with pancreatic cancer?
plasma chromogranin A
what is the 1st line diagnostic for pancreatic cancer?
multiphase, thin cut CT with contrast
what diagnostic will provide a definitive diagnosis for pancreatic cancer?
percutaneous FNA
what is the treatment of choice for carcinoma of the head of the pancreas without evidence of extension or mets?
surgical resection (whipple)
AKA pancreaticoduodenal resection
what treatment can be used for non-surgical candidates to relieve jaundice?
endoscopic stenting
