Liver cancer

Question 1

Pathology

Answer 1

90% of liver tumours are secondary metastases

Men: stomach, lung, colon
Women: breast, colon, stomach, uterus

90% of primary tumours are hepatocellular carcinomas

Question 2

Symptoms

Answer 2

Benign tumours are usually asymptomatic

Systemic: FLAWS

RUQ pain: stretching of Glisson’s capsule

Jaundice is often late, except in cholangiocarcinoma

May rupture → intraperitoneal haemorrhage

Question 3

Signs of HCC

Answer 3

Hepatomegaly: smooth or hard and irregular
Signs of chronic liver disease
Abdominal mass
Hepatic bruit (HCC)

Question 4

Ix

Answer 4

Abdo exam
Basic obs
Bloods: LFTs, hepatitis serology, AFP

Imaging:
USS or CT / MRI ± guided diagnostic biopsy

ERCP + biopsy in suspected cholangiocarcinoma

Find primary:
Colonoscopy, mammography

Question 5

Risk factors

Answer 5

Viral hepatitis

Cirrhosis: EtOH, PBC

Question 6

Mx of liver cancer

Answer 6

Resection of solitary tumours

Chemo, percutaneous ablation and embolization

Question 7

Cholangiocarcinoma

Answer 7

Biliary tree malignancy

Question 8

Commonest cause of hepatocellulat carcinoma

Answer 8

Hepatitis B