Liver cancer Flashcards
Two types of primary liver cancer (that originate in the liver)
hepatocellular carcinoma (80%)
cholangiocarcinoma (20%).
Liver cancer mets can occur from which primary sites?
Metastasis to the liver can occur in almost any cancer that spreads.
There is a poor prognosis of any cancer with liver metastasis.
Risk factors for HCC
Main risk factor is liver cirrhosis due to any of:
- Viral hepatitis B/C
- Alcohol
- NAFLD
- Other chronic liver disease
Patients with chronic liver disease are screened for HCC
Cholangiocarcinoma is associated with…
PSC
However, only 10% of patients with cholangiocarcinoma had primary sclerosing cholangitis
Presentation of HCC
Weight loss Abdominal pain Anorexia Nausea and vomiting Jaundice Pruritus
Cholangiocarcinoma presentation
Painless jaundice in a similar way to pancreatic cancer.
Weight loss
Anorexia
N+V
Investigations in suspected liver cancer
Alpha-fetoprotein is a tumour marker for hepatocellular carcinoma.
CA19-9 is a tumour marker for cholangiocarcinoma.
Liver ultrasound can identify tumours.
CT and MRI scans are used for diagnosis and staging of the cancer.
ERCP can be used to take biopsies or brushings to diagnose cholangiocarcinoma.
Prognosis and treatment of HCC
HCC has a very poor prognosis unless diagnosed early.
Resection can be curative in early disease
Liver transplant can be done if cancer confined to the liver
Kinase inhibitors can be used to prevent cancer proliferation e.g. sorafenib, lenvatinib
Radiotherapy may also be used
Prognosis and treatment of cholangiocarcinoma
Poor prognosis, unless early diagnosis
Early disease may be cured with surgical resection
ERCP + stent can allow drainage of bile and improve Sx
Generally resistant to chemo and radiotherapy.
What is a haemangioma?
Haemangiomas are common benign tumours of the liver.
Often found incidentally.
They cause no symptoms and have no potential to become cancerous.
No treatment needed
What is focal nodular hyperplasia?
Benign liver tumour made of fibrotic tissue
Usually asymptomatic
No malignant potential
Often related to oestrogen (more common in women and those on OCP)
No treatment needed
What are some benign liver tumours?
Haemangioma
Focal nodular hyperplasia
