Liver Cancer

Question 1

What are the two types of liver cancer?

Answer 1

Hepatocellular carcinoma (80%)
Cholangiocarcinoma (20%)

Question 2

What are the causes of hepatocellular carcinoma?

Answer 2

Viral hepatitis (B and C)
Alcohol
Non alcoholic fatty liver disease
Other chronic liver disease

Question 3

What are the causes of cholangiocarcinoma?

Answer 3

Cholangiocarcinoma is associated with primary sclerosing cholangitis.

Question 4

What investigations would be used for investigating liver cancer?

Answer 4

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 brishings

Question 5

What are the treatment options for hepatocellular carcinoma?

Answer 5

There are several kinase inhibitors that are licensed as medical treatment for HCC. They work by inhibiting the proliferation of cancer cells. Some examples of these are sorafenib, regorafenib and lenvatinib. They can potentially extend life by months.

Generally resistant to chemos -> poor diagnosis unless diagnosed early

Question 6

What is the treatment for cholangiocarcinoma?

Answer 6

Cholangiocarcinomas have a very poor prognosis unless diagnosed very early. Early disease can potentially be cured with surgical resection.

ERCP can be used to place a stent in the bile duct where the cholangiocarcinoma is compressing the duct. This allows for drainage of bile and usually improves symptoms.

Cholangiocarcinoma is also generally considered resistant to chemo and radiotherapy.

Question 7

What is focal nodular hyperplasia?

Answer 7

Focal nodular hyperplasia is a benign liver tumour made of fibrotic tissue. This is often found incidentally. It is usually asymptomatic and has no malignant potential. It is often related to oestrogen and is therefore more common in women and those on the oral contraceptive pill. No treatment of monitoring is required.

Question 8

What factors suggest unsuitability for a liver transplant?

Answer 8

Significant co-morbidities (e.g. severe kidney or heart disease)
Excessive weight loss and malnutrition
Active hepatitis B, hepatitis C or other infection
End-stage HIV
Active alcohol use (generally 6 months of abstinence is required)