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House AMP > Liver Cancer > Flashcards

Liver Cancer Flashcards

1
Q

Worldwide, liver cancers are the ________ most common cause of cancer-related death and rank _______ in terms of incident cases.

A

fourth; sixth

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2
Q

On the basis of annual projections, the World Health Organization estimates that more than _________ patients will die from liver cancer in 2030.

A

1 million

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3
Q

In the United States, the rate of death from liver cancer increased by 43% (from 7.2 to 10.3 deaths per 100,000) between 2000 and 2016.

T/F

A

T

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4
Q

Liver cancer is the _______ most lethal tumor, after _________ cancer.

The 5 year survival is _____%

A

second; pancreatic

18

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5
Q

The majority of hepatocellular carcinomas occur in patients with ___________________, mostly as a result of _______________________ infection or __________.

A

underlying liver disease

hepatitis B or C virus (HBV or HCV)

alcohol abuse

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6
Q

Malignant tumours of the liver

________ tumors
_________ or ________ tumours

A

Primary

Secondary or metastatic

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7
Q

Malignant tumours of the liver
Primary tumors
__________ carcinoma
 _________carcinoma
_________________
_____________-associated with ________,________, or ________

A

Hepatocellular

Cholangio

Hepatoblastoma

Angiosarcoma

vinyl chloride, arsenic or thorotrast

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8
Q

Malignant tumors of the liver

Secondary or metastatic tumours
_____________
 ______
__________
 _______
_______
others

A

Neuroendocrine

Pancreas

Colorectal

Breast

Lung

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9
Q

Hepatocellular carcinoma

 Synonyms: ________________________________ (PLCC), ___________

 Accounts for ______% of all primary liver cancer

A

prmary liver cell carcinoma; hepatoma

> 90

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10
Q

Hepatocellular carcinoma

 Incidence highest in Korea, Taiwan, Mozambique & SE Asia

 (Blacks or Whites?) >(black or whites?)
 (Male or Female?) >(male or female?)

A

Blacks>whites

Male>female

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11
Q

Pathogenesis of liver cancer

 Patients with chronic liver disease have sustained hepatic _________,_________ , and aberrant ________

 These abnormalities can cause ——— and favor a series of _____ and _________ events.

 These culminate in the formation of _________________, which are bona fide _____________

A

inflammation, fibrosis

hepatocyte regeneration.

cirrhosis; genetic and epigenetic

dysplastic nodules

preneoplastic lesions

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12
Q

Genetic Alterations

 Hepatocellular carcinoma cells accumulate _________ alterations, including _______ and ________ aberrations.

A

somatic DNA; mutations and chromosomal

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13
Q

Genetic Alterations

 Mutations in the _________ are the most frequent genetic alterations, accounting for approximately ____% of cases.

A

TERT promoter

60

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14
Q

Genetic Alterations

 They can be detected in _________, and the _________ is a recurrent insertion site for the genome of HBV.

A

dysplastic nodules

TERT promoter

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15
Q

Genetic Alterations

Besides TERT PROMOTER:

 Other mutations involve: ______ (30%); ________ (30%); ________ (10%) etc.

A

TP53

CTNNB1

ARID1A

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16
Q

Genetic Alterations

Besides TERT PROMOTER:

 Other mutations involve: TP53 (____%); CTNNB1 (_____%); ARID1A (___%) etc.

A

30

30

10

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17
Q

pathogenesis: HBV

 Integration of viral DNA leading to __________ that ends up in ______________ ___________

 ____ protein is also proposed to play a role such as:

•Disrupt __________ of infected cells

•Bind _____ gene & interferes with ________

A

mutation; malignant transformation

HBx; normal growth control

p53; growth suppression

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18
Q

pathogenesis of liver cancer

_________ and ______ disease in developed countries

A

HCV & Alcoholic liver

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19
Q

pathogenesis of Liver cancer

_________-products intercalate into DNA and promote mutation

A

Aflatoxins

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20
Q

pathogenesis of liver dancer

_______–HCV,alcohol, haemochromatosis & other causes of cirrhosis

A

Cirrhosis

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21
Q

Morphology-gross

 _____focal (small or large?) mass

______-focal masses of ______ sizes

 Diffusely _____ tumour involving the _____

_____ stain with _____ hue

 (loose or Firm?) and gritty

 Vascular invasionportal veinIVCright atrium

A

Uni; large

Multi; varying

infiltrative; whole liver

Bile; greenish

Firm and gritty

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22
Q

microscopy of liver cancer

Ranges from ___________ tumour to _____________ tumour

A

well differentiated

anaplastic undiffrentiated

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23
Q

microscopy of liver cancer

Well-differentiated tumour-
__________ hepatocytic tumour cells
 Form _______,_______, or _________ patterns

A

Recognizable

trabecular, acinar or pseudo-glandular

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24
Q

microscopy of liver cancer

Poorly-differentiated tumour-
 ___________ cells with numerous _________ cells
________ shaped sarcomatous type

A

pleomorphic; anaplastic giant

spindle

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25
Q

Fibrolamellar carcinoma

 Occur in (young or old?) male & female age ____-____ yrs

 It develops in _______ liver

A

Young; 20-40

non-cirrhotic

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26
Q

Fibrolamellar carcinoma has No association with HBV

T/F

A

T

27
Q

Fibrolamellar carcinoma

Macroscopy

 (single or multiple?) , (small or large?) , (soft or hard?) & ________ tumour

A

Single; large ; hard
scirrhous

28
Q

Fibrolamellar carcinoma may Sometimes be multiple

T/F

A

T

29
Q

Fibrolamellar carcinoma

Micro-

 (poorly or well?) differentiated _______ cells in _______ or ______ separated by _________________ of ____________

A

Well; polygonal

nests or cords

dense lamellae of collagen bundles

30
Q

Fibrolamellar carcinoma

It has a (better or worse?) prognosis than classical PLCC

With reason

A

Better

because it is often times surgically resectable & also lack of cirrhosis)

31
Q

Fibrolamellar carcinoma

spread
 Venous invasion into the _______ - ______ - ________

 Lymph node : peri-hilar, peri-pancreatic, aortic nodes below and above the diaghragm

A

portal veinIVCright atrium

32
Q

Fibrolamellar carcinoma

Haematogenous spread is frequent

T/F

A

F

Haematogenous spread not frequent

33
Q

clinical

 Non-specific-abdominal pain, malaise, fatigue, weight loss
__________ liver (ref. amoebic liver disease, CCF)
 Jaundice, fever, git bleeding
_________ protein in ___%(others yolk sac tumour, cirrhosis, hepatitis, pregnancy, neural tube defect

A

Enlarged tender

Alpha-feto; 60

34
Q

investigation Of Liver cancer

 _________-________scan
 Angiography
_____ scan
_____

A

Radiological- ultrasound

CT

MRI

35
Q

Death due to:

 Cancer _______
_______ or ——- _________
 Liver failure with ______
 Tumour _______ with severe _______

A

cachexia

GIT or variceal bleeding

hepatic coma

rupture; haemorrhage

36
Q

cholangiocarcinoma

 Arise from ____________

 Predisposing factors-
 __________________ infestation
 Primary_________ ————-
 Congenital ___________ of the _______

A

bile duct epithelium

Opisthorchis sinensis

sclerosing cholangitis

cystic lesions ; biliary tree

37
Q

cholangiocarcinoma

 Gross- similar to _____

 Micro-
•__________ differentiated sclerosing adenocarcinoma with well formed _______ and __________ lined by _________ ————— epithelial cells

•_________ ———- ________ separates the glands

A

PLCC

moderately

glandular and tubular structure

anaplastic cuboidal-columnar

Dense collagenous stroma

38
Q

Cholangiocarcinoma

 Spread-((more or less?) common than for PLCC) by _______ to lungs, vertebrae,adrenals, brain etc
 ____________

A

More ; blood

Lymph node

39
Q

The most common liver tumour of childhood is??

A

Hepatoblastoma

40
Q

Hepatoblastoma

 Occur in the ______ years of life (usually ____ yrs)

 Composed of _________________ elements

A

first few; <2

epithelial and mesenchymal

41
Q

Hepatoblastoma

 Composed of epithelial and mesenchymal elements
 Epithelial consists of _________ cells that form _________, tubules or ______ structures

 Mesenchymal element consists of _____________, osteoid, cartilage or _________

A

small polygonal

small acini; papillary

primitive mesenchyme; striated muscle

42
Q

Hepatoblastoma

Predominantly ______ or _______ types can also occur

A

epithelial or mixed

43
Q

Lymphomas & Leukemiaa
_________ Disease
_______ lymphoma
 _____________
 Leukemia

A

Hodgkin

Non-Hodgkins

Multiple myeloma

44
Q

Most primary cancers of liver arise from hepatocytes and are termed ______________________

Less common are cancers that arise from bile duct known as __________________________.

A

hepatocellular carcinoma (HCC).

cholangiocarcinoma

45
Q

Aspergillus

Fungus that produces ______

Can contaminate ______,______, and _____

High rates of dietary intake associated with _______

A

aflatoxin

corn, soybeans, and peanuts

HCC

46
Q

Aspergillus

Industrialized countries screen for aflatoxin

T/F

A

T

47
Q

Aspergillus

Exposure from:•Food from ______________ countries•_______ grown foods

A

non-industrialized

Locally

48
Q

Hepatocellular Carcinoma
Clinical Features

_____glycemia
_________
Can cause the __________ syndrome

A

Hypo

Erythrocytosis

Budd Chiari

49
Q

Hepatocellular Carcinoma
Clinical Features

Hypoglycemia• Seen with (small or large?) tumors due to _____________
• Rarely, tumors produces ___________________________

A

Large ; high metabolic rate

insulin-like growth factor-II

50
Q

Hepatocellular Carcinoma
Clinical Features

Erythrocytosis• HCC can secrete ______

A

EPO

51
Q

Hepatocellular Carcinoma
Clinical Features

Can cause the Budd Chiari syndrome•________ state plus _____ of venous structures• ________ of ________ that drain liver

A

Hypercoagulable

compression

Occlusion of hepatic veins

52
Q

Classic triad of Budd-Chiari syndrome :

_________
____________
___________

A

abdominal pain, ascites, hepatomegaly

53
Q

Hepatocellular Carcinoma
Diagnosis
Alpha fetal protein (AFP)• Secreted by ______• Can be elevated in _______ disease• Rise in level from baseline suspicious for HCC

A

HCC

chronic liver

54
Q

Hepatocellular carcinoma

Metastatic Disease

Rare at time of diagnosis (____-___ % cases)

Usually spreads via _______ not ______

Common sites: _____,_____

A

5-15

blood not lymph
Lung, bone

55
Q

Hepatic Adenoma

(Benign or malignant ?) epithelial liver tumors

Usually solitary in (left or right?) lobe

Common in (young or old?) (men or women?) (____-___)

A

Benign; Right

Young; women

56
Q

Hepatic Adenoma is Rarely symptomatic

T/F

A

F
Rarely symptomatic

57
Q

Hepatic Adenoma

Often detected during work-up abdominal pain

Associated with __________ use, ____________

Case reports of rupture during ———-

A

contraceptive; anabolic steroids

pregnancy

58
Q

Hepatic Hemangioma

•___________ Hemangioma
• Composed of vascular spaces
Often filled with ______

A

Cavernous; thrombus

59
Q

Hepatic Hemangioma is Often discovered incidentally at surgery or imaging

T/F

A

T

60
Q

Hepatic Angiosarcoma

(Common or Rare?) , (low or high?)-grade (benign or malignant?) vascular tumor

Abdominal pain, jaundice, _________ , weight loss

Associated with _____________

A

Rare; high ; malignant

ascites

toxic exposures

61
Q

Most common benign liver tumor is ???

A

Hepatic hemangioma

62
Q

Hepatic Angiosarcoma

Vinyl chloride
• Used to make —————
•________ can lead to angiosarcoma

Arsenic
• Found in ___,____,_____
• Certain geographic areas have high levels• Many industrial uses

A

PVC plastic
Inhalation

rocks, soil, water

63
Q

Hepatic Angiosarcoma

_________

_____________

_______________

A

Vinyl chloride

Arsenic

Thiotrast

House AMP (65 decks)

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