Liver Cancer Flashcards
Worldwide, liver cancers are the ________ most common cause of cancer-related death and rank _______ in terms of incident cases.
fourth; sixth
On the basis of annual projections, the World Health Organization estimates that more than _________ patients will die from liver cancer in 2030.
1 million
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
T
Liver cancer is the _______ most lethal tumor, after _________ cancer.
The 5 year survival is _____%
second; pancreatic
18
The majority of hepatocellular carcinomas occur in patients with ___________________, mostly as a result of _______________________ infection or __________.
underlying liver disease
hepatitis B or C virus (HBV or HCV)
alcohol abuse
Malignant tumours of the liver
________ tumors
_________ or ________ tumours
Primary
Secondary or metastatic
Malignant tumours of the liver
Primary tumors
__________ carcinoma
_________carcinoma
_________________
_____________-associated with ________,________, or ________
Hepatocellular
Cholangio
Hepatoblastoma
Angiosarcoma
vinyl chloride, arsenic or thorotrast
Malignant tumors of the liver
Secondary or metastatic tumours
_____________
______
__________
_______
_______
others
Neuroendocrine
Pancreas
Colorectal
Breast
Lung
Hepatocellular carcinoma
Synonyms: ________________________________ (PLCC), ___________
Accounts for ______% of all primary liver cancer
prmary liver cell carcinoma; hepatoma
> 90
Hepatocellular carcinoma
Incidence highest in Korea, Taiwan, Mozambique & SE Asia
(Blacks or Whites?) >(black or whites?)
(Male or Female?) >(male or female?)
Blacks>whites
Male>female
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 _____________
inflammation, fibrosis
hepatocyte regeneration.
cirrhosis; genetic and epigenetic
dysplastic nodules
preneoplastic lesions
Genetic Alterations
Hepatocellular carcinoma cells accumulate _________ alterations, including _______ and ________ aberrations.
somatic DNA; mutations and chromosomal
Genetic Alterations
Mutations in the _________ are the most frequent genetic alterations, accounting for approximately ____% of cases.
TERT promoter
60
Genetic Alterations
They can be detected in _________, and the _________ is a recurrent insertion site for the genome of HBV.
dysplastic nodules
TERT promoter
Genetic Alterations
Besides TERT PROMOTER:
Other mutations involve: ______ (30%); ________ (30%); ________ (10%) etc.
TP53
CTNNB1
ARID1A
Genetic Alterations
Besides TERT PROMOTER:
Other mutations involve: TP53 (____%); CTNNB1 (_____%); ARID1A (___%) etc.
30
30
10
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 ________
mutation; malignant transformation
HBx; normal growth control
p53; growth suppression
pathogenesis of liver cancer
_________ and ______ disease in developed countries
HCV & Alcoholic liver
pathogenesis of Liver cancer
_________-products intercalate into DNA and promote mutation
Aflatoxins
pathogenesis of liver dancer
_______–HCV,alcohol, haemochromatosis & other causes of cirrhosis
Cirrhosis
Morphology-gross
_____focal (small or large?) mass
______-focal masses of ______ sizes
Diffusely _____ tumour involving the _____
_____ stain with _____ hue
(loose or Firm?) and gritty
Vascular invasionportal veinIVCright atrium
Uni; large
Multi; varying
infiltrative; whole liver
Bile; greenish
Firm and gritty
microscopy of liver cancer
Ranges from ___________ tumour to _____________ tumour
well differentiated
anaplastic undiffrentiated
microscopy of liver cancer
Well-differentiated tumour-
__________ hepatocytic tumour cells
Form _______,_______, or _________ patterns
Recognizable
trabecular, acinar or pseudo-glandular
microscopy of liver cancer
Poorly-differentiated tumour-
___________ cells with numerous _________ cells
________ shaped sarcomatous type
pleomorphic; anaplastic giant
spindle
Fibrolamellar carcinoma
Occur in (young or old?) male & female age ____-____ yrs
It develops in _______ liver
Young; 20-40
non-cirrhotic
Fibrolamellar carcinoma has No association with HBV
T/F
T
Fibrolamellar carcinoma
Macroscopy
(single or multiple?) , (small or large?) , (soft or hard?) & ________ tumour
Single; large ; hard
scirrhous
Fibrolamellar carcinoma may Sometimes be multiple
T/F
T
Fibrolamellar carcinoma
Micro-
(poorly or well?) differentiated _______ cells in _______ or ______ separated by _________________ of ____________
Well; polygonal
nests or cords
dense lamellae of collagen bundles
Fibrolamellar carcinoma
It has a (better or worse?) prognosis than classical PLCC
With reason
Better
because it is often times surgically resectable & also lack of cirrhosis)
Fibrolamellar carcinoma
spread
Venous invasion into the _______ - ______ - ________
Lymph node : peri-hilar, peri-pancreatic, aortic nodes below and above the diaghragm
portal veinIVCright atrium
Fibrolamellar carcinoma
Haematogenous spread is frequent
T/F
F
Haematogenous spread not frequent
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
Enlarged tender
Alpha-feto; 60
investigation Of Liver cancer
_________-________scan
Angiography
_____ scan
_____
Radiological- ultrasound
CT
MRI
Death due to:
Cancer _______
_______ or ——- _________
Liver failure with ______
Tumour _______ with severe _______
cachexia
GIT or variceal bleeding
hepatic coma
rupture; haemorrhage
cholangiocarcinoma
Arise from ____________
Predisposing factors-
__________________ infestation
Primary_________ ————-
Congenital ___________ of the _______
bile duct epithelium
Opisthorchis sinensis
sclerosing cholangitis
cystic lesions ; biliary tree
cholangiocarcinoma
Gross- similar to _____
Micro-
•__________ differentiated sclerosing adenocarcinoma with well formed _______ and __________ lined by _________ ————— epithelial cells
•_________ ———- ________ separates the glands
PLCC
moderately
glandular and tubular structure
anaplastic cuboidal-columnar
Dense collagenous stroma
Cholangiocarcinoma
Spread-((more or less?) common than for PLCC) by _______ to lungs, vertebrae,adrenals, brain etc
____________
More ; blood
Lymph node
The most common liver tumour of childhood is??
Hepatoblastoma
Hepatoblastoma
Occur in the ______ years of life (usually ____ yrs)
Composed of _________________ elements
first few; <2
epithelial and mesenchymal
Hepatoblastoma
Composed of epithelial and mesenchymal elements
Epithelial consists of _________ cells that form _________, tubules or ______ structures
Mesenchymal element consists of _____________, osteoid, cartilage or _________
small polygonal
small acini; papillary
primitive mesenchyme; striated muscle
Hepatoblastoma
Predominantly ______ or _______ types can also occur
epithelial or mixed
Lymphomas & Leukemiaa
_________ Disease
_______ lymphoma
_____________
Leukemia
Hodgkin
Non-Hodgkins
Multiple myeloma
Most primary cancers of liver arise from hepatocytes and are termed ______________________
Less common are cancers that arise from bile duct known as __________________________.
hepatocellular carcinoma (HCC).
cholangiocarcinoma
Aspergillus
Fungus that produces ______
Can contaminate ______,______, and _____
High rates of dietary intake associated with _______
aflatoxin
corn, soybeans, and peanuts
HCC
Aspergillus
Industrialized countries screen for aflatoxin
T/F
T
Aspergillus
Exposure from:•Food from ______________ countries•_______ grown foods
non-industrialized
Locally
Hepatocellular Carcinoma
Clinical Features
_____glycemia
_________
Can cause the __________ syndrome
Hypo
Erythrocytosis
Budd Chiari
Hepatocellular Carcinoma
Clinical Features
Hypoglycemia• Seen with (small or large?) tumors due to _____________
• Rarely, tumors produces ___________________________
Large ; high metabolic rate
insulin-like growth factor-II
Hepatocellular Carcinoma
Clinical Features
Erythrocytosis• HCC can secrete ______
EPO
Hepatocellular Carcinoma
Clinical Features
Can cause the Budd Chiari syndrome•________ state plus _____ of venous structures• ________ of ________ that drain liver
Hypercoagulable
compression
Occlusion of hepatic veins
Classic triad of Budd-Chiari syndrome :
_________
____________
___________
abdominal pain, ascites, hepatomegaly
Hepatocellular Carcinoma
Diagnosis
Alpha fetal protein (AFP)• Secreted by ______• Can be elevated in _______ disease• Rise in level from baseline suspicious for HCC
HCC
chronic liver
Hepatocellular carcinoma
Metastatic Disease
Rare at time of diagnosis (____-___ % cases)
Usually spreads via _______ not ______
Common sites: _____,_____
5-15
blood not lymph
Lung, bone
Hepatic Adenoma
(Benign or malignant ?) epithelial liver tumors
Usually solitary in (left or right?) lobe
Common in (young or old?) (men or women?) (____-___)
Benign; Right
Young; women
Hepatic Adenoma is Rarely symptomatic
T/F
F
Rarely symptomatic
Hepatic Adenoma
Often detected during work-up abdominal pain
Associated with __________ use, ____________
Case reports of rupture during ———-
contraceptive; anabolic steroids
pregnancy
Hepatic Hemangioma
•___________ Hemangioma
• Composed of vascular spaces
Often filled with ______
Cavernous; thrombus
Hepatic Hemangioma is Often discovered incidentally at surgery or imaging
T/F
T
Hepatic Angiosarcoma
(Common or Rare?) , (low or high?)-grade (benign or malignant?) vascular tumor
Abdominal pain, jaundice, _________ , weight loss
Associated with _____________
Rare; high ; malignant
ascites
toxic exposures
Most common benign liver tumor is ???
Hepatic hemangioma
Hepatic Angiosarcoma
Vinyl chloride
• Used to make —————
•________ can lead to angiosarcoma
Arsenic
• Found in ___,____,_____
• Certain geographic areas have high levels• Many industrial uses
PVC plastic
Inhalation
rocks, soil, water
Hepatic Angiosarcoma
_________
_____________
_______________
Vinyl chloride
Arsenic
Thiotrast
