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
Fibrolamellar carcinoma  Occur in (young or old?) male & female age ____-____ yrs  It develops in _______ liver
Young; 20-40 non-cirrhotic
26
Fibrolamellar carcinoma has No association with HBV T/F
T
27
Fibrolamellar carcinoma Macroscopy  (single or multiple?) , (small or large?) , (soft or hard?) & ________ tumour
Single; large ; hard scirrhous
28
Fibrolamellar carcinoma may Sometimes be multiple T/F
T
29
Fibrolamellar carcinoma Micro-  (poorly or well?) differentiated _______ cells in _______ or ______ separated by _________________ of ____________
Well; polygonal nests or cords dense lamellae of collagen bundles
30
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)
31
Fibrolamellar carcinoma spread  Venous invasion into the _______ - ______ - ________  Lymph node : peri-hilar, peri-pancreatic, aortic nodes below and above the diaghragm
portal veinIVCright atrium
32
Fibrolamellar carcinoma Haematogenous spread is frequent T/F
F Haematogenous spread not frequent
33
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
34
investigation Of Liver cancer  _________-________scan  Angiography _____ scan _____
Radiological- ultrasound CT MRI
35
Death due to:  Cancer _______ _______ or ——- _________  Liver failure with ______  Tumour _______ with severe _______
cachexia GIT or variceal bleeding hepatic coma rupture; haemorrhage
36
cholangiocarcinoma  Arise from ____________  Predisposing factors-  __________________ infestation  Primary_________ ————-  Congenital ___________ of the _______
bile duct epithelium Opisthorchis sinensis sclerosing cholangitis cystic lesions ; biliary tree
37
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
38
Cholangiocarcinoma  Spread-((more or less?) common than for PLCC) by _______ to lungs, vertebrae,adrenals, brain etc  ____________
More ; blood Lymph node
39
The most common liver tumour of childhood is??
Hepatoblastoma
40
Hepatoblastoma  Occur in the ______ years of life (usually ____ yrs)  Composed of _________________ elements
first few; <2 epithelial and mesenchymal
41
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
42
Hepatoblastoma Predominantly ______ or _______ types can also occur
epithelial or mixed
43
Lymphomas & Leukemiaa _________ Disease _______ lymphoma  _____________  Leukemia
Hodgkin Non-Hodgkins Multiple myeloma
44
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
45
Aspergillus Fungus that produces ______ Can contaminate ______,______, and _____ High rates of dietary intake associated with _______
aflatoxin corn, soybeans, and peanuts HCC
46
Aspergillus Industrialized countries screen for aflatoxin T/F
T
47
Aspergillus Exposure from: •Food from ______________ countries •_______ grown foods
non-industrialized Locally
48
Hepatocellular Carcinoma Clinical Features _____glycemia _________ Can cause the __________ syndrome
Hypo Erythrocytosis Budd Chiari
49
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
50
Hepatocellular Carcinoma Clinical Features Erythrocytosis • HCC can secrete ______
EPO
51
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
52
Classic triad of Budd-Chiari syndrome : _________ ____________ ___________
abdominal pain, ascites, hepatomegaly
53
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
54
Hepatocellular carcinoma Metastatic Disease Rare at time of diagnosis (____-___ % cases) Usually spreads via _______ not ______ Common sites: _____,_____
5-15 blood not lymph Lung, bone
55
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
56
Hepatic Adenoma is Rarely symptomatic T/F
F Rarely symptomatic
57
Hepatic Adenoma Often detected during work-up abdominal pain Associated with __________ use, ____________ Case reports of rupture during ———-
contraceptive; anabolic steroids pregnancy
58
Hepatic Hemangioma •___________ Hemangioma • Composed of vascular spaces Often filled with ______
Cavernous; thrombus
59
Hepatic Hemangioma is Often discovered incidentally at surgery or imaging T/F
T
60
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
61
Most common benign liver tumor is ???
Hepatic hemangioma
62
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
63
Hepatic Angiosarcoma _________ _____________ _______________
Vinyl chloride Arsenic Thiotrast