Liver Cancer Flashcards by Iseoluwa Ojo

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

fourth; sixth

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

1 million

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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

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

The 5 year survival is _____%

second; pancreatic

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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

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Malignant tumours of the liver

________ tumors
_________ or ________ tumours

Primary

Secondary or metastatic

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

Hepatocellular

Cholangio

Hepatoblastoma

Angiosarcoma

vinyl chloride, arsenic or thorotrast

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Malignant tumors of the liver

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

Neuroendocrine

Pancreas

Colorectal

Breast

Lung

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Hepatocellular carcinoma

 Synonyms: ________________________________ (PLCC), ___________

 Accounts for ______% of all primary liver cancer

prmary liver cell carcinoma; hepatoma

> 90

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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

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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

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Genetic Alterations

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

somatic DNA; mutations and chromosomal

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Genetic Alterations

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

TERT promoter

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Genetic Alterations

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

dysplastic nodules

TERT promoter

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Genetic Alterations

Besides TERT PROMOTER:

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

TP53

CTNNB1

ARID1A

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Genetic Alterations

Besides TERT PROMOTER:

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

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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

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pathogenesis of liver cancer

_________ and ______ disease in developed countries

HCV & Alcoholic liver

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pathogenesis of Liver cancer

_________-products intercalate into DNA and promote mutation

Aflatoxins

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pathogenesis of liver dancer

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

Cirrhosis

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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

Uni; large

Multi; varying

infiltrative; whole liver

Bile; greenish

Firm and gritty

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microscopy of liver cancer

Ranges from ___________ tumour to _____________ tumour

well differentiated

anaplastic undiffrentiated

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microscopy of liver cancer

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

Recognizable

trabecular, acinar or pseudo-glandular

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microscopy of liver cancer

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

pleomorphic; anaplastic giant

spindle

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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

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

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 veinIVCright 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

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

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

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Liver Cancer Flashcards

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