Liver Cancer

Question 1

What is a sister Mary Joseph node?

Answer 1

palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

Question 2

What is the main primary liver cancer?

Answer 2

HCC

Question 3

What is the main risk factor for HCC? and what can cause this?

Answer 3

Liver cirrhosis due to:
• Alcohol-related liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Hepatitis B
• Hepatitis C
• Rarer causes (e.g., primary sclerosing cholangitis)

Question 4

How are patients with liver cirrhosis screened for HCC?

Answer 4

Every 6 months have:
Ultrasound
Alpha-fetoprotein

Question 5

What are some symptoms of liver cancer? (7)

Answer 5

• Weight loss
• Abdominal pain
• Anorexia
• Nausea and vomiting
• Jaundice
• Pruritus
• Upper abdominal mass on palpation

Question 6

What is alpha fetoprotein?

Answer 6

Tumour marker for HCC

Question 7

What is the tumour marker for HCC?

Answer 7

Alpha fetoprotein

Question 8

What is the first line imaging for liver cancer?

Answer 8

Ultrasound

Question 9

What imaging is used for further assessment and staging of liver cancer?

Answer 9

CT
MRI

Question 10

What surgery can be done in liver cancer? (2)

Answer 10

○ Resection can be used when the tumour is isolated in a removable liver area.
○ A liver transplant is an option when the tumour is isolated to the liver and the patient meets specific criteria.

Question 11

What are some options for treating liver cancer? (5)

Answer 11

○ Radiofrequency ablation (destroying the tumour cells with heat)
○ Microwave ablation (destroying the tumour cells with heat)
○ Transarterial chemoembolisation (TACE)
○ Radiotherapy
○ Targeted drugs (e.g., kinase inhibitors and monoclonal antibodies)

Question 12

What is transarterial chemo embolisation?

Answer 12

○ A chemotherapy drug is injected into the hepatic artery feeding the tumour, delivering the dose directly to the tumour.
○ This is followed by embolisation of the vessel to block the tumour’s blood supply.

Question 13

What is a cholangiocarcinoma?

Answer 13

Type of cancer originating in the bile ducts

Question 14

What type of cancer are cholangiocarcinomas mainly?

Answer 14

Adenocarcinoma

Question 15

Where is the most common site of cholangiocarcinoma?

Answer 15

• The most common site is in the perihilar region, where the right and left hepatic ducts have joined to become the common hepatic duct just after leaving the liver.

Question 16

What is cholangiocarcinoma most commonly associated with?

Answer 16

Primary sclerosing cholangitis

Question 17

What is the typical patient with cholangiocarcinoma?

Answer 17

• Cholangiocarcinoma usually presents in patients over 50 years old unless related to primary sclerosing cholangitis.

Question 18

What is the main feature of cholangiocarcinoma?

Answer 18

Obstructive jaundice
- pale stool
- dark urine
- generalised itching

Question 19

What are 2 main worrying differentials of painless jaundice?

Answer 19

Head of pancreas cancer (most common)
Cholangiocarcinoma

Question 20

What is CA19-9 a marker of?

Answer 20

Cholangiocarcinoma

Question 21

What is the tumour marker of cholangiocarcinoma?

Answer 21

CA19-9

Question 22

What is the management of cholangiocarcinoma?

Answer 22

• Cholangiocarcinomas have a very poor prognosis unless diagnosed early.
Surgical resection is potentially successful in early disease.

Question 23

What is a haemangioma?

Answer 23

• Haemangiomas are common benign tumours of the liver.

Question 24

What are the symptoms of haemangiomas?

Answer 24

• They cause no symptoms and have no potential to become cancerous.

Question 25

What is the management of haemangiomas?

Answer 25

• No treatment or monitoring is required.

Question 26

What is focal modular hyperplasia?

Answer 26

• Focal nodular hyperplasia is a benign liver tumour made of fibrotic tissue.

Question 27

What can focal nodular hyperplasia be associated with?

Answer 27

• It can be related to oestrogen and is more common in women and those on the oral contraceptive pill.

Question 28

What is the management of focal nodular hyperplasia?

Answer 28

• No treatment or monitoring is required.