Liver cancer Flashcards
What is primary liver cancer and what is the main type?
Primary liver cancer originates in the liver. The main type is hepatocellular carcinoma (HCC).
What is secondary liver cancer and how does it differ from primary liver cancer?
Secondary liver cancer originates outside the liver and spreads (metastasizes) to the liver. It can occur with almost any cancer, while primary liver cancer starts in the liver itself.
What are the main risk factors for hepatocellular carcinoma (HCC)?
Liver cirrhosis, which can result from:
* Alcohol-related liver disease
* Non-alcoholic fatty liver disease (NAFLD)
* Hepatitis B and C
* Primary sclerosing cholangitis (rare cause)
Patients with liver cirrhosis are typically screened for HCC every 6 months using ultrasound and alpha-fetoprotein.
What are common presenting symptoms of liver cancer?
Liver cancer often remains asymptomatic until late stages, but when symptoms appear, they may include:
* Weight loss
* Abdominal pain
* Anorexia
* Nausea and vomiting
* Jaundice
* Pruritus (itching)
* Upper abdominal mass on palpation.
What are the key investigations for diagnosing liver cancer?
Alpha-fetoprotein (AFP): A tumor marker for hepatocellular carcinoma.
Liver ultrasound: First-line imaging.
CT and MRI scans: Used for staging and further assessment.
Biopsy: Used for histological confirmation.
How is hepatocellular carcinoma (HCC) treated?
Surgical resection: Possible for isolated tumors in early-stage disease.
Liver transplant: Considered if the tumor is confined to the liver and the patient meets criteria.
Other treatments:
* Radiofrequency ablation (RFA)
* Microwave ablation (MWA)
* Transarterial chemoembolization (TACE)
* Radiotherapy and targeted drugs (e.g., kinase inhibitors, monoclonal antibodies).
What is cholangiocarcinoma, and where does it originate?
Cholangiocarcinoma is a cancer that originates in the bile ducts, either inside the liver (intrahepatic) or outside the liver (extrahepatic). It is most commonly found in the perihilar region of the bile ducts.
What are the key risk factors and associations for cholangiocarcinoma?
Strong association with primary sclerosing cholangitis (only 10% of cholangiocarcinomas have this association).
Typically affects individuals over 50 years old.
Obstructive jaundice is the hallmark presenting feature.
What are the key symptoms and signs of cholangiocarcinoma?
Key presenting feature:
* Obstructive jaundice, which can cause:
* Pale stools
* Dark urine
* Generalized itching.
How is cholangiocarcinoma diagnosed?
CA19-9: A tumor marker for cholangiocarcinoma.
Ultrasound, CT, and MRI: Used for imaging and identifying biliary obstruction.
Biopsy: Can confirm diagnosis.
How is cholangiocarcinoma treated?
Surgical resection is potentially curative for early-stage disease. However, it has a very poor prognosis unless diagnosed early.
What are haemangiomas and focal nodular hyperplasia (FNH) in the liver?
Haemangiomas: Common, benign liver tumors, often found incidentally, with no symptoms or cancerous potential.
Focal nodular hyperplasia (FNH): A benign liver tumor made of fibrotic tissue, often asymptomatic and unrelated to cancer. More common in women, especially those on oral contraceptives. No treatment or monitoring required.
