Liver Cancer Flashcards
what is common and what are rare
primary adenomas and carcinomas rare; more often to get metastasis from somewhere else
what are benign lesions
hemangioma focal nodular hyperplasia hepatic adenoma hydatid cysts polycystic liver disease
what is hemangioma
common in non-cirrhotic pateints
well demarcated spot on US; usually asymptomatic
no treatment
what is focal nodular hyperplasia
central scar containing large artery, radiating branches to large periphery
what presents histiologically with FNH
sinusoids, dile ductules and kupffer cells
who does FNH affect
young and middle-aged women; usually asymptomatic
what does FNH look like on US and CT
nodule with varying echogenicity on US and hypervascular mass with central scar on CT
no treatment
what is hepatic adenoma associated with
women
glycogen storage disease and oral contraceptive pill
what is symptom of hepatic adenoma
often asymptomatic, may have RUQ pain
how to diagnose hepatic adenoma
US (filling defect), CT (diffuse arterial enhancement)
how to treat hepatic adenoma
stop hormones, weight loss
males - always surgery
female - surgery if >5cm
complication of hepatic adenoma
can rupture or bleed
what causes hydatid cysts
echinococcus granulosus
eastern europe, central america, south america, middle east and north africa
farmers - sheep parasites?
what may patients with hydatid cysts present with
disseminated disease or erosion of cyst into adjacent structure and vessels (IVC)
what treatment used in hydatid cysts
surgery - open cystectomy or pericystectomy
medical - albendazole
percutaneous drainage
how does polycystic liver disease arise
due to embryonic malformation of bile ducts
how does polycystic liver disease present
abdominal pain and distension
what is treatment of polycystic liver disease
conserve treatment to halt cyst growth
invasive (defenestration or transplant) rarely used - only with co-morbidities
what are malignant tumours of liver
hepatocellular carcinoma and fibro-lamellar carcinoma
is hepatocellular carcinoma most common liver cancer
yes
what is risk factor for hepatocellular carcinoma
cirrhosis from any cause (also HBV and HCV)
what are signs of hepatocellular carcinoma
weight loss, RUQ pain, mass, worsening of pre-existing liver disease, acute liver failure
examination findings of hepatocellular carcinoma
signs of cirrhosis, hard enlarged RUQ mass, liver bruit (rare)
what is treatment of hepatocellular carcinoma
transplant
resection (small tumours)
local ablation (non resectable tumours with advanced cirrhosis)
TACE (inject chemo selectively in hepatic artery - only if early cirrhosis)
when does fibro-lamellar carcinoma present
young patients (5-35) not related to cirrhosis - AFP normal
what does CT show in fibro-lamellar carcinoma
stellate scar with radial septa showing persistent enhancement
what is treatment in fibro-lamellar carcinoma
surgical resection or transplant
TACE for non resectable tumour
what is general causes of liver cancer
cirrhosis
alcohol, smoking or drugs
hepatitis
autoimmune disease
what is general symptoms
weight loss
hepatomegaly
abdominal pain
lymphadenopathy
what is stages of diagnosis
US -> CT -> liver biopsy
what causes liver abscess
this isny cancer just didnt know where to put it
coliforms
anaerobes
enterococci
staph aureus
how to treat liver abscess
IV gentamicin +
IV amoxicillin +
IV metrondiazole
