Liver cancer Flashcards
What is the most common cancer of the liver?
Hepatocellular carcinoma
Where in the world is hepatocellular carcinoma (HCC) more prevalent?
China
What causes HCC?
Chronic inflammation process affecting the liver usually due to viral hepatitis, chronic alcoholism, hereditary haemochromatosis, primary biliary cirrhosis, family history, smoking and aflatoxin
What are the clinical features of HCC?
Liver cirrhosis so vague non specific symptoms like fatigue, fever, weight loss and lethargy, dull ache in the right upper abdomen
How would a HCC present on examination?
irregular, enlarged, craggy and tender liver
What are the differential diagnosis for HCC?
Infectious hepatitis, cardiac failure, benign hepatocellular adenoma, liver cirrhosis
What blood tests should you take for suspected HCC?
Liver function tests may be deranged, low platelets and prolonged clotting, alpha fetoprotein
What is the AST:ALT ratio for alcoholic liver disease?
greater than 2
If AST:ALT is around 1 what is the diagnosis likely to be?
viral hepatitis
What is the imaging for HCC?
Ultrasound then CT scan, MRI scan, biopsy or percutaneous fine needle aspiration
How is HCC staged?
Barcelona clinic liver cancer staging
What is a child pugh score?
Uses bilirubin, albumin, INR, degree of ascites, evidence of encephalopathy to calculate prognosis of patient with liver cirrhosis
What is MELD score?
better predictor of mortality that child pugh score, uses creatinine, bilirubin, INR, sodium and the use of dialysis, predicts likelihood of a patient tolerating a potential liver transplant
What is the management for HCC?
Surgical resection, transplantation, image guided ablation, tranasrtieal chemoembolisation
Where does secondary liver malignancy usually metastasise from?
bowel, breast, pancreas, stomach and lung
