liver cancer

Question 1

what are the risk factors?

Answer 1

• viral hepatitis (B and C)
• high alcohol intake
• smoking
• advanced age (70+)
• aflatoxin exposure
• family history of liver disease

Question 2

what are the clinical features of liver cancer?

Answer 2

• liver cirrhosis
• dull ache in right upper abdomen is uncommon
• irregular, enlarged, craggy , tender liver is suggestive of malignancy
• ascites

Question 3

what are the differentials?

Answer 3

non specific liver signs may give you the differentials of:

• Infectious hepatitis (presence of specific serology)
• Cardiac failure (smooth hepatomegaly)
• Benign hepatocellular adenoma

Question 4

what lab tests can be done?

Answer 4

• LFTs
• routine bloods may show low platelets or prolonged clotting, associated with liver failure
• Alpha fetoprotein (AFP) as its raised in the majority of cases. Can also be used to monitor treatment response and recurrence.

Question 5

how does the ALT:AST ratio suggest the liver issue?

Answer 5

AST:ALT ratio>2, likely alcholic liver disease

AST:ALT ratio around 1, likely viral hepatitis

Question 6

what imaging is done?

Answer 6

• USS , if mass >2cm is found with raised AFP, this is diagnostic. can do a staging CT following.
• MRI can be done if USS only shows nodules
• if still in doubt, a biopsy or percutaneous fine needle aspiration may be performed to confirm

Question 7

how is cancer staged?

Answer 7

the Barcelona clinic liver staging system for hepatocellular carcinomas.

Question 8

what is the surgical manahement?

Answer 8

• surgical resection

- transplanation

Question 9

what is the non surgical management?

Answer 9

• image guided ablation done with USS probes to induce necrosis in tumour mass
• transarterial chemoembolisation, where chemotherapy drugs are injected directly into the hepatic artery branche supplying the tumour as well as emobilising agent to induce ischameia

Question 10

what is the prognosis for hepatocellular carcinoma?

Answer 10

Median survival time from diagnosis is around 6 months.

Question 11

where do the most common metasteses to the liver come from?

Answer 11

• bowel via portel circulation
• breast
• pancreas
• stomach
• lung

Question 12

why is a biopsy of metasteses to liver not advisable if the tumour is operable?

Answer 12

Biopsy is not advised if the tumour is operable, as the needle tract may lead to seeding of tumour.