Liver Cancer

Question 1

Liver Cancer

Answer 1

Primary liver cancer is cancer which originates in the liver. Two main types:

• hepatocellular carcinoma
• cholangiocarcinoma

Secondary liver cancer originates outside the liver and mets to the liver.

Question 2

risk factors for liver cancer

Answer 2

The main risk factor for hepatocellular carcinoma (HCC) is liver cirrhosis due to:

• Viral hepatitis (B and C)
• Alcohol
• Non alcoholic fatty liver disease
• Other chronic liver disease
  (Patients with chronic liver disease are screened for HCC.)

Cholangiocarcinoma- associated with primary sclerosing cholangitis.

Question 3

Presentation of liver cancer

Answer 3

asymptomatic for a long time and then presents late making prognosis poor

Weight loss
Abdominal pain
Anorexia
Nausea and vomiting
Jaundice
Pruritus

cholangiocarcinoma- painless jaundice (simlarly to pancreatic cancer)

Question 4

investigations for liver cancer

Answer 4

Alpha-fetoprotein is a tumour marker for hepatocellular carcinoma.
CA19-9 is a tumour marker for cholangiocarcinoma.
Liver ultrasound can identify tumours.
CT and MRI scans are used for diagnosis and staging of the cancer.
ERCP can be used to take biopsies or brushings to diagnose cholangiocarcinoma.

Question 5

hepatocellular carcinoma treatment

Answer 5

poor prognosis unless diagnosed early

resection of early disease
liver transplant
kinase inhibitor (sorafenib, regorafenib, lnvatinib)

generally resistant to chemo and raidotehrapy
palliative / trials

Question 6

cholangiocarcinoma treatment

Answer 6

poor prognosis unless diagnosed eatly