Liver cancers

Question 1

Name the primary liver cancers

Answer 1

Hepatocellular carcinoma (HCC)
Cholangiocarcinoma
Benign liver cancer

Question 3

Name the common causes of secondary liver cancer

Answer 3

GIT cancer
Breast cancer
Bronchial cancer

Question 4

Is liver cancer most commonly primary or secondary cancer?

Answer 4

Secondary (metastases)

Question 5

HCC arises from liver ____and makes up 90% of all primary liver cancer

Answer 5

parenchyma (functional tissue rather than connective)

Question 6

What are risk factors for HCC?

Answer 6

Chronic hepatitis C and Hep B
Cirrhosis from ALD or NAFLD or hemochromatosis

Question 7

Where can HCC metastasis travel to?

Answer 7

Lymph nodes
Bones
Lungs

Question 8

How do HCC metastases travel?

Answer 8

Haematogenous spread through hepatic or portal veins

Question 9

What are signs of HCC?

Answer 9

Decompensated liver failure:
jaundice, ascites, HE…

TATT
Unexplained weight loss
Irregular hepatomegaly

Question 10

What testing would you do for suspected HCC?

Answer 10

May show increased serum AFP

Ultrasound (1st line)
CT (gold standard, used to confirm)

Note: biopsy often not used to avoid seeding of the tumour to elsewhere

Question 11

What is the treatment for HCC?

Answer 11

Surgical resection of tumour

Liver transplant when decompensated cirrhosis

Question 12

What vaccine can be given to reduced risk of HCC?

Answer 12

HBV (hep B)
prevents Hep B infection with its increased risk of HCC

Question 13

What type of liver cancer arises from the biliary tree and is typically adenocarinomas

Answer 13

cholangiocarcinoma

Question 14

Cholangiocarcinoma account for __% of all liver cancers

Answer 14

10%

Question 15

What are risk factors of cholangiocarcinoma?

Answer 15

Parasitic flukeworms
biliary cysts
IBD
PSC (primary sclerosing cholangitis)

Question 16

What are symptoms of cholangiocarcinoma?

Answer 16

Abdominal pain
Jaundice
Weight loss
Pruritis
Fevers
Courvoisier sign (jaundice and enlarged but painless gall bladder - more common in pancreatic cancer)

Late constellation of symptoms because the tumour is slow growing

Question 17

What are the diagnostic tests for cholangiocarcinoma?

Answer 17

Increased CEA and CA19-9 (tumour markers released into bloodstream)
LFT: Increased bilirubin and ALP

Abdo ultrasound and CT (first line)

ERCP (imaging of biliary tree) = gold standard.

Biopsy

Question 18

What are the uses of ERCP?

Answer 18

Invasive
Therapeutic use = stent strictures in biliary tree
Diagnostic = obtain sample for biopsy

Question 19

What is treatment for cholangiocarcinoma?

Answer 19

Mostly inoperable as patients present very late

Question 20

What is the most common benign primary liver tumour?

Answer 20

Haemangioma - seen in infants as “strawberry mark” on skin within first weeks of life

Question 21

What is another common benign primary liver tumour (not haemangioma)?

Answer 21

Hepatic adenoma

Question 22

What investigations are carried out for secondary liver tumour

Answer 22

Increased serum ALP
USS (1st line)
CT/MRI (gold standard) for staging and identifying primary tumour

Question 23

What is treatment of secondary liver cancer?

Answer 23

Surgical resection if possible. Chemotherapy.