Liver cancers Flashcards
Name the primary liver cancers
Hepatocellular carcinoma (HCC)
Cholangiocarcinoma
Benign liver cancer
Name the common causes of secondary liver cancer
GIT cancer
Breast cancer
Bronchial cancer
Is liver cancer most commonly primary or secondary cancer?
Secondary (metastases)
HCC arises from liver ____and makes up 90% of all primary liver cancer
parenchyma (functional tissue rather than connective)
What are risk factors for HCC?
Chronic hepatitis C and Hep B
Cirrhosis from ALD or NAFLD or hemochromatosis
Where can HCC metastasis travel to?
Lymph nodes
Bones
Lungs
How do HCC metastases travel?
Haematogenous spread through hepatic or portal veins
What are signs of HCC?
Decompensated liver failure:
jaundice, ascites, HE…
TATT
Unexplained weight loss
Irregular hepatomegaly
What testing would you do for suspected HCC?
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
What is the treatment for HCC?
Surgical resection of tumour
Liver transplant when decompensated cirrhosis
What vaccine can be given to reduced risk of HCC?
HBV (hep B)
prevents Hep B infection with its increased risk of HCC
What type of liver cancer arises from the biliary tree and is typically adenocarinomas
cholangiocarcinoma
Cholangiocarcinoma account for __% of all liver cancers
10%
What are risk factors of cholangiocarcinoma?
Parasitic flukeworms
biliary cysts
IBD
PSC (primary sclerosing cholangitis)
What are symptoms of cholangiocarcinoma?
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
What are the diagnostic tests for cholangiocarcinoma?
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
What are the uses of ERCP?
Invasive
Therapeutic use = stent strictures in biliary tree
Diagnostic = obtain sample for biopsy
What is treatment for cholangiocarcinoma?
Mostly inoperable as patients present very late
What is the most common benign primary liver tumour?
Haemangioma - seen in infants as “strawberry mark” on skin within first weeks of life
What is another common benign primary liver tumour (not haemangioma)?
Hepatic adenoma
What investigations are carried out for secondary liver tumour
Increased serum ALP
USS (1st line)
CT/MRI (gold standard) for staging and identifying primary tumour
What is treatment of secondary liver cancer?
Surgical resection if possible. Chemotherapy.
