Liver Tumors

Question 1

Epidemiology of liver cancer

Answer 1

• cirrhosis leads to hepatocellular carcinoma (HCC)
• increased risk in easetern cultures than western

Question 2

Etiology of liver cancer

Answer 2

• alcohol
• HBV, HCV
• alfatoxin

Question 3

Histology of liver cancer

Answer 3

commonly metastatic tumors

• HCC: poorly differentiated
• cholangiocellular carcinoma: second most common tumor
• extrahepatic bile duct tumors
• gall bladder tumors

Question 4

Symptoms of liver cancer

Answer 4

• HCC: abdominal pain, anemia, back pain, jaundice, pruritis, ascites, bruising, anorexia, weight loss, nausea, fever
• CAC: abdominal pain, weight loss, liver enlargement, sweating, jaundice

Question 5

Diagnosis of liver cancer

Answer 5

• history/physical
• US, CT, MRI
• Biopsy, Lab tests, AFP

Question 6

Radiation therapy for liver cancer

Answer 6

• 60-80% are unresectable at diagnosis
• liver is very sensitive to RT but not HCC
• SBRT in nodules

Question 7

Surgical therapy for liver cancer

Answer 7

• HCC and intrahepatic bile duct tumors: radical portal lymphadenectomy
• 30% of liver must remain for survival
• laparoscopic surgery for minor resections
• chemoembolization

Question 8

Pharmacological therapy for liver cancer

Answer 8

• HCC is chemo-refractory; systemic chemotherapy is not routinely given
• intraarterial chemotherapy in case tumor is confined to liver: anthracycline, mitomycin-C, cisplatin
• targeted therapy: sorafenib (VEGF), regorafenib
• immune therapy: nivolumab