Liver Tumours Flashcards
1
Q
Why are MRIs done
A
Determines spread of a tumour
2
Q
Dukes Classification of Colorectal Carcinomas
A
A = Limited to muscular mucosae (95% 5yr survival) B = Extension through muscularis mucosae (not lymph) (75% survival) C = Involvement of regional lymph nodes (35% survival) D = Distant metastases (6.6%)
3
Q
What does the T stand for in the TNM system
A
- Refers to primary tumour and is suffixed by a number that denotes tumour size
- Number varies according to organ harbouring the tumour
4
Q
What does the N stand for in the TNM system
A
- Refers to lymph node status and is suffixed by a number that denotes the number of lymph nodes or groups of lymph nodes containing metastases
5
Q
What does the M stand for in the TNM system
A
- Anatomical extent of distant metastases
6
Q
What does a T1 breast carcinoma mean
A
Equal/less than 20mm in diameter - large numbers denote large tumours
7
Q
What does an N0 tumour mean
A
No nodal metastases
8
Q
What does N1 mean
A
Some nodal metastases seen
9
Q
What does N2 mean
A
Many metastases
10
Q
What does M0 mean
A
No metastases present
11
Q
What does M1 mean
A
Distant metastases
12
Q
What is Dukes B classification
A
pT4 (in peritoneum but untreatable)
P = pathology
13
Q
How are CRCs surgically treated
A
- Right sided = Right hemicoectomy
- Transverse = extended right hemicoectomy
- Left-sided = left hemicolectomy
- Sigmoid = sigmoid colectomy
- Low sigmoid, high rectal = anterior resection
14
Q
Pros of laprosocpic surgery
A
- Less time in hospital
2. Safe and has same results
15
Q
Advantage of endoscopic stunting
A
Less need for colostomy
16
Q
What is a colostomy
A
Part of the colon is cut and made exterior (protrudes out of abdomen for management in hospitals
17
Q
When is radiotherapy used (in which cancers
A
Colonic cancers = palliation
Rectal cancers = Pre-op
18
Q
How are polyps treated
A
Colonoscopy removal
19
Q
How are rectal cancers treated (they are treated differently to all other cancers of GI)
A
- Hard to excise
- Identify position on MRI and remove using low anterior resection
- Chemotherapy (neoadjuvant chemo) to shrink tumour if advance
20
Q
Most common type of tumours found in the liver (malignant or benign)
A
Malignant
21
Q
Where is HEPATOCELLULAR CARCINOMA common
A
China
22
Q
In what gender does HEPATOCELLULAR CARCINOMA effect
A
Males
23
Q
Risk factors for HEPATOCELLULAR CARCINOMA
A
- Carriers of HBV and HCV have an extremely high risk of developing HCC
- Associated cirrhosis (alcoholic, non-alcoholic fatty liver and haemochromatosis)
24
Q
How do liver tumours metastasise
A
Via hepatic or portal veins to lymph nodes, bones and lungs
25
What do cells do liver tumours consist of
They resemble hepatocytes
26
Clinical presentations of HEPATOCELLULAR CARCINOMA
1. Weight loss
2. Anorexia
3. Fever
4. Fatigue
5. Jaundice
6. Ache in RIGHT HYPOCHONDRIUM
7. Ascites
8. Rapid development of all these symptoms
27
Where is pain in HEPATOCELLULAR CARCINOMA felt
RIGHT HHYPOCHONDRIUM
28
What can be felt in physical examination for HEPATOCELLULAR CARCINOMA
Enlarged tender liver
29
Blood tests for HEPATOCELLULAR CARCINOMA
1. Serum alpha-fetoprotein raised
30
What three diagnostics other than blood tests are used for HEPATOCELLULAR CARCINOMA
1. Ultrasound
2. Enhanced CT
3. Liver biopsy
31
Role of ultrasound in HEPATOCELLULAR CARCINOMA
Shows filling defects
32
Role of enhanced CT in HEPATOCELLULAR CARCINOMA
1. Identified HCC but hard to confirm diagnosis if lesion is less than 1cm
2. Usually confirms diagnosis if lesion is large enough
33
Role of liver biopsy in HEPATOCELLULAR CARCINOMA
1. This + ultrasound used for diagnosis
34
Why is liver biopsy not commonly used in HEPATOCELLULAR CARCINOMA
Because it could potentially spread tumour along biopsy tract
35
How are liver tumours treated
1. Surgical resection of isolated lesion
| 2. Liver transplant
36
How is liver tumour prevented
1. Low risk of BV infection
| 2. Vaccination against HBV
37
What is cholangiocarcinoma
Cancer of the biliary tree
38
Risk factors for cholangiocarcinoma
1. Flukes (worms)
2. Biliary cysts
3. Inflammatory Bowel Disease
39
What is the pathophysiology of cholangiocarcinoma
1. Slow growing
| 2. Distal extra hepatic or perihilar region
40
Clinical presentation of cholangiocarcinoma
1. Fever
2. Abdo pain + ascites
3. Malaise
4. Raised bilirubin/jaundice
5. Raised alkaline phosphate
41
How is cholangiocarcinoma treated
1. Surgical resection is NOT used
| 2. Liver transplant is contraindicated
42
Should hemangiomas be treated
No
43
How common are hemangiomas
COMMON
44
How common are hepatic adenomas
Common
45
What causes hepatic adenomas
1. Oral contraceptives
2. Anabolic steroids
3. Pregnancy
46
Clinical presentation of hepatic adenoma
1. Abdo pain
| 2. Intraperitoneal bleeding
47
When is surgical intervention for hepatic adenomas required
When symptomatic
Tumours are larger than 5cm in diameter
48
What is the most common liver tumour
Secondary metastatic tumour
49
Where do secondary metastasise from
1. GI tract
2. Breast
3. Bronchus
50
Risk factors for secondary liver metastasis
Primary cancers
51
Clinical presentation of liver metastases
1. Weight loss
2. Malaise
3. Upper abdo pain
4. Hepatomegaly + jaundice
52
How is liver metastases diagnosed
2. Ultrasound with CT/MRI to define metastases and look for primary
3. SERUM ALKALINE PHOSPHATASE IS RAISED
53
How is secondary liver cancers treated
Depends on site of primary and burden of liver metastases
Removal of primary tumour and hepatic resection
Chemotherapy, particularly great cancer
54
In what part of the pancreas are pancreatic adenocarcinomas common
Exocrine
55
In what gender do pancreatic adenocarcinomas effect
Males over 60
56
Risk factor of pancreatic adenocarcinomas
1. Smoking
2. Excessive alcohol or coffee
3. Excessive aspirin
4. Chronic pancreatitis
5. Diabetes
6. Genetic mutations
7. Family history
57
Where do pancreatic adenocarcinomas evolve from
1. Pre-malignant lesions
58
When in the course of cancer development does metastasis of pancreatic adenocarcinomas take place
Early and present late
59
Clinical presentation of pancreatic adenocarcinomas
1. Anorexia
2. Weight loss
3. Diabetes
4. Acute Pancreatitis
60
Symptoms of pancreatic adenomas in the pancreatic head
Painless obstructive jaundice (pale stools and dark urine)
61
Symptoms of pancreatic adenomas in the body and tail of the pancreas
1. Epigastric pain radiating to the back
62
How is epigastric pain from body and tail pancreatic adenomas reduced
Sitting forward
63
Differential diagnosis of pancreatic adenocarcinomas
1. IgG4-related autoimmune pancreatitis
64
How is pancreatic adenocarcinomas diagnosed
1. Cholestatic jaundice helps assess prognosis
2. Transabdominal Ultrasound and CT to find mass and dilated biliary tree
3. Biopsy to help stage
65
Survival rate of pancreatic adenoma in 5 years
3%
66
Surgical treatment of pancreatic adenomas
1. Pancreato-duodectomy if no metastases
2. Palliatic therapy (stenting to reduce jaundice)
3. Opiates for pain
4. Nutritional supplementation
67
Con of surgery for pancreatic adenomas
High morbidity
Post-op chemotherapy delays disease progression
68
What is a hernia
1. Profusion of viscus or part of a viscus through a defect of the walls of its contains cavity into an abnormal position
69
What is a viscus
Organ
70
What is a reducible hernia
Can be pushed back into abdominal cavity with manual manoeuvring
71
What is an irreducible hernia
Cannot be pushed back into place
72
What three types of irreducible hernias are there
1. Obstructed
2. Incarcerated
3. Strangulated
73
What is an obstructed hernia
Intetsine is obstructed within hernia due to pressure from edges of the hernia (but blood flow is maintained)
74
What is an incarcerated hernia
Contents of hernial sac are stuck inside by adhesions (adhesions between intestines and hernial sac)
75
What is a strangulated hernia
Blood supply of the sac is cut-off resulting in ischaemia +/- gangrene/perforation of the hernial contents (patient becomes toxic and requires urgent surgery)
