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Year 2 > Liver Tumours > Flashcards

Liver Tumours Flashcards

1
Q

Why are MRIs done

A

Determines spread of a tumour

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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%)
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3
Q

What does the T stand for in the TNM system

A
  1. Refers to primary tumour and is suffixed by a number that denotes tumour size
  2. Number varies according to organ harbouring the tumour
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4
Q

What does the N stand for in the TNM system

A
  1. 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
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5
Q

What does the M stand for in the TNM system

A
  1. Anatomical extent of distant metastases
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6
Q

What does a T1 breast carcinoma mean

A

Equal/less than 20mm in diameter - large numbers denote large tumours

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7
Q

What does an N0 tumour mean

A

No nodal metastases

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8
Q

What does N1 mean

A

Some nodal metastases seen

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9
Q

What does N2 mean

A

Many metastases

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10
Q

What does M0 mean

A

No metastases present

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11
Q

What does M1 mean

A

Distant metastases

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12
Q

What is Dukes B classification

A

pT4 (in peritoneum but untreatable)

P = pathology

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13
Q

How are CRCs surgically treated

A
  1. Right sided = Right hemicoectomy
  2. Transverse = extended right hemicoectomy
  3. Left-sided = left hemicolectomy
  4. Sigmoid = sigmoid colectomy
  5. Low sigmoid, high rectal = anterior resection
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14
Q

Pros of laprosocpic surgery

A
  1. Less time in hospital

2. Safe and has same results

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15
Q

Advantage of endoscopic stunting

A

Less need for colostomy

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16
Q

What is a colostomy

A

Part of the colon is cut and made exterior (protrudes out of abdomen for management in hospitals

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17
Q

When is radiotherapy used (in which cancers

A

Colonic cancers = palliation

Rectal cancers = Pre-op

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18
Q

How are polyps treated

A

Colonoscopy removal

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19
Q

How are rectal cancers treated (they are treated differently to all other cancers of GI)

A
  1. Hard to excise
  2. Identify position on MRI and remove using low anterior resection
  3. Chemotherapy (neoadjuvant chemo) to shrink tumour if advance
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20
Q

Most common type of tumours found in the liver (malignant or benign)

A

Malignant

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21
Q

Where is HEPATOCELLULAR CARCINOMA common

A

China

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22
Q

In what gender does HEPATOCELLULAR CARCINOMA effect

A

Males

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23
Q

Risk factors for HEPATOCELLULAR CARCINOMA

A
  1. Carriers of HBV and HCV have an extremely high risk of developing HCC
  2. Associated cirrhosis (alcoholic, non-alcoholic fatty liver and haemochromatosis)
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24
Q

How do liver tumours metastasise

A

Via hepatic or portal veins to lymph nodes, bones and lungs

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25
Q

What do cells do liver tumours consist of

A

They resemble hepatocytes

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26
Q

Clinical presentations of HEPATOCELLULAR CARCINOMA

A
  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
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27
Q

Where is pain in HEPATOCELLULAR CARCINOMA felt

A

RIGHT HHYPOCHONDRIUM

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28
Q

What can be felt in physical examination for HEPATOCELLULAR CARCINOMA

A

Enlarged tender liver

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29
Q

Blood tests for HEPATOCELLULAR CARCINOMA

A
  1. Serum alpha-fetoprotein raised
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30
Q

What three diagnostics other than blood tests are used for HEPATOCELLULAR CARCINOMA

A
  1. Ultrasound
  2. Enhanced CT
  3. Liver biopsy
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31
Q

Role of ultrasound in HEPATOCELLULAR CARCINOMA

A

Shows filling defects

32
Q

Role of enhanced CT in HEPATOCELLULAR CARCINOMA

A
  1. Identified HCC but hard to confirm diagnosis if lesion is less than 1cm
  2. Usually confirms diagnosis if lesion is large enough
33
Q

Role of liver biopsy in HEPATOCELLULAR CARCINOMA

A
  1. This + ultrasound used for diagnosis
34
Q

Why is liver biopsy not commonly used in HEPATOCELLULAR CARCINOMA

A

Because it could potentially spread tumour along biopsy tract

35
Q

How are liver tumours treated

A
  1. Surgical resection of isolated lesion

2. Liver transplant

36
Q

How is liver tumour prevented

A
  1. Low risk of BV infection

2. Vaccination against HBV

37
Q

What is cholangiocarcinoma

A

Cancer of the biliary tree

38
Q

Risk factors for cholangiocarcinoma

A
  1. Flukes (worms)
  2. Biliary cysts
  3. Inflammatory Bowel Disease
39
Q

What is the pathophysiology of cholangiocarcinoma

A
  1. Slow growing

2. Distal extra hepatic or perihilar region

40
Q

Clinical presentation of cholangiocarcinoma

A
  1. Fever
  2. Abdo pain + ascites
  3. Malaise
  4. Raised bilirubin/jaundice
  5. Raised alkaline phosphate
41
Q

How is cholangiocarcinoma treated

A
  1. Surgical resection is NOT used

2. Liver transplant is contraindicated

42
Q

Should hemangiomas be treated

43
Q

How common are hemangiomas

44
Q

How common are hepatic adenomas

45
Q

What causes hepatic adenomas

A
  1. Oral contraceptives
  2. Anabolic steroids
  3. Pregnancy
46
Q

Clinical presentation of hepatic adenoma

A
  1. Abdo pain

2. Intraperitoneal bleeding

47
Q

When is surgical intervention for hepatic adenomas required

A

When symptomatic

Tumours are larger than 5cm in diameter

48
Q

What is the most common liver tumour

A

Secondary metastatic tumour

49
Q

Where do secondary metastasise from

A
  1. GI tract
  2. Breast
  3. Bronchus
50
Q

Risk factors for secondary liver metastasis

A

Primary cancers

51
Q

Clinical presentation of liver metastases

A
  1. Weight loss
  2. Malaise
  3. Upper abdo pain
  4. Hepatomegaly + jaundice
52
Q

How is liver metastases diagnosed

A
  1. Ultrasound with CT/MRI to define metastases and look for primary
  2. SERUM ALKALINE PHOSPHATASE IS RAISED
53
Q

How is secondary liver cancers treated

A

Depends on site of primary and burden of liver metastases

Removal of primary tumour and hepatic resection

Chemotherapy, particularly great cancer

54
Q

In what part of the pancreas are pancreatic adenocarcinomas common

55
Q

In what gender do pancreatic adenocarcinomas effect

A

Males over 60

56
Q

Risk factor of pancreatic adenocarcinomas

A
  1. Smoking
  2. Excessive alcohol or coffee
  3. Excessive aspirin
  4. Chronic pancreatitis
  5. Diabetes
  6. Genetic mutations
  7. Family history
57
Q

Where do pancreatic adenocarcinomas evolve from

A
  1. Pre-malignant lesions
58
Q

When in the course of cancer development does metastasis of pancreatic adenocarcinomas take place

A

Early and present late

59
Q

Clinical presentation of pancreatic adenocarcinomas

A
  1. Anorexia
  2. Weight loss
  3. Diabetes
  4. Acute Pancreatitis
60
Q

Symptoms of pancreatic adenomas in the pancreatic head

A

Painless obstructive jaundice (pale stools and dark urine)

61
Q

Symptoms of pancreatic adenomas in the body and tail of the pancreas

A
  1. Epigastric pain radiating to the back
62
Q

How is epigastric pain from body and tail pancreatic adenomas reduced

A

Sitting forward

63
Q

Differential diagnosis of pancreatic adenocarcinomas

A
  1. IgG4-related autoimmune pancreatitis
64
Q

How is pancreatic adenocarcinomas diagnosed

A
  1. Cholestatic jaundice helps assess prognosis
  2. Transabdominal Ultrasound and CT to find mass and dilated biliary tree
  3. Biopsy to help stage
65
Q

Survival rate of pancreatic adenoma in 5 years

66
Q

Surgical treatment of pancreatic adenomas

A
  1. Pancreato-duodectomy if no metastases
  2. Palliatic therapy (stenting to reduce jaundice)
  3. Opiates for pain
  4. Nutritional supplementation
67
Q

Con of surgery for pancreatic adenomas

A

High morbidity

Post-op chemotherapy delays disease progression

68
Q

What is a hernia

A
  1. Profusion of viscus or part of a viscus through a defect of the walls of its contains cavity into an abnormal position
69
Q

What is a viscus

70
Q

What is a reducible hernia

A

Can be pushed back into abdominal cavity with manual manoeuvring

71
Q

What is an irreducible hernia

A

Cannot be pushed back into place

72
Q

What three types of irreducible hernias are there

A
  1. Obstructed
  2. Incarcerated
  3. Strangulated
73
Q

What is an obstructed hernia

A

Intetsine is obstructed within hernia due to pressure from edges of the hernia (but blood flow is maintained)

74
Q

What is an incarcerated hernia

A

Contents of hernial sac are stuck inside by adhesions (adhesions between intestines and hernial sac)

75
Q

What is a strangulated hernia

A

Blood supply of the sac is cut-off resulting in ischaemia +/- gangrene/perforation of the hernial contents (patient becomes toxic and requires urgent surgery)

Year 2 (155 decks)

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