Liver Tumours

Question 1

Commonest liver tumour

Answer 1

Mets
90% are mets
Primaries are uncommon

Question 2

Commonest mets in men and women
Men- stomach lung colon
Women- breast colon stomach uterus

Answer 2

Men- stomach lung colon

Women- breast colon stomach uterus

Question 3

Malignant primary tumours

Answer 3

HCC
Cholangiocarcinoma
Angiosarcoma 
Hepatoblastoma
Fibrosarcoma
Hepatic GIST - Gastrointestinal Stromal tumour formally leiomyoma

Question 4

Benign primaries

Answer 4

Cysts
Haemangioma 
Adenoma
Focal modular hyperplasia
Fibroma
Benign GIST

Question 5

Symptoms

Answer 5

Fever
Malaise
Anorexia
Dec weight
RUQ pain due to liver capsule stretching
Jaundice late stage except cholangiocarcinoma
Benign often asymptomatic
Intraperitoneal haemorrhage due to rupture

Question 6

Signs

Answer 6

Hepatomegaly - smooth, hard, irregular - mets, cirrhosis, HCC
Signs chronic liver disease + evidence of decompensation (jaundice, ascites)
Abdominal mass
Bruit over liver

Question 7

Tests

Answer 7

Blood, FBC, Clotting, LFTs, hepatitis serology, alpha feta protein
Imaging US CT lesion and biopsy
MRI distinguish between benign and malignant
ERCP + biopsy = cholangiocarcinoma
MDT treatment, resectable, depends of bleeding and seeding in the biliary tract risk

Question 8

What to do to find primary if liver mets

Answer 8

CXR, mammography, CT, MRI, colonoscopy

Question 9

What does liver met signify and what treatment

Answer 9

Advanced disease
Treatment prognosis vary chemotherapy may be used, resection small lesion
PALLIATION
Prog <6months

Question 10

What % of primaries are HCC

Answer 10

90

Question 11

Is it common in the UK

Answer 11

No more common in China and Africa

Question 12

What is HCC associated with

Answer 12

HBV, HCV, AIH, NAFLD, cirrhosis, aflatoxin, clonorchis sinesis, anabolic steroids,

Question 13

HCC presentation

Answer 13

Fatigue, dec appetite, RUQ pain, dec weight, jaundice, ascites haemobilia

Question 14

HCC tests

Answer 14

3 phase CT, CT with delayed washout with contrast
MRI
Biopsy

Question 15

Treatment HCC

Answer 15

Respect solitary tumour if <3cm inc survival
59% reoccur
Transplant 70% 5 year survival
Percutaneous ablation, tumour embolisation, sorafenib

Question 16

Prevent HCC

Answer 16

HBV vaccine

Screening if at risk USS alpha feta protein

Question 17

What is haemobilia

Answer 17

Late HCC bleed into the biliary tree

Whenever Winckes triad obtains - RUQ pain, upper GI haemorrhage, jaundice, may be life threatening

Question 18

Criteria for transplant in HCC

Answer 18

1 nodule less than <5cm
2-3 nodules <3cm
Milan Criteria

Question 19

What is sorafinib

Answer 19

Kinase inhibitor

Question 20

What is TACE

Answer 20

Transarterial chemoembolisation

Question 21

What is aflatoxin

Answer 21

Produced by certain fungi on agricultural crops - Maize

Aspergillus flavus,aspergillus parasiticus abundant in humid regions

Question 22

What is Chinese liver fluke

Answer 22

Clonorchis sinesis

Parasite feeds on bile

Question 23

What is carioli’s disease

Answer 23

Communicating artery ectasia, inherited cystic dilated bile duct in the liver so is intrahepatic

Question 24

Cholangiocarcinoma makes up what % of liver primaries

Answer 24

10

Question 25

Causes

Cholangiocarcinoma

Answer 25

Flukes , PSC, biliary cyst, carolis, HBV, HCV, DM, N-nitosotoxins

Question 26

Presentation cholangiocarcinoma

Answer 26

Fever, abdo pain, +- ascites, malaise inc bilirubin, inc ALP

Question 27

Pathology cholangiocarcinoma

Answer 27

Slow growing

Distal extra hepatic perihilar

Question 28

Management cholangiocarcinoma

Answer 28

70% inoperable
76% reoccur
Surgery
Major hepatectomy + extra hepatic bile duct excisions + caudate lobe resection
Stent tree percutaneously via ERCP improve quol
Transplant rarely possible

Question 29

Prognosis Cholangiocarcinoma

Answer 29

5 months