Liver Tumours

Question 1

Liver tumour signs/symptoms

Answer 1

Fever, weight loss, anorexia
RUQ pain due to liver capsule stretch
Hepatomegaly
Bruit over liver

Question 2

Liver tumour tests

Answer 2

alpha-fetoprotein for HCC
US/CT/MRI
ERCP for cholangiocarcinoma
Liver biopsy

Question 3

Liver tumour causes

Answer 3

90% metastases from breast/bronchus/GI tract
HBV/HCV/AIH/cirrhosis for HCC
Anabolic steroids

Question 4

Benign liver tumours

Answer 4

Haemangiomas most common benign liver tumours, incidental finding on CT/US and don’t need treatment
Adenomas caused by anabolic steroids, the pill, pregnancy; only treated if symptomatic

Question 5

HCC presentation

Answer 5

Fatigue
Anorexia/weight loss
RUQ pain
Jaundice
Ascites
Haemobilia

Question 6

What is HCC

Answer 6

Hepatocellular carcinoma, accounts for 90% of primary liver cancers

Question 7

HCC causes

Answer 7

HBV/HCV/AIH
Cirrhosis/NASH
Anabolic steroids
Aflatoxin

Question 8

HCC Treatment

Answer 8

Resect solitary tumours <3cm across
Liver transplant
Percutaneous ablation (transarterial chemoembolisation, TACE), tumour embolisation and sorafenib

Question 9

What is cholangiocarcinoma

Answer 9

Biliary tree cancer

Question 10

Cholangiocarcinoma causes

Answer 10

Fluke parasites (from eating raw fish)
PSC
HBV/HCV
Diabetes Mellitus

Question 11

Cholangiocarcinoma presentation

Answer 11

Fever
Abdo pain ± ascites
Malaise
Inc bilirubin and ALP

Question 12

Cholangiocarcinoma treatment

Answer 12

70% inoperable, 76% recurrence of those that are (Hepatectomy + Extrahepatic bile duct excision + caudate lobe resection) and post-op complications e.g. liver failure/GI bleeding
Stenting of extrahepatic biliary tree improves quality of life
Liver transplant rarely possible

Question 13

Cholangiocarcinoma prognosis

Answer 13

Approx. 5 mths