LIVER TUMOURS

Question 1

Most tumours of the liver are primary or secondary?

Answer 1

Secondary: metastatic

Question 2

What is the most common primary liver tumour? What causes it?

Answer 2

Hepatocellular carcinoma

Usually consequence of chronic liver disease: hepatitis B/C, alcoholic cirrhosis, Wilsons disease, haemochromatosis, alpha-1 antitrypsin

Question 3

What glucose blood result is characteristic of hepatocellular carcinoma? Give 3 reasons why this happens

Answer 3

Hypoglycaemia

• Tumours have high metabolic rate
• Tumours may produce insulin like growth factor
• Tumours may damage liver to point it impairs gluconeogenesis

Question 4

Why do hepatocellular carcinomas sometimes cause erythrocytosis?

Answer 4

May secrete EPO

Question 5

In someone with hepatocellular carcinoma who presents with an abrupt onset of abdominal pain, ascites and hepatomegaly, which condition must you consider?

Answer 5

Budd-Chiari syndrome

• ​Hypercoagulable state + compression of hepatic veins that drain liver ⇒ blood clot
• Classic symptom triad: abdominal pain, ascites, hepatomegaly

Question 6

What protein can be measured to indicate hepatocellular carcinoma? What is the problem with measuring this protein?

Answer 6

Alpha-fetoprotein (AFP)

Not specific to hepatocellular carcinoma, can be elevated in chronic liver disease therefore useful to monitor for rise in baseline level

Question 7

How do you diagnose hepatocellular carcinoma?

Answer 7

Imaging: CT, MRI, ultrasound

Biopsy: definitive diagnosis

Question 8

Hepatocellular carcinoma metastases is rare. If it does occur what does it spread by and where does it normally go?

Answer 8

5 to 15% of cases have metastases at time of diagnosis

Usually spreads via blood to lungs

Question 9

What is the treatment of hepatocellular carcinoma? What is the overall prognosis?

Answer 9

Notoriously poorly responsive to chemotherapy and radiotherapy

• Surgical excision often not possible due to extensive liver involvement
• Liver transplant an option
• Poor prognosis overall: median survival 6 to 20 months

Question 10

What are Aflatoxins and what do they cause?

Answer 10

Toxins produced by fungi found on crops e.g. corn, peanuts, cottonseed, tree nuts. Among most carcinogenic substances known to man

Mainly Aspergillus, abundant in humid regions. Contaminate crops in field, at harvest, during storage

• Exposure: inhalation, skin permeation and consumption
• Associated with liver & gallbladder cancer

Happens more in developing countries

Question 11

Which type of liver tumour is most associated with women between 20 and 40?

what is the prognosis and risk?

Answer 11

Hepatocellular adenoma → benign tumour. Most commonly in people with elevated oestrogen, classically in women taking oestrogen contraceptives.

rarely symptomatic but case reports of rupture during pregnancy

Question 12

What is the most common benign liver tumour?

what is not recommended in this type of tumour?

Answer 12

Hepatic haemangioma - lumps consist of blood vessels and are usually harmless.

→ often discovered incidentally during surgery or imagery

→ biopsy not recommended due to risk of fatal haemorrhage

Question 13

Exposure to which 2 toxic substances increases risk of hepatic angiosarcoma?

Answer 13

• Vinyl chloride
• Arsenic

Question 14

Metastases to liver are much more common than primary tumours. Cancer n which 3 areas of body are most likely to send metastasis to liver?

what is characteristic of metasteses in liver on imaging when compared to primary tumours?

Answer 14

• Anywhere along GIT
• Breast
• Lung

On imaging, metastases are likely to show as multiple nodules in liver (this is less likely if tumour is primary)