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Y3M - Gastro > Liver Tumours > Flashcards

Liver Tumours Flashcards

1
Q

Most common liver tumours.

A

Metastases from e.g. breast, bronchus or GI tract.

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2
Q

Types of liver tumours.

A

Metastases

Hepatocellular carcinoma (90% of primary liver cancers)

Cholangiocarcinoma (Around 10% of primary liver cancers)

Haemangiomas (benign)

Adenomas (benign)

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3
Q

Types of malignant primary liver tumours.

A

HCC

Cholangiocarcinoma

Angiosarcoma

Hepatoblastoma

Fibrosarcoma and hepatic GI stromal tumour (this was formerly known as leiomyosarcoma)

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4
Q

Types of benign primary liver tumours.

A

Cysts

Haemangioma

Adenoma

Focal nodular hyperplasia

Fibroma

Benign gastro intestinal stromal tumour (formerly known as leiomyoma)

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5
Q

Clinical features of liver tumours.

A

Fever

Malaise

Anorexia

Weight loss

RUQ pain as the liver capsule stretch

Jaundice is late (one exception)

Can cause intraperitoneal haemorrhage

Benign tumours are often asymptomatic

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6
Q

Which liver tumour can cause jaundice early?

A

Cholangiocarcinoma

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7
Q

Investigations of liver tumours.

A

Bloods - FBC, clotting, LFTs, hepatitis serology, AFP, immunology screen

Imaging

Liver biopsy

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8
Q

Imaging of liver tumours.

A

US or CT to identify lesions and guide biopsy

MRI can distinguish benign from malignant lesions.

ERCP and biopsy if suspecting cholangiocarcinoma

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9
Q

What is liver biopsy good for in liver tumours?

A

May achieve a histological diagnosis.

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10
Q

Treatment of liver metastases.

A

It signifies advanced cancer.

Treatment and prognosis will depend on the primary tumour location and the extent of metastases

Chemotherapy may be effective

Small solitary metastases can be resected.

However usually the treatment will be palliative.

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11
Q

Where in the world is HCC more common?

A

China and Africa (40% of all cancers compared to UK’s 2%, largely attributable to Hepatitis)

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12
Q

Clinical features of HCC.

A

Fatigue

Loss of appetite

RUQ pain

Loss of weight

Jaundice

Ascites

Haemobilia

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13
Q

Causes of HCC.

A

Hep B is the leading cause worldwide.

Hep C

AIH

Anythign that causes cirrhosis essential (alcohol, NAFLD, haemochromatosis, PBC, Wilson’s)

Aflatoxin

Clonorchis sinensis

Anabolic steroids

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14
Q

Diagnosis of HCC.

A

3-phase CT

MRI

Biopsy

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15
Q

Treatment of HCC.

A

Resection of solitary tumours < 3 cm across.

50% will have recurrence after 3 years.

Liver transplant gives a 5 year survival rate of 70%

Percutaneous ablation and tumour embolisation and sorafenib are options as well.

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16
Q

Prevention of HCC.

A

Hep B vaccination

Don’t reuuse needles

Screen blood

Decrease aflatoxin exposure

AFP +/- ultrasound screening if at risk.

17
Q

What is cholangiocarcinoma?

A

Biliary tree cancer

18
Q

Causes of cholangiocarcinoma.

A

Flukes (Clonorchis)

PSC

Biliary cysts

Caroli’s disease

HBV

HCV

DM

N-nitroso toxins

19
Q

Clinical features of cholangiocarcinoma.

A

Fever

Abdominal pain +/- ascites

Malaise

Increased bilirubin

Markedly increased ALP

20
Q

Pathology of cholangiocarcinoma.

A

Tumours are slow-growin and most are distal extrahepatic or perihilar

21
Q

Treatment of cholangiocarcinoma.

A

70% are inoperable at presentation.

Of those that are operable, 76% will recur.

You can do major hepatectomy + extrahepatic bile duct excision + caudate lobe resection.
This gives a 30% 5 year survival rate.

Stenting of obstructed extrahepatic biliary tree, percutaneously or via ERCP can improve quality of life.

Liver transplant is rarely possible.

22
Q

Prognosis of cholangiocarcinoma.

A

Approximately 5 months

23
Q

Most common benign liver tumour.

A

Haemangioma

Often incidental finding

They don’t require treatment and should not be biopsied.

24
Q

Causes of adenoma in the liver.

A

Anabolic steroids

COCP

Pregnancy

Should only be treated if symptomatic.

25
Q

Common liver metastases in men.

A

Stomach

Lung

Colon

26
Q

Common liver metastases in women.

A

Breast

Colon

Stomach

Uterus

27
Q

Less common liver metastases regardless of sex.

A

Pancreas

Leukaemia

Lymphoma

Carcinoid tumours

Y3M - Gastro (21 decks)

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