Liver Tumours Flashcards
Most common liver tumours.
Metastases from e.g. breast, bronchus or GI tract.
Types of liver tumours.
Metastases
Hepatocellular carcinoma (90% of primary liver cancers)
Cholangiocarcinoma (Around 10% of primary liver cancers)
Haemangiomas (benign)
Adenomas (benign)
Types of malignant primary liver tumours.
HCC
Cholangiocarcinoma
Angiosarcoma
Hepatoblastoma
Fibrosarcoma and hepatic GI stromal tumour (this was formerly known as leiomyosarcoma)
Types of benign primary liver tumours.
Cysts
Haemangioma
Adenoma
Focal nodular hyperplasia
Fibroma
Benign gastro intestinal stromal tumour (formerly known as leiomyoma)
Clinical features of liver tumours.
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
Which liver tumour can cause jaundice early?
Cholangiocarcinoma
Investigations of liver tumours.
Bloods - FBC, clotting, LFTs, hepatitis serology, AFP, immunology screen
Imaging
Liver biopsy
Imaging of liver tumours.
US or CT to identify lesions and guide biopsy
MRI can distinguish benign from malignant lesions.
ERCP and biopsy if suspecting cholangiocarcinoma
What is liver biopsy good for in liver tumours?
May achieve a histological diagnosis.
Treatment of liver metastases.
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.
Where in the world is HCC more common?
China and Africa (40% of all cancers compared to UK’s 2%, largely attributable to Hepatitis)
Clinical features of HCC.
Fatigue
Loss of appetite
RUQ pain
Loss of weight
Jaundice
Ascites
Haemobilia
Causes of HCC.
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
Diagnosis of HCC.
3-phase CT
MRI
Biopsy
Treatment of HCC.
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.
Prevention of HCC.
Hep B vaccination
Don’t reuuse needles
Screen blood
Decrease aflatoxin exposure
AFP +/- ultrasound screening if at risk.
What is cholangiocarcinoma?
Biliary tree cancer
Causes of cholangiocarcinoma.
Flukes (Clonorchis)
PSC
Biliary cysts
Caroli’s disease
HBV
HCV
DM
N-nitroso toxins
Clinical features of cholangiocarcinoma.
Fever
Abdominal pain +/- ascites
Malaise
Increased bilirubin
Markedly increased ALP
Pathology of cholangiocarcinoma.
Tumours are slow-growin and most are distal extrahepatic or perihilar
Treatment of cholangiocarcinoma.
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.
Prognosis of cholangiocarcinoma.
Approximately 5 months
Most common benign liver tumour.
Haemangioma
Often incidental finding
They don’t require treatment and should not be biopsied.
Causes of adenoma in the liver.
Anabolic steroids
COCP
Pregnancy
Should only be treated if symptomatic.
