Malignant Liver lesions Flashcards
What are the 5 main malignant liver tumours
Hepatocellular carcinoma (HCC) Fibro-lamellar carcinoma of the liver Hepatoblastoma Intrahepatic cholangiocarcinoma Metastases
What is the most common primary liver cancer
Hepatocellular carcinoma
Who is likely to have HCC
Saudi Men
What is the most important risk factor for HCC
Cirrhosis
What 4 things can cause HCC
Hep B
Hep C
Alcohol
Aflatoxin
What is aflatoxin
Mould on peanuts
Is HCC usually symptomatic or asymptomatic?
Asymptomatic
What are the 2 common presentations for HCC in those who are symptomatic
Weight loss and RUQ pain
Where are the 6 common places for HCC metastases
Rest of the lvier, Via the portal vein Lymph nodes Lung Bone Brain
What is the most common protein marker for HCC
Alfa feto protein (AFP)
What is the problem with testing AFP?
An elevation is only seen in 70% of the patients
How can we diagnose HCC
Elevated AFP US Triphasic CT MRI Biopsy
What is the prognosis of HCC
Depends on the tumour size and whether there is extrahepatic spread
Underlying liver disease
What is the best available treatment for HCC
Liver transplantation
When are we able to do a liver transplantation for patients with HCC
If there is only a single tuour which is less than 5cm or if there are less than 3 tumours less than 3cm each
When is HCC resection feasible
For small tumours with preserved liver function (no jaundice or portal Hypertension
What can we do for a patient with non resectable HCC
Local Ablation
What type of technique is local ablation
Palliative
What does radio frequency ablation involve
Putting devices into the liver and cooking boiling or killing them with alcohol
How is chemoembolisation performed
Inject chemotherapy into the hepatic artery
Who is most likely to get fibro-lamellar carcinoma
Young patients - 5-35
What is fibro-lamellar carcinoma not related to
Cirrhosis
What does a CT show in fibro-lamellar Carcinoma
Stellate scar with radial septa showing persistant enhancement
Where is the most common site for blood born metastases
Liver
Where are the common primaries metastases
Colon Breast Lung Stomach Pancreas Melanoma
How can we diagnose secondary liver metastases
Imaging or FNA
What does treatment depend on for secondary liver metastases
The primary cancer
