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Liver > Tumours liver, pancreas + gall bladder > Flashcards

Tumours liver, pancreas + gall bladder Flashcards

1
Q

What liver tumours can you get?

A

Benign:

  • adenomas
  • haemangiomas

Malignant:

  • primary: hepatocellular carcinoma, cholangiocarcinoma,
  • secondary: metastases
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2
Q

What are liver adenomas?

A

Benign tumours of hepatocytes, they are pretty harmless

Common

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3
Q

What causes liver adenomas?

A

Hormones
The oral contraceptive pill
Anabolic steroids

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4
Q

Can liver adenomas cause any problems?

A

Occasionally they can rupture causing abdominal pain

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5
Q

Management of liver adenomas?

A

Only treat if symptomatic

Resection

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6
Q

What are liver haemangiomas?

A

Benign mass of tangled blood vessels in the liver

Harmless and very common

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7
Q

How are liver haemangiomas picked up?

A

Often incidentally!

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8
Q

Management of liver haemangiomas?

A

No treatment required

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9
Q

What is the most common malignant primary liver tumour?

A

Hepatocellular carcinoma (HCC)

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10
Q

Clinical features of HCC?

A 
Fatigue
Loss of appetite
Right upper quadrant pain
Weight loss
Ascites
Jaundice

Rapid development of these symptoms

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11
Q

What causes HCC?

A

Hepatitis: B, C, autoimmune

Cirrhosis

Non-alcoholic fatty liver disease
Steroids
Family history

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12
Q

How can you prevent HCC?

A

Prevent Hep B + C: vaccination, safety using needles

Screen the liver in at-risk people

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13
Q

Investigation of HCC?

A

Blood:

  • Alpha fetoprotein (AFP), a tumour marker, may be raised
  • Liver function tests will show dysfunction

USS, CT + MRI: to look for lesions, MRI is best at distinguishing benign from malignant

Biopsy: only performed where there is doubt

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14
Q

Why should you be wary of doing a biopsy of a liver tumour?

A

If it is malignant, there is a risk of the needle causing the tumour to seed (spread) into the needle tract

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15
Q

A patient with cirrhosis who is found to have a lesion in the liver should have a biopsy to confirm the cause.

True or false?

A

False

You can be almost certain that the lesion is HCC
Doing a biopsy has risks of cancer spreading so just treat for HCC

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16
Q

Treatment of HCC?

A

Surgical resection if tumour is small enough, although they often get recurrence within 3 years

Transplant

Ablation using chemicals or high frequency US can cause necrosis

Chemo is not very beneficial

17
Q

What is cholangiocarcinoma?

A

Cancer of the biliary tree

Adenocarcinoma

18
Q

What causes cholangiocarcinoma?

A

Flukes: a type of parasitic flatworm

Primary Sclerosis Cholangitis

Biliary cysts

Hepatitis B + C

Diabetes Mellitus

19
Q

Clinical features of cholangiocarcinoma?

A

Fever
Abdominal pain
Ascites
Malaise

20
Q

Investigations of cholangiocarcinoma?

A

Blood:

  • raised bilirubin
  • very raised alkaline phosphatase

USS: of liver and biliary tree

ERCP: endoscopic retrograde cholangiopancreatography

Surgical exploration + biopsy

21
Q

Management of cholangiocarcinoma?

A

Surgery is rarely beneficial, and even if it is successful recurrence is highly likely

Most treatment is palliative: stenting of obstructed bile duct to improve quality of life

Liver transplant very rarely indicated

22
Q

What is the prognosis of cholangiocarcinoma? Why?

A

Very poor, approx. 5 months

Because metastasis often occurs before discovery of cancer and there are not many treatments aside from surgery

23
Q

Where are the most common origins of secondary liver tumours?

A 
Stomach
Lung
Colon
Breast
Uterus
24
Q

What is the most common type of pancreatic cancer?

A

Adenocarcinoma of the pancreatic ducts

25
Q

What are the risk factors of pancreatic cancer?

A 
Being male
Age above 60
Smoking
Alcohol
Diabetes mellitus
Chronic pancreatitis
Large waist circumference
Poor diet: lots of red meat, processed food
Family history
26
Q

Where in the pancreas do malignant tumours most commonly arise?

A

Head of pancreas

27
Q

Clinical features of pancreatic cancer?

A

Depends on site!

Head of pancreas of ampulla of Vater:

  • painless jaundice
  • weight loss

Body + tail of pancreas:

  • abdominal pain
  • weight loss

Signs of metastasis
Diabetes due to problems with insulin production
Non-specific symptoms

28
Q

Why do cancers of the head of the pancreas and ampulla of Vater cause jaundice?

A

Because they cause obstruction to the common bile duct

29
Q

Investigations of pancreatic cancer?

A

Blood:

  • tumour markers
  • cholestatic jaundice

USS + CT: show mass or common bile duct obstruction

MRI: staging

ERCP

30
Q

Management of pancreatic cancer?

A

Surgical resection is only hope of cure, but only in fit patients with no mets

In patients where surgery is not advised offer chemo and/or radiotherapy

If not, palliative treatment: implant stent into common bile duct to remove symptoms + jaundice

Analgesia

Refer to palliative care team

31
Q

What is the prognosis like for pancreatic cancer? Why?

A

Poor

Often presents too late

Liver (10 decks)

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