EXAM #3: HEPATOBILIARY MALIGNANCY Flashcards Preview

Gastrointestinal System > EXAM #3: HEPATOBILIARY MALIGNANCY > Flashcards

Flashcards in EXAM #3: HEPATOBILIARY MALIGNANCY Deck (43):
1

How many segments is the liver divided into? How are these segments devised?

8, based on vascular supply

2

List the benign liver lesions.

1) Focal Nodular Hyperplasia
2) Simple Cyst
3) Hemangioma*
4) Adenoma

*Most common

3

What are Liver Adenomas?

Benign glanduar liver tumor

4

What are Liver Adenomas associated with?

Oral contraceptives--regress with contraceptive cessation

5

What is the greatest risk with a Hepatic Adenoma?

Rupture especially during pregnancy

*Also can transform to liver metastasis

6

What are the buzzwords for describing FNH?

Nodular hyperplasia with a "CENTRAL SCAR"

7

What imaging study is best for visualizing FNH?

CT Scan, specifically in the "arterial phase"

8

What is a Hemangioma?

Blood filled space

9

What is a "Giant Hemangioma?"

Hemangioma that is greater than 5cm

10

What are the two primary liver cancers?

1) Hepatocellular carcinoma
2) Cholangiocarcinoma (bile duct cancer)

****Note that sometimes HCC is called Hepatoma*****

11

Where is HCC common?

Worldwide (non-US and Europe) b/c of endemic viral hepatitis

12

What are the risk factors for HCC?

1) Viral hepatitis (HBV and HCV)
2) Anything causing cirrhosis
- Alcoholism
- Hemochromatosis
- Wilson's Disease
- Alpha-1 antitrypsin def.
- NAFLD
3) Aflatoxin

13

What are the subtypes of HCC?

- Solitary
- Diffuse
- Fibrolamellar

14

What is unique about Fibrolamellar HCC?

Best prognosis

****Commonly seen in women younger than 35****

15

What is a Hepatoblastoma?

Childhood primary liver cancer-- neoplastic proliferation of fetal liver cells

16

What tumor marker is associated with Hepatoblastoma?

Alpha-fetoprotein

17

How does HCC present?

- Hepatosplenomegaly
- Ascites
- Abdominal pain
- Weight loss

****Typically in males over 60 w/ underlying cirrhosis****

18

What is the classic diagnostic study for HCC?

Serum alpha-fetoprotein

19

What can you do if you're unsure that a mass is HCC?

Percutaneous liver biopsy

20

What are the surgical procedures for HCC?

1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant

21

What are the challenges of liver surgery?

1) Dual blood supply (hepatic a. and portal vein)
2) Hepatic reserve
3) Coagulopathy

22

What is a Child Pugh Score?

Measure of hepatic reserve

23

What is the scale used for the Child Pugh Score?

Class A, B, or C
A= good risk
B= moderate risk
C= poor risk

B and C normally don't get resected

24

What makes a good surgical candidate for surgical live resection?

1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Less than 3 cm tumor size

25

What are the alternative local therapies for patients that are poor surgical candidates?

1) Cryosurgery
2) Microwave ablation
3) Radiofrequency ablation
4) Ethanol injection
5) Acetic acid injection

26

What blood supply feeds most of the tumor tissue? Normal liver?

Hepatic artery= tumor
Portal circulation= normal

27

What are the treatment modalities that will use the hepatic a. to treat un-resectable HCC?

1) Embolization
2) Radiation therapy

28

What drug is specifically used as a chemotherapy for HCC?

Sorafenib

*****Note that this is commonly given via the hepatic a.*****

29

What is the MOA of Sorafenib?

1) Blocks angiogenesis
2) Targets HCC surface proteins

30

What are the three classifications of Cholangiocarcinoma?

1) Intrahepatic
2) Perihilar*
3) Distal

*Perihilar is most common

31

What are the risk factors for Cholangiocarcinoma?

1) PSC i.e. UC
2) Liver flukes
3) Congenital malformations i.e. "Choledochal cyst"

32

What is the only known cure for Cholangiocarcinoma?

Surgery

33

What is the clinical presentation for a Cholangiocarcinoma?

1) Constitutional sx. associated with all cancer
2) Painless jaundice
3) Biliary tract obstruction

34

What is the PE sign associated with a palpable Gallbladder?

Courvoisier's sign

35

What lab studies assist in the diagnosis of Cholangiocarcinoma?

1) Liver fxn tests
2) CEA
3) CA 19-9

36

What imaging studies are used to diagnose Cholangiocarcinoma?

1) ERCP
2) CT/MRI with cholangiography
3) US

37

What surgery is used to treat a perihilar Cholangiocarcinoma?

Roux en Y Hepaticojejunostomy

38

What surgery is used to treat a distal Cholangiocarcinoma?

Whipple Procedure

39

What procedure is used for most cases of Cholangiocarcinoma?

*Most are unresectable b/c of late disease presentation*
- Palliative biliary decompression

40

How does Gallbaldder cancer compare to Cholangiocarcinoma?

Much more aggressive/ poor prognosis

41

What is the typical patient with Gallbladder cancer?

Elderly women without liver disese
- Urban areas
- Chilean women

42

What is the classic imaging finding associated with Gallbladder cancer?

Porcelain gallbladder i.e. calcification of the gallbladder

43

What stage of GB cancer has the best prognosis?

T1a--incidentally found on lap chole for other pathology