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