Hepatobiliary CA

Question 1

The majority of liver CA are what?

Answer 1

Mets from other organs

Question 2

The falciform ligament separates what parts of the liver?

Answer 2

lobes 2 and 3

Question 3

What is the most common benign condition of the liver that is mistaken for hepatocellular CA? What are the other three?

Answer 3

Focal nodular hyperplasia

Simple cysts
Hemangiomas
Adenomas

Question 4

What type of drugs are associated with liver adenomas? What are the cells that are found within these lesions?

Answer 4

Oral contraceptives

Only Hepatocytes

Question 5

How often are liver adenomas symptomatic?

Answer 5

50% of the time

Question 6

Which gender usually gets FNH?

Answer 6

Women

Question 7

How do you diagnose FNH? What is the characteristic finding?

Answer 7

Characteristic CT findings (macroscopic central scar)

Question 8

What are the cell types within FNH?

Answer 8

Hepatocytes
Scar
Biliary tract

Question 9

True or false: focal nodular hyperplasia is not seen well on ultrasound

Answer 9

True

Question 10

What is the most common benign primary tumor of the liver? What are they? What is the treatment?

Answer 10

Hemangioma

Endothelium lined, blood filled spaces

Unless really big (greater than 5 cm), nothing

Question 11

What is the most common primary malignant tumor of the liver?

Answer 11

Hepatocellular CA

Question 12

Why is HCC common in other countries? Why is there a rise in the US?

Answer 12

Viral hepatitis B

Rise in Hep C in US

Question 13

What are the risk factors for HCC? (gender, infx, liver conditions)

Answer 13

Male
Aflatoxin
Hepatitis
Cirrhosis
Liver diseases

Question 14

What are aflatoxins?

Answer 14

Toxins produced by aspergillus species, and is commonly on food products

Question 15

What are the three forms of hepatocellular CA?

Answer 15

Solitary
Diffuse
Fibrolamellar

Question 16

What is hepatoblastoma?

Answer 16

Childhood liver cancer of blastomas

Question 17

In whom is the fibrolamellar HCC more common? Why do these have a better outcome?

Answer 17

women younger than 35

Does not cause cirrhosis or does not completely affect the liver

Question 18

What is the protein that is followed with HCC? What is this used for?

Answer 18

Alpha-fetoprotein

Not used for screening–follow pt levels after a surgical resection

Question 19

In whom is HCC common?

Answer 19

males above 60 yo

Question 20

What is the best way to diagnose hepatocellular CA?

Answer 20

Imaging

Question 21

What is the most common surgery for liver cancer? Are transplants common for liver cancer?

Answer 21

Lobectomy

Transplant rare–usually used for other diseases

Question 22

What are the three challenges of liver surgery?

Answer 22

1. Dual blood supply
2. Hepatic reserve (need enough)
3. Coagulopathy

Question 23

What is the measurement of hepatic reserve? What is measured for this score? What is class A?

Answer 23

Child-Pugh score (lower is better)

• Encephalopathy
• Ascites
• Albumin
• PT
• Bili

6 points or less is class A

Question 24

What are the optimal characteristics for liver resection?

Answer 24

Solitary tumors without major vascular invasion

Question 25

How good is the survival rate after a liver surgery for HCC? Recurrence rate?

Answer 25

50% live 5 years 70%

Question 26

How is radiofrequency performed?

Answer 26

Microwave ablation percutaneously

Question 27

What are the three general types of embolization for liver CA?

Answer 27

Arterial embolization Chemoembolization Radioembolization

Question 28

What is the chemo agent for HCC? MOA?

Answer 28

Sorafenib Blocks tumors from forming new blood vessels, and slows the growth by binding surface proteins

Question 29

What are the three classifications of intrahepatic cholangiocarcinomas?

Answer 29

Intrahepatic Perihilar Distal

Question 30

How is intrahepatic cholangiocarcinoma treated?

Answer 30

Like primary liver CA

Question 31

Where are the majority of cholangio CAs? What age?

Answer 31

Perihilar region | Greater than 65 yo

Question 32

True or false: most pts with cholangiocarcinoma have no known risk factors

Answer 32

True

Question 33

What are the risk factors for cholangiocarcinoma? (infx, autoimmune)

Answer 33

Chinese liver fluke | Sclerosing cholangitis

Question 34

What is the ab that is elevated with primary biliary cirrhosis?

Answer 34

AMA

Question 35

What is the antibody that is elevated with Primary sclerosing cholangitis?

Answer 35

pANCA

Question 36

Which gallbladder cancer is associated with UC?

Answer 36

Primary sclerosing cholangitis

Question 37

What are the ssx of bile duct carcinoma?

Answer 37

Biliary tract obstructive ssx

Question 38

What are the markers for bile duct carcinomas? (2)

Answer 38

CA19-9 or CEA

Question 39

What are the ways to diagnose cholangiocarcinoma?

Answer 39

ERCP and imaging

Question 40

What is the treatment for cholangiocarcinoma?

Answer 40

Surgical excision Biliary decompression/relief of obstruction

Question 41

What is the reconstruction surgery that is used to treat cholangiocarcinoma? How effective is this?

Answer 41

Roux-en-y (hepaticojejunostomy) Still really poor outcomes

Question 42

Is radiation effective for cholangiocarcinoma? Chemo?

Answer 42

Not really--increase survival by 2 months Chemo ineffective

Question 43

What is the survival rate like with late cholangiocarcinoma?

Answer 43

Really poor

Question 44

What is the classic patient for gallbladder CA? Survival rates?

Answer 44

elderly women without liver disease (chilean women in particular) Really low survival rates

Question 45

What are the characteristics of gallbladder cancer?

Answer 45

Aggressive and metastasizes quickly

Question 46

Who is the classic patient for HCC?

Answer 46

elderly man with liver disease

Question 47

What is a porcelain gallbladder?

Answer 47

Calcification of the gallbladder d/t gallbladder cancer

Question 48

Gallstones are present in what percent of gallbladder cancer pts? Why is this significant?

Answer 48

75-98% Not necessarily significant, since a lot of people have gallstones

Question 49

What is the only stage of gallbladder cancer that has an excellent prognosis?

Answer 49

T1a (cancer limited to mucosa and lamina propria)

Question 50

What percent of patients with Primary sclerosing cholangitis develop cholangiocarcinoma?

Answer 50

10-36%

Question 51

What is Courvoisier's sign?

Answer 51

Palpable gallbladder

Question 52

What is T1b gallbladder CA?

Answer 52

CA into the muscularis mucosa