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GI and General surgery > Liver Cancer > Flashcards

Liver Cancer Flashcards

1
Q

What proportion of liver tumours are metastases?

A

90%

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2
Q

What are common sites for liver mets to spread from?

A
  • Stomach
  • Colon
  • Pancreas
  • Bone - leukaemia/lymphoma
  • Carcinoid tumours
  • Breast
  • Bronchus
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3
Q

What are symptoms of liver tumours?

A
  • Fever
  • Malaise
  • Anorexia
  • Decreased weight
  • RUQ pain
  • Jaundice - late unless cholangiocarcinoma
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4
Q

What are signs that someone may have a luiver tumour?

A
  • Hepatomegaly
  • Signs of chronic liver disease +/- evidence of decompensation
  • Abdominal masses
  • Liver bruit
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5
Q

What are causes of hepatocellular carcinoma?

A
  • HBV
  • HCV
  • Cirrhosis - alcohol, haemochromatosis, PBC
  • NAFLD
  • Anabolic steroids
  • Aflatoxin
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6
Q

What sex does HCC occur most commonly in?

A

Males

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7
Q

What investigations would you consider doing if you suspected liver cancer?

A
  • Bloods - FBC, U+E’s, Clotting, LFTs, hepatitis serology, alpha-fetoprotein
  • Imaging - US/CT, MRI, ERCP (if chlangiocarcinoma suspected),
  • Other - biopsy

If secondary mets found, perform CXR/Mammography/colonoscopy/CT/MRI/marrow biopsy when looking for primary

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8
Q

What specific type of imaging would you use in suspected HCC?

A

3-phase CT - delayed wash-out in a suspected mass

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9
Q

What might you find on FBC in someone with HCC?

A
  • Microcytic anaemia - due to bleeding in e.g. alcoholic liver cirrhosis
  • Thrombocytopenia - indicative of portal hypertension due to cirrhosis
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10
Q

What might you see on U+E’s in someone with HCC?

A
  • Hyponatraemia - volume overload/diuretic use
  • Increased Urea - secondary to prerenal azotaemia, AKI, cCKD, or hepatorenal syndrome.
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11
Q

What might you see on LFTs in someone with liver cancer?

A
  • ALT/AST increased
  • ALP increased
  • Bilirubin increased
  • Low albumin
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12
Q

What might you find on hepatitis screening in someone with suspected HCC?

A

Hepatitis B/C

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13
Q

What tumour marker is used in the detection of HCC?

A

Alpha-fetoprotein

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14
Q

What imaging would you use first in someone who you suspected had liver cancer?

A

US of liver - poorly defined margins, and course, irregular internal echoes

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15
Q

Hwo would you manage HCC?

A

Early disease

  • Consider resection - if < 3cm
  • Consider Liver transplantation +/- TACE +/- RFA

Intermediate disease

  • Transcatheter arterial chemoembolization (TACE)
  • Percutaneous ablation

Advanced

  • Chemotherapy
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16
Q

Where in the biliary tree can cholangiocarcinoma occur?

A

Intra or extrahepatic

17
Q

What are causes of cholangiocarcinoma?

A
  • Liver Flukes
  • Alcoholic liver disease
  • PSC
  • Choledocal cyst
  • CAroli’s disease
  • HBV/HCV
  • Diabetes
  • Toxins
18
Q

What are clinical features of cholangiocarcinoma?

A
  • Fever
  • Abdo Pain
  • Obstructive jaundice – no pain
  • Itching
  • Weight loss
19
Q

How are extrahepatic cholangiocarcinomas divided in terms of location?

A
  • Perihilar
  • Distal
20
Q

What is the most common type of cholangiocarcinoma; intra- or extra-hepatic?

A

Extra-hepatic

21
Q

What investigations would you consider doing in someone who you suspected might have cholangiocarcinoma?

A
  • Bloods - LFTs, PT, serum CA 19-9/CA-125
  • Abdo ultrasound
  • Consider CT/MRI abdo/MRCP/ERCP
  • Consider PET scan
  • Biopsy and cytology
22
Q

How would you manage someone with cholangiocarcinoma?

A
  • Surgical resection - only curative option
  • Palliative interventions
23
Q

What palliative procedures can be done to paliate someone with chlangiocarcinoma?

A
  • Surgical bypass
  • Stenting (Percutaneous vs Endoscopic)
  • Palliative radiotherapy
  • Chemotherapy
  • PDT
  • Liver transplant (not standard)
24
Q

What are examples of benign liver cancers?

A
  • Haemangiomas
  • Adenomas
  • Cysts
  • Fibroma
  • Benign GIST
  • Focal nodular hyperplasia
25
Q

What are types of malignant primary liver cancers?

A
  • HCC
  • Cholangiocarcinoma
  • Angiosarcoma
  • Hepatoblastoma
  • GIST
  • Fibrosarcoma

GI and General surgery (44 decks)

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