Liver & Biliary Neoplasms

Question 1

what is the most common benign liver neoplasm? what is it associated with?

Answer 1

cavernous hemangioma
oral contraceptive pills

Question 2

what symptoms will a patient with a benign liver neoplasm present with? (2)

Answer 2

RUQ pain
+/- palpable RUQ mass

Question 3

what imaging is preferred for a benign liver neoplasm?

Answer 3

multiphase CT/MRI

Question 4

in which patients is surgical resection of a benign neoplasm done? (3)

Answer 4

symptomatic lesion
tumor > 5cm
rapidly enlarging tumor

Question 5

when can benign liver adenomas regress?

Answer 5

when OCPs are stopped

Question 6

malignant neoplasms that form from the liver’s normal hepatocytes

Answer 6

hepatocellular carcinoma

Question 7

what is the most common risk factor for hepatocellular carcinoma?

Answer 7

cirrhosis

Question 8

a patient presents with cachexia, bitemporal wasting, fatigue, ascites +/- blood, palpable liver enlargement and auscultation of bruit over tumor within the liver. Dx?

Answer 8

hepatocellular carcinoma

Question 9

what labs will be found in a patient with hepatocellular carcinoma? (4)

Answer 9

leukocytosis
anemia
elevated liver enzymes
elevated alpha-fetoprotein

Question 10

what is the marker for hepatocellular carcinoma?

Answer 10

alpha-fetoprotein

Question 11

what will be present if a patient has hepatocellular carcinoma with viral load or antibodies?

Answer 11

concurrent hepatitis

Question 12

what imaging is used to determine location and vascularity of hepatocellular carcinoma?

Answer 12

CT / MRI

Question 13

what imaging is used to diagnose hepatocellular carcinoma?

Answer 13

multiphasic CT or MRI with contrast

Question 14

what gives a definitive diagnosis of hepatocellular carcinoma?

Answer 14

liver biopsy

Question 15

what is the protocol of imaging if a hepatocellular lesion is <1cm? (2)

Answer 15

US q 3 months
biopsy if lesion enlarges

Question 16

what is the treatment for hepatocellular carcinoma that offers the best prognosis for patients with early HCC?

Answer 16

hepatic resection + liver transplant

Question 17

what are 2 palliative treatments for HCC in patients who are non-surgical candidates? (2)

Answer 17

radiofrequency ablation
sorafenib

Question 18

in which patients should we screen for HCC? (2)

Answer 18

chronic HBV
cirrhosis due to HBV, HBV, or alcohol

Question 19

what is the surveillance method for HCC?

Answer 19

U/S + alpha-fetoprotein q 6 months

Question 20

what is the most common neoplasm of the pancreas? and which part of the pancreas?

Answer 20

pancreatic adenocarcinoma
head

Question 21

a pancreatic adenocarcinoma is most symptomatic if it’s located where in the pancreas?

Answer 21

head

Question 22

in which patients should we suspect pancreatic cancer?

Answer 22

middle-age or older patients with weight loss and/or painless jaundice

Question 23

what indicates advanced disease beyond the pancreatic cancer?

Answer 23

pain

Question 24

a patient presents with diarrhea, migratory thrombophlebitis, weight loss, satiety, and silver stools (thomas sign). Dx?

Answer 24

pancreatic cancer

Question 25

what are 2 clinical signs that would indicate pancreatic cancer?

Answer 25

Courvoisier sign (palpable nontender gallbladder) sister mary joseph nodule (hard periumbilical nodule d/t mets to abdominal wall)

Question 26

what labs will be present in a patient with pancreatic cancer? (5)

Answer 26

mild anemia CA19-9 + FOB test +/- DM/hyperglycemia +/- elevated amylase/lipase

Question 27

what will indicate biliary obstruction in a patient with pancreatic cancer?

Answer 27

elevated LFTs

Question 28

what is elevated with neuroendocrine tumors in a patient with pancreatic cancer?

Answer 28

plasma chromogranin A

Question 29

what is the 1st line diagnostic for pancreatic cancer?

Answer 29

multiphase, thin cut CT with contrast

Question 30

what diagnostic will provide a definitive diagnosis for pancreatic cancer?

Answer 30

percutaneous FNA

Question 31

what is the treatment of choice for carcinoma of the head of the pancreas without evidence of extension or mets?

Answer 31

surgical resection (whipple) *AKA pancreaticoduodenal resection*

Question 32

what treatment can be used for non-surgical candidates to relieve jaundice?

Answer 32

endoscopic stenting