Liver Cancer Flashcards
(35 cards)
Types of liver cancer
- primary liver cancer: originates in the liver - hepatocellular carcinoma
- secondary liver cancer: originates outside the liver + metastasises to liver (most commonly colorectal)
Risk factor of Hepatocellular carcinoma
liver cirrhosis due to:
- alcohol related liver disease
- non alcoholic fatty liver disease
- hep B+C
- primary sclerosing cholangitis
.
- smoking
- family history
Outline screening of hepatocellular carcinoma in patients with liver cirrhosis
Screening every 6 months with USS + alpha fetoprotein
Presentation of liver cancer
- asymptomatic until late stages
- weight loss
- abdominal pain
- N+V
- ascites
- upper abdominal mass on palpation
- jaundice
- Pruritus
Investigations of liver cancer
- alpha fetoprotein - HCC tumour marker
- liver USS
- CT+ MRI for staging + further assessment
- biopsy for histology
- bloods: LFTs, clotting, viral hepatitis panel
Management of hepatocellular carcinoma
- poor prognosis due to late presentation
- resection
- liver transplant
- radiofrequency ablation
- microwave ablation
- transarterial chemoembolisation TACE
- radiotherapy
What is transarterial chemoembolisation?
- Interventional radiology procedure
- chemotherapy drug injected into hepatic artery > delivers dose to tumour
- followed by embolisation of vessel to block blood supply to tumour
What score is used to define liver function?
Childs-Pugh score
What cancers commonly metastasise to the liver?
Bowel
Pancreas
Breast
Lung
outline carcinoid syndrome
- occurs when metastases are present in the liver + release serotonin into systemic circulation
Presentation of carcinoid tumours
- flushing
- diarrhoea
- Cushing’s syndrome due to ACTH release
Investigations of carcinoid tumours
urinary 5-HIAA
plasma chromogranin A y
Management of carcinoid tumours
- somatostatin analogues e.g. octreotide
- anti-diarrhoeals for symptom relief
Types liver transplant
- entire liver from deceased donor
- portion of liver from living donor - living honour transplant
- split liver transplant from deceased donor (*liver split in half + transplanted into 2 recipients)
Types of liver transplants in terms of location
- orthtopic transplant: diseased liver removed + new liver placed in same location (most common)`
- heterotopic transplant: new organ in different anatomical location to diseased liver
Indications of liver transplants
- Acute liver failure: acute viral hepatitis, paracetamol overdose
- chronic liver failure: hepatocellular carcinoma, alcoholic liver disease, non alcoholic fatty liver disease
Contraindications of liver transplants in terms
- uncontrolled sepsis
- active alcohol or substance abuse
- significant co-morbidities e.g. severe kidney, lung or heart disease
- untreated HIV
- extra-hepatic malignancy
Types of incisions for liver transplants
Roof top incision
Mercedes Benz incision
Along lower costal margin +/- line up midline
What is donor recipient matching based on?
- ABO compatibility
- graft to recipient weight ratio
Complications of liver transplants in terms
- post operative haemorrhage
- rejection
- graft primary non function
- hepatic artery or portal vein thrombosis > venous outflow obstruction
- strictures
Post transplantation care after liver transplant
- lifelong immunosuppression + monitoring
- avoid alcohol + smoking
- treating opportunistic infections
- monitor disease recurrence + cancer
What could suggest liver transplant rejection
- abnormal LFTs
- fatigue
- jaundice
- fever
What are haemangiomas?
Common benign tumours of the liver
Presentation of haemangiomas
Asymptomatic
Found incidentally
