Liver Cancer

Question 1

What percentage of liver cancers are primary and what percentage are metastatic

Answer 1

10% primary

90% mets

Question 2

What are the common causes of HCC

Answer 2

Viral hep
Chronic alcoholism
PBC

Question 3

Give risk factors for HCC

Answer 3

Viral hep B,C
Excess alcohol 
Smoking 
70yrs + 
FH
Aflatoxins

Question 4

What are the clincal features of HCC

Answer 4

Liver cirrhosis ( HCC associated with chronic inflammation)
Ascites
Jaundice
Enlarged liver with irregular nodules

Question 5

What are the differentials

Answer 5

Viral hep
Cardiac failure ( hepatomegaly )
Benign hepatocellular adenoma

Question 6

Which blood tests would you order to investigate liver cancer

Answer 6

LFTs will be de-ranged
FBC
COAG
CRP
AFP

Question 7

What imaging modalities will be used to investigate liver cancer

Answer 7

USS - if mass found and raised AFP, this is diagnostic and is followed up by CT scan to help stage the cancer
If doubtful then do a FNA under USS/CT guidance

Question 8

Which scoring system is used to stage HCC

Answer 8

Barcelona clinic liver cancer score

Question 9

Which score can be used to assess liver cirrhosis risk

Answer 9

Child-Pugh score

MELD score

Question 10

Which parameters are included in the child Pugh score

Answer 10

Total bilirubin 
Albumin 
Degree of ascites 
INR
Evidence of encephalopathy

Question 11

What parameters are used in the MELD score

Answer 11

Creatinine 
Bilirubin 
INR
Sodium 
Use of dialysis

Question 12

What is the management of liver cancer

Answer 12

Surgical management
Surgical resection
Transplantation - must fulfil the Milan criteria

Non-surgical management

• image guided ablation
• alcohol ablation
• trans arterial chemo embolisation - BCLC stage B

Question 13

Which cancers are most likely to spread to the liver

Answer 13

GI cancers
Stomach
Pancreas
Lung