Liver Cancer and Liver Transplant Flashcards
What are the 2 types of liver cancer?
Hepatocellular carcinoma (80%)
Cholangiocarcinoma (20%)
Risk factors for hepatocellular carcinoma
CIRRHOSIS due to:
Viral hepatitis (B and C)
Alcohol
Non alcoholic fatty liver disease
Other chronic liver disease
How does liver cancer present?
Asymptomatic for a long time and then presents late
Weight loss Abdominal pain Anorexia Nausea and vomiting Jaundice Pruritus
Cholangiocarcinoma often presents with painless jaundice (pancreatic cancer)
Investigations in liver ca (5)
Alpha-fetoprotein (tumour marker in hepatocellular carcinoma)
CA19-9 (tumour marker in cholangiocarcinoma)
Liver ultrasound can identify tumours
CT and MRI scans are used for diagnosis and staging of the cancer
ERCP used to take biopsies or brushings to diagnose cholangiocarcinoma
Treatment for hepatocellular carcinoma
Very poor prognosis unless diagnosed early
Resection in early disease can be curative
Transplant when HCC is isolated
Kinase inhibitors work by inhibiting the proliferation of cancer cells -
Sorafenib, Regorafenib and Lenvatinib
HCC is generally considered resistant to chemo and radiotherapy (sometimes used palliatively)
Treatment for cholangiocarcinoma
Very poor prognosis unless diagnosed very early - can potentially be cured with resection
ERCP can be used for stenting to improve symptoms
Generally considered resistant to chemo and radiotherapy
What are haemangioma?
Common benign tumours of the liver
Often found incidentally
Cause no symptoms and have no potential to become cancerous
No treatment or monitoring is required
What is focal nodular hyperplasia?
Benign liver tumour made of fibrotic tissue
Usually asymptomatic and has no malignant potential
Often related to oestrogen and is therefore more common in women and those on the oral contraceptive pill
No treatment of monitoring is required
Types of transplant
Orthotopic
Living donor
Split donation
Reasons for tranplant
Acute liver failure (require immediate transplant) - viral hepatitis and paracetamol overdose
Chronic liver failure - wait longer, normal for it to take around 5 months for a liver to become available
Unsuitability for transplantation (5)
Significant co-morbidities (e.g. severe kidney or heart disease)
Excessive weight loss and malnutrition
Active hep B or C or other infection
End stage HIV
Active alcohol use (generally 6 months of abstinence is required)
Lifestyle and monitoring advice for patients receiving transplant
Avoid alcohol and smoking
Treating opportunistic infections
Monitoring for disease recurrence (i.e. of hepatitis or primary biliary cirrhosis)
Monitoring for cancer as there is a significantly higher risk in immunosuppressed patients
Monitoring for rejection (4)
Abnormal LFTs
Fatigue
Fever
Jaundice
