Malignant Liver lesions

Question 1

What are the 5 main malignant liver tumours

Answer 1

Hepatocellular carcinoma (HCC)
Fibro-lamellar carcinoma of the liver 
Hepatoblastoma
Intrahepatic cholangiocarcinoma 
Metastases

Question 2

What is the most common primary liver cancer

Answer 2

Hepatocellular carcinoma

Question 3

Who is likely to have HCC

Answer 3

Saudi Men

Question 4

What is the most important risk factor for HCC

Answer 4

Cirrhosis

Question 5

What 4 things can cause HCC

Answer 5

Hep B
Hep C
Alcohol
Aflatoxin

Question 6

What is aflatoxin

Answer 6

Mould on peanuts

Question 7

Is HCC usually symptomatic or asymptomatic?

Answer 7

Asymptomatic

Question 8

What are the 2 common presentations for HCC in those who are symptomatic

Answer 8

Weight loss and RUQ pain

Question 9

Where are the 6 common places for HCC metastases

Answer 9

Rest of the lvier,
Via the portal vein
Lymph nodes
Lung
Bone 
Brain

Question 10

What is the most common protein marker for HCC

Answer 10

Alfa feto protein (AFP)

Question 11

What is the problem with testing AFP?

Answer 11

An elevation is only seen in 70% of the patients

Question 12

How can we diagnose HCC

Answer 12

Elevated AFP
US
Triphasic CT
MRI
Biopsy

Question 13

What is the prognosis of HCC

Answer 13

Depends on the tumour size and whether there is extrahepatic spread
Underlying liver disease

Question 14

What is the best available treatment for HCC

Answer 14

Liver transplantation

Question 15

When are we able to do a liver transplantation for patients with HCC

Answer 15

If there is only a single tuour which is less than 5cm or if there are less than 3 tumours less than 3cm each

Question 16

When is HCC resection feasible

Answer 16

For small tumours with preserved liver function (no jaundice or portal Hypertension

Question 17

What can we do for a patient with non resectable HCC

Answer 17

Local Ablation

Question 18

What type of technique is local ablation

Answer 18

Palliative

Question 19

What does radio frequency ablation involve

Answer 19

Putting devices into the liver and cooking boiling or killing them with alcohol

Question 20

How is chemoembolisation performed

Answer 20

Inject chemotherapy into the hepatic artery

Question 21

Who is most likely to get fibro-lamellar carcinoma

Answer 21

Young patients - 5-35

Question 22

What is fibro-lamellar carcinoma not related to

Answer 22

Cirrhosis

Question 23

What does a CT show in fibro-lamellar Carcinoma

Answer 23

Stellate scar with radial septa showing persistant enhancement

Question 24

Where is the most common site for blood born metastases

Answer 24

Liver

Question 25

Where are the common primaries metastases

Answer 25

``` Colon Breast Lung Stomach Pancreas Melanoma ```

Question 26

How can we diagnose secondary liver metastases

Answer 26

Imaging or FNA

Question 27

What does treatment depend on for secondary liver metastases

Answer 27

The primary cancer