Flashcards in Tumours liver, pancreas + gall bladder Deck (31):
What liver tumours can you get?
- primary: hepatocellular carcinoma, cholangiocarcinoma,
- secondary: metastases
What are liver adenomas?
Benign tumours of hepatocytes, they are pretty harmless
What causes liver adenomas?
The oral contraceptive pill
Can liver adenomas cause any problems?
Occasionally they can rupture causing abdominal pain
Management of liver adenomas?
Only treat if symptomatic
What are liver haemangiomas?
Benign mass of tangled blood vessels in the liver
Harmless and very common
How are liver haemangiomas picked up?
Management of liver haemangiomas?
No treatment required
What is the most common malignant primary liver tumour?
Hepatocellular carcinoma (HCC)
Clinical features of HCC?
Loss of appetite
Right upper quadrant pain
Rapid development of these symptoms
What causes HCC?
Hepatitis: B, C, autoimmune
Non-alcoholic fatty liver disease
How can you prevent HCC?
Prevent Hep B + C: vaccination, safety using needles
Screen the liver in at-risk people
Investigation of HCC?
- Alpha fetoprotein (AFP), a tumour marker, may be raised
- Liver function tests will show dysfunction
USS, CT + MRI: to look for lesions, MRI is best at distinguishing benign from malignant
Biopsy: only performed where there is doubt
Why should you be wary of doing a biopsy of a liver tumour?
If it is malignant, there is a risk of the needle causing the tumour to seed (spread) into the needle tract
A patient with cirrhosis who is found to have a lesion in the liver should have a biopsy to confirm the cause.
True or false?
You can be almost certain that the lesion is HCC
Doing a biopsy has risks of cancer spreading so just treat for HCC
Treatment of HCC?
Surgical resection if tumour is small enough, although they often get recurrence within 3 years
Ablation using chemicals or high frequency US can cause necrosis
Chemo is not very beneficial
What is cholangiocarcinoma?
Cancer of the biliary tree
What causes cholangiocarcinoma?
Flukes: a type of parasitic flatworm
Primary Sclerosis Cholangitis
Hepatitis B + C
Clinical features of cholangiocarcinoma?
Investigations of cholangiocarcinoma?
- raised bilirubin
- very raised alkaline phosphatase
USS: of liver and biliary tree
ERCP: endoscopic retrograde cholangiopancreatography
Surgical exploration + biopsy
Management of cholangiocarcinoma?
Surgery is rarely beneficial, and even if it is successful recurrence is highly likely
Most treatment is palliative: stenting of obstructed bile duct to improve quality of life
Liver transplant very rarely indicated
What is the prognosis of cholangiocarcinoma? Why?
Very poor, approx. 5 months
Because metastasis often occurs before discovery of cancer and there are not many treatments aside from surgery
Where are the most common origins of secondary liver tumours?
What is the most common type of pancreatic cancer?
Adenocarcinoma of the pancreatic ducts
What are the risk factors of pancreatic cancer?
Age above 60
Large waist circumference
Poor diet: lots of red meat, processed food
Where in the pancreas do malignant tumours most commonly arise?
Head of pancreas
Clinical features of pancreatic cancer?
Depends on site!
Head of pancreas of ampulla of Vater:
- painless jaundice
- weight loss
Body + tail of pancreas:
- abdominal pain
- weight loss
Signs of metastasis
Diabetes due to problems with insulin production
Why do cancers of the head of the pancreas and ampulla of Vater cause jaundice?
Because they cause obstruction to the common bile duct
Investigations of pancreatic cancer?
- tumour markers
- cholestatic jaundice
USS + CT: show mass or common bile duct obstruction
Management of pancreatic cancer?
Surgical resection is only hope of cure, but only in fit patients with no mets
In patients where surgery is not advised offer chemo and/or radiotherapy
If not, palliative treatment: implant stent into common bile duct to remove symptoms + jaundice
Refer to palliative care team