Tumours liver, pancreas + gall bladder Flashcards Preview

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Flashcards in Tumours liver, pancreas + gall bladder Deck (31):
1

What liver tumours can you get?

Benign:
- adenomas
- haemangiomas

Malignant:
- primary: hepatocellular carcinoma, cholangiocarcinoma,
- secondary: metastases

2

What are liver adenomas?

Benign tumours of hepatocytes, they are pretty harmless
Common

3

What causes liver adenomas?

Hormones
The oral contraceptive pill
Anabolic steroids

4

Can liver adenomas cause any problems?

Occasionally they can rupture causing abdominal pain

5

Management of liver adenomas?

Only treat if symptomatic
Resection

6

What are liver haemangiomas?

Benign mass of tangled blood vessels in the liver
Harmless and very common

7

How are liver haemangiomas picked up?

Often incidentally!

8

Management of liver haemangiomas?

No treatment required

9

What is the most common malignant primary liver tumour?

Hepatocellular carcinoma (HCC)

10

Clinical features of HCC?

Fatigue
Loss of appetite
Right upper quadrant pain
Weight loss
Ascites
Jaundice

Rapid development of these symptoms

11

What causes HCC?

Hepatitis: B, C, autoimmune

Cirrhosis

Non-alcoholic fatty liver disease
Steroids
Family history

12

How can you prevent HCC?

Prevent Hep B + C: vaccination, safety using needles

Screen the liver in at-risk people

13

Investigation of HCC?

Blood:
- 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

14

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

15

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?

False

You can be almost certain that the lesion is HCC
Doing a biopsy has risks of cancer spreading so just treat for HCC

16

Treatment of HCC?

Surgical resection if tumour is small enough, although they often get recurrence within 3 years

Transplant

Ablation using chemicals or high frequency US can cause necrosis

Chemo is not very beneficial

17

What is cholangiocarcinoma?

Cancer of the biliary tree
Adenocarcinoma

18

What causes cholangiocarcinoma?

Flukes: a type of parasitic flatworm

Primary Sclerosis Cholangitis

Biliary cysts

Hepatitis B + C

Diabetes Mellitus

19

Clinical features of cholangiocarcinoma?

Fever
Abdominal pain
Ascites
Malaise

20

Investigations of cholangiocarcinoma?

Blood:
- raised bilirubin
- very raised alkaline phosphatase

USS: of liver and biliary tree

ERCP: endoscopic retrograde cholangiopancreatography

Surgical exploration + biopsy

21

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

22

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

23

Where are the most common origins of secondary liver tumours?

Stomach
Lung
Colon
Breast
Uterus

24

What is the most common type of pancreatic cancer?

Adenocarcinoma of the pancreatic ducts

25

What are the risk factors of pancreatic cancer?

Being male
Age above 60
Smoking
Alcohol
Diabetes mellitus
Chronic pancreatitis
Large waist circumference
Poor diet: lots of red meat, processed food
Family history

26

Where in the pancreas do malignant tumours most commonly arise?

Head of pancreas

27

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
Non-specific symptoms

28

Why do cancers of the head of the pancreas and ampulla of Vater cause jaundice?

Because they cause obstruction to the common bile duct

29

Investigations of pancreatic cancer?

Blood:
- tumour markers
- cholestatic jaundice

USS + CT: show mass or common bile duct obstruction

MRI: staging

ERCP

30

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

Analgesia

Refer to palliative care team

31

What is the prognosis like for pancreatic cancer? Why?

Poor
Often presents too late