B13. Epidemiology, etiology, histology, staging, symptoms and diagnosis of liver tumours  Flashcards Preview

Oncology > B13. Epidemiology, etiology, histology, staging, symptoms and diagnosis of liver tumours  > Flashcards

Flashcards in B13. Epidemiology, etiology, histology, staging, symptoms and diagnosis of liver tumours  Deck (10):

Most common tumors of the liver

Metastatic tumors, especially from the GI


Most common two primary liver tumors

1.) hepatocellular carcinoma
2.) cholangiocellular carcinoma

Other: important ones: extrahepatic bile duct tumor and gallbladder cancer


Epidemiology of liver tumors

3rd leading cause of cancer death worldwide


Risk factors for liver cancer

-Chronic liver inflammation: cirrhosis from any cause
-chronic hep B and C, hemochromatosis, alpha1-antitrypsin deficiency
-Medications: OCPs (3x increased risk), steroids
-smoking, alcohol, betel nuts
-Chemical carcinogens (aflatoxin, microcystin, vinyl chloride- associated with angiosarcoma)


Prognosis of liver cancer

Median survival: 6-20 months
5 year survival: all patients- 5%; patients undergoing complete resection- 11-40%


Histology and staging of hepatocellular cancer

Originate from hepatocytes.
-Often difficult to produce from biopsy samples
-Poorly differentiated similar to metastatic tumors


Bile duct cancers histology and staging

Diagnosed using either brush cytology from ERCP, or liver biopsy sample. Characteristically of primary cancers of the liver and its bile tracts, surgical resection is the only option for a long-term cure


TNM staging of liver tumors

-Tumor is confined to liver (max 1-5 nodules)=surgical resectability
-Tumor confined to liver= not surgically resectable
-lymph no involvement


Symptoms of liver cancer

-RUQ discomfort/shoulder pain
-jaundice, weakness, weight loss +/- fever (if central tumor necrosis)
-Ascites with blood (risk of sudden intra-abdominal hemorrhage)
-paraneoplastic syndrome- hypoglycemia, hypercalcemia, erythrocytosis, watery diarrhea
-metastasis: lung, bone, brain, peritoneal seeding


Investigation of liver tumor

-Elevated ALP, bilirubin, and alpha-fetoprotein (80% of patients)
-US (poorly defined margins with internal echos), triphasic CT (enhancement on arterial phase and washout on portal venous phase), MRI
-Liver enzyme and liver function tests: AST, ALT, ALP, bilirubin, albumin, INR