Cancer of the liver, gallbladder, and biliary tree Flashcards Preview

General Surgery > Cancer of the liver, gallbladder, and biliary tree > Flashcards

Flashcards in Cancer of the liver, gallbladder, and biliary tree Deck (20)
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Which cancers are commonest in the liver?

Secondary liver cancer. Most common metastases from breast, bowel, or lung cancer.


Describe the prognosis of secondary liver cancer

Most common cause of cancer death (35%)
Only 25% are suitable for curative surgery


How does secondary liver cancer present?

Hepatomegaly and ascites (50%)
-Ascites indicates wide dissemination and poor prognosis
Obstructive metastases: Jaundice, malaise, anorexia, weight loss


How is secondary liver cancer investigated?

FBC - anaemia and leukocytosis
LFTs - may be abnormal
Bilirubin, ALP, ALT may be raised
Alpha fetoprotein, PVIKA-II, CEA, CA19-9
CXR and Abdominal USS
Biopsy - not advised if tumour is operable


What management options exist for secondary liver cancer?

Hepatectomy for stage IV colorectal cancer
Freezing, ethanol, lasers, radio frequency ablation
Transcatheter arterial chemoembolisation
Laparoscopic liver resection for solitary liver met
Selective internal radiation therapy for non-resectable colorectal metastases in the liver


What are the types of primary liver cancer?

Hepatocellular carcinoma (90%)
Intrahepatic cholangiocarcinoma
Fibrolamella carcinoma - large vascular mass
Hepatoblastoma - children


What is the link between HCC and chronic liver disease?

70-90% of HCC develops in patients with chronic liver disease. Tumours are multifocal in 75% at presentation.


Describe the epidemiology of hepatocellular carcinoma

<1% of all new cancers in UK
Prevalence follows HBV and HCV infection
Common in Africa and Asia
M>F 4-8:1


Name 5 risk factors for hepatocellular carcinoma

90-95% have underlying cirrhosis
-Chronic HBV: commonest worldwide cause of HCC
-HCV: commonest cause of HCC in Europe
-Hereditary haemochromatosis
-Primary biliary cirrhosis
-Aflatoxins, contraceptives, androgens
-Metabolic syndrome, diabetes, smoking


How does hepatocellular carcinoma present?

Commonest: rapid deterioration of pre-existing cirrhosis

Symptoms: Pruritus, splenomegaly, bleeding oesophageal varicose, weight loss, jaundice, hepatic encephalopathy, ascites, RUQ pain

Signs: Jaundice, hepatomegaly, ascites, spider naevi, peripheral oedema, anaemia, caput medusa, liver flap/asterixis


Where does primary liver cancer metastasise?

Portal vein
Periportal lymph nodes


How are primary liver cancers investigated?

Alpha fetoprotein (AFP) >500ng/mL ➔ highly suggestive of HCC
USS: identifies site and cause of obstruction
Needle biopsy to confirm HCC diagnosis

ERCP to diagnose ampullary and bile duct carcinomas
PTC to diagnose intrahepatic biliary tumours
CT to assess local spread, LN, and metastases


What surgical treatment is available for primary liver cancer?

Partial hepatectomy (HCC)
Liver transplant (HCC associated with chronic hepatitis)

Embolisation. Percutaneous thermal or radio frequency ablation


What is the prognosis of HCC?

44% 5yr survival if surgically resectable
20% resectable at diagnosis


What types of cholangiocarcinoma exist?

Ductal adenocarcinoma (>90%)
Squamous cell carcinoma


Where can cholangiocarcinomas occur?

Perihilar region "Klatskin tumour" (commonest)
Distal: upper border of pancreas to ampulla of Vater


Describe the epidemiology of cholangiocarcinoma

Rare: 1-2 per 100,000 population per year
Most occur in over 60s
High incidence in SE Asia due to liver flukes parasite


Name 2 risk factors for cholangiocarcinoma

Primary sclerosing cholangitis
Liver flukes infection
Industrial chemical exposure
Thorium exposure
Congenital bile duct abnormalities
Caroli's disease - dilatation of intrahepatic biliary tree


How is cholangiocarcinoma managed?

Radical excision of bile duct with reconstruction
Pancreaticoduodenectomy (distal cholangiocarcinoma)
Endoscopic/percutaneous stenting (palliative)


What is the prognosis of cholangiocarcinoma?

Median survival 9 months