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Flashcards in Liver Cancer Deck (83)
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1

What % of liver cancers are metastatic?

90%

2

What % of liver cancers are primary?

10%

3

What is the main primary liver tumour?

Hepatocellular carcinoma

4

How common is hepatocellular carcinoma compared to other cancers?

6th most common cancer worldwide

5

How deadly is hepatocellular carcinoma compared to other cancers?

It is the third leading cause of cancer death

6

How do the incidence rates of hepatocellular cancer differ throughout the world?

They vary significantly across the globe, with China having a high incidence and UK having a low incidence

7

Who do the majority of cases of hepatocellular carcinoma in the UK occur in?

Those aged over 70 years

8

What % of hepatocellular carcinoma in the UK occurs in males?

64%

9

What does hepatocellular carcinoma arise as a result of?

Chronic inflammatory processes affecting the liver

10

What is the most common cause of chronic inflammation leading to HCC worldwide?

Viral hepatitis

11

What are the other common causes of inflammation leading to HCC?

Chronic alcoholism
Hereditary haemochromatosis
Primary biliary cirrhosis
Aflatoxin

12

What is aflatoxin?

A toxic fungal metabolite that can be found on cereals and nuts

13

What are the risk factors for hepatocellular carcinoma?

Viral hepatitis
High alcohol intake
Smoking
Advancing age
Aflatoxin exposure
Family history of liver disease

14

What are the most common causative organisms of viral hepatitis leading to HCC?

Hepatitis B virus
Hepatitis C virus

15

What % of HCC cases are accounted for by viral hepatitis in developing countries?

Around 90%

16

Which demographic is HCC more commonly found in developing countries?

Asian individuals

17

Why is HCC more common in Asian individuals?

Secondary to childhood infections with hepatitis B

18

Why is the incidence of HCC caused by Hep B decreasing?

Due to current vaccination programmes

19

What % of cases of HCC in the UK are thought to arise secondary to hepatitis?

16

20

What is the relationship between the combined oral contraceptive pill and HCC?

While the combined oral contraceptive pill is known to increase the risk of hepatic adenomas, data remains inconclusive regarding its relationship with malignant disease

21

What are the main symptoms of hepatocellular carcinoma?

That of liver cirrhosis, and may include vague, non-specific symptoms such as fatigue, fever, weight loss, and lethargy

22

Does hepatocellular carcinoma cause a dull ache in the right upper abdomen?

It is uncommon, however when present is characteristic of hepatocellular carcinoma, and should raise suspicion in patients with known cirrhosis

23

How might advanced HCC present?

Features of liver failure, such as worsening ascites or jaundice

24

What will be found on examination in HCC?

An irregular, enlarged, craggy and tender liver

25

What may the differential diagnoses include in a patient presenting with liver failure or non-specific liver signs?

Infectious hepatitis
Cardiac failure
Benign hepatocellular adenoma
Other causes of liver cirrhosis

26

What will suggest a diagnosis of infectious hepatitis rather than HCC?

Presence of non-specific serology

27

What will suggest a diagnosis of cardiac failure rather than HCC?

Smooth hepatomegaly

28

What investigations should be done in HCC?

Bloods
Imaging
Staging

29

What may the bloods show in HCC?

Deranged liver function tests (ALP, AST, ALT, bilirubin)
Low platelets or prolonged clotting

30

How is the AST:ALT ratio important diagnostically in HCC?

An AST:ALT ratio >2 suggests likely alcoholic liver disease
An AST:ALT <2 suggests likely viral hepatitis