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Which of the following is a common complication caused by certain chemotherapeutics like cisplatin?
What is the most appropriate initial management strategy for Tumor Lysis Syndrome (TLS)?
Which symptom is NOT typically associated with hypercalcemia?
What is a recommended medication for managing nausea and vomiting in cancer patients?
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In the management of central nervous system metastasis, what is a common therapeutic approach?
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What is the primary goal of palliative care for cancer patients?
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Which of the following is a key component of managing electrolyte imbalances in cancer patients?
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What is a common psychosocial complication experienced by cancer patients?
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What is a common risk factor associated with the development of liver cancer?
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Which of the following is NOT a symptom typically associated with hepatocellular carcinoma (HCC)?
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What is the main purpose of utilizing imaging studies like ultrasound in diagnosing liver cancer?
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Which pathway is associated with cell proliferation and survival in liver cancer?
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What is the characteristic imaging finding associated with hepatocellular carcinoma evident on a CT scan?
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Which condition increases the risk of liver cancer due to genetic predisposition?
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What is the role of alpha-fetoprotein (AFP) in the context of liver cancer?
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Which of the following signs is typically associated with chronic liver disease?
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What is the purpose of the Barcelona Clinic Liver Cancer (BCLC) Classification?
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Which stage of the BCLC Classification is characterized by multiple tumors and good liver function?
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Which treatment option is most suitable for a patient with a solitary tumor and preserved liver function?
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What is a characteristic of advanced stage HCC according to BCLC Classification?
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Which systemic therapy is used for inhibiting tumor growth in advanced HCC?
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What factor is crucial for improving survival rates in HCC?
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Which type of therapy is indicated for patients with intermediate-stage HCC?
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What is a preventive measure for reducing the risk of HCC in high-risk individuals?
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What is classified as a direct complication of cancer?
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Which of the following best describes febrile neutropenia?
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How can thrombocytopenia be managed in cancer patients?
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What is a common consequence of chemotherapy on pulmonary function?
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Which method is NOT considered a non-pharmacological approach for managing cancer pain?
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In which situation is broad-spectrum antibiotics administration critical?
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What is a risk factor for venous thromboembolism in cancer patients?
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Which complication is associated with the use of doxorubicin in chemotherapy?
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Which professional is NOT typically part of the multidisciplinary team addressing cancer patient needs?
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What is the primary type of liver cancer discussed?
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Which of the following factors significantly increases the risk of developing HCC?
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What is a major precursor to HCC?
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Which region has a higher incidence of HCC due to endemic hepatitis infections?
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What type of liver cancer primarily affects children?
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What condition is increasingly recognized as a risk factor for liver cancer due to the obesity epidemic?
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Which of the following is NOT a common source of metastatic liver disease?
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Study Notes
Liver Cancer Overview
- Liver cancer refers mainly to hepatocellular carcinoma (HCC), arising from liver cells.
- It's the sixth most common cancer globally, with a high incidence in East Asia and sub-Saharan Africa, often linked to hepatitis infections.
Types of Liver Cancer
- HCC is the most common type of primary liver cancer, occurring as a single or multiple tumors.
- Cholangiocarcinoma is a cancer of the bile ducts within or outside the liver.
- Hepatoblastoma is a rare liver cancer affecting children under 3 years old.
- Metastatic Liver Disease is more common than primary liver cancer, with colorectal, breast, lung, and pancreatic cancers being frequent sources.
Risk Factors
- Chronic Viral Hepatitis from HBV and HCV are major risk factors, especially with chronic infection and cirrhosis.
- Cirrhosis, a major pre-cursor to HCC, occurs due to various causes like alcohol, viral hepatitis, and autoimmune diseases.
- Alcohol Abuse leads to alcoholic liver disease, cirrhosis, and eventually HCC.
- NAFLD is an increasing risk factor due to the obesity epidemic and its association with metabolic syndrome.
- Aflatoxin Exposure from mold on crops can be carcinogenic and is a risk factor in certain geographical areas.
- Genetic Conditions like hemochromatosis and Wilson's disease increase the risk of liver cancer.
Pathophysiology
- HCC often develops from a background of cirrhosis, where hepatocyte injury, inflammation, and regeneration lead to genetic mutations.
- Wnt/β-catenin Pathway and PI3K/AKT Pathway are dysregulated in HCC, affecting cell proliferation, survival, and metabolism.
- Mutations in tumor suppressor genes (e.g., TP53) and oncogenes (e.g., KRAS) contribute to cancer development.
Clinical Presentation
- Symptoms are usually vague and nonspecific, including weight loss, loss of appetite, fatigue, nausea, vomiting, abdominal pain, and jaundice.
- Signs include hepatomegaly, ascites, and signs of chronic liver disease like spider angiomata and palmar erythema.
- Complications can arise from portal hypertension leading to variceal bleeding and liver failure symptoms.
Diagnosis
- Ultrasound is the initial imaging test, detecting liver masses and assessing size.
- CT Scan provides detailed imaging, showing hypervascularity typical of HCC.
- MRI helps characterize lesions and differentiate HCC from other masses.
- Biopsy, often avoided due to bleeding risk, can be performed with FNA or core needle biopsy.
- Alpha-fetoprotein (AFP) levels are often elevated in HCC, serving as a diagnostic and monitoring tool.
Staging
- TNM Staging System assesses tumor size, regional lymph node involvement, and distant metastases.
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BCLC Classification integrates tumor size, number, liver function (Child-Pugh score), and performance status for treatment decisions:
- Stage 0: Very early with one tumor and no vascular invasion.
- Stage A: Early with one tumor or up to three, and good liver function.
- Stage B: Intermediate with more than three tumors, large tumors or vascular invasion.
- Stage C: Advanced with vascular invasion or metastasis.
- Stage D: Terminal with poor liver function and performance status.
Treatment Options
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Surgical Options include:
- Liver Resection for patients with a single tumor and preserved liver function.
- Liver Transplantation for patients with cirrhosis and early-stage HCC meeting specific criteria.
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Ablative Therapies for small tumors include:
- Radiofrequency Ablation (RFA) and Microwave Ablation.
- TACE delivers chemotherapy directly to the tumor while blocking blood supply.
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Systemic Therapies include:
- Targeted Therapies like Sorafenib and lenvatinib for advanced HCC, inhibiting tumor growth and angiogenesis.
- Immunotherapy with Nivolumab and pembrolizumab for advanced disease, harnessing the body's immune system.
- Supportive Care provides symptomatic relief and improves quality of life for advanced cancer patients.
Prognosis
- Early-stage detection significantly improves outcomes.
- Liver function and overall health status are crucial for prognosis.
- Survival rates are generally poor for advanced HCC, but can exceed 70% for early-stage HCC treated with resection or transplant.
Prevention
- Hepatitis B Vaccination can prevent HBV infection and reduce HCC risk.
- Screening for high-risk individuals like chronic hepatitis carriers and patients with cirrhosis is essential, involving ultrasound and AFP tests.
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Description
This quiz covers the essential information about liver cancer, focusing on its types, particularly hepatocellular carcinoma (HCC). Explore the different types of liver cancer, their risk factors, and the global prevalence of this disease. Perfect for students studying oncology or public health.
