Podcast
Questions and Answers
What is the most common cause of HCC in the United States?
What is the most common cause of HCC in the United States?
What percentage of patients with cirrhosis develop liver cancer each year?
What percentage of patients with cirrhosis develop liver cancer each year?
Which of the following is NOT a common manifestation of early liver cancer?
Which of the following is NOT a common manifestation of early liver cancer?
What is the most common site of metastatic growth for liver cancer?
What is the most common site of metastatic growth for liver cancer?
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What is the most common screening test for liver cancer?
What is the most common screening test for liver cancer?
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What is the primary focus of liver cancer prevention?
What is the primary focus of liver cancer prevention?
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Which of the following is a risk associated with a liver biopsy?
Which of the following is a risk associated with a liver biopsy?
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What is the role of serum α-fetoprotein (AFP) levels in liver cancer diagnosis?
What is the role of serum α-fetoprotein (AFP) levels in liver cancer diagnosis?
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Which of the following is NOT a late stage manifestation of liver cancer?
Which of the following is NOT a late stage manifestation of liver cancer?
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What is the significance of the liver's high rate of blood flow and extensive capillary network in relation to liver cancer?
What is the significance of the liver's high rate of blood flow and extensive capillary network in relation to liver cancer?
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Which of these treatment options is NOT typically considered for patients with early-stage liver cancer?
Which of these treatment options is NOT typically considered for patients with early-stage liver cancer?
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What is the main advantage of liver resection for liver cancer?
What is the main advantage of liver resection for liver cancer?
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Which of the following is a potential complication of percutaneous ablation?
Which of the following is a potential complication of percutaneous ablation?
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What is the primary mechanism by which transarterial chemoembolization (TACE) works?
What is the primary mechanism by which transarterial chemoembolization (TACE) works?
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Which of the following is NOT a systemic therapy option for liver cancer?
Which of the following is NOT a systemic therapy option for liver cancer?
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In what circumstance is liver transplantation a viable treatment option for liver cancer?
In what circumstance is liver transplantation a viable treatment option for liver cancer?
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What is the primary reason for the poor prognosis of liver cancer?
What is the primary reason for the poor prognosis of liver cancer?
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Which of the following is a common complication of advanced liver cancer?
Which of the following is a common complication of advanced liver cancer?
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What role does screening play in improving the prognosis of liver cancer?
What role does screening play in improving the prognosis of liver cancer?
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Which of the following interventions is considered minimally invasive and involves injecting chemotherapy drugs into the tumor’s arterial supply?
Which of the following interventions is considered minimally invasive and involves injecting chemotherapy drugs into the tumor’s arterial supply?
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Study Notes
Primary Liver Cancer
- Primary liver cancer originates within the liver, with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (bile duct cancer) being the most common types.
- In 2018, approximately 42,220 cases of liver cancer and 30,200 deaths occurred in the US.
- Globally, liver cancer ranks as the 5th most common cancer and the 2nd leading cause of cancer mortality.
- Cirrhosis, particularly HCV-related cirrhosis, is a major risk factor for HCC in the US, followed by NAFLD.
- About 2% of cirrhosis patients develop liver cancer yearly.
- Lesions can be single or multiple, nodular or diffuse across the liver.
- Metastasis to the lungs is common.
- Tumors can infiltrate other organs (e.g., gallbladder), the peritoneum, or diaphragm.
Metastatic Liver Cancer
- Metastatic liver cancer (cancer spreading to the liver) is more prevalent than primary liver cancer.
- The liver's high blood flow and capillary network make it a frequent site for metastatic growth.
- Cancer cells from other parts of the body often reach the liver through the portal circulation.
Clinical Manifestations and Diagnosis
- Early liver cancer often shows no or subtle symptoms, frequently linked to underlying cirrhosis conditions.
- Manifestations may include hepatomegaly, splenomegaly, fatigue, peripheral edema, ascites, and portal hypertension complications.
- Late-stage symptoms include fever, chills, jaundice, anorexia, weight loss, palpable mass, and right upper quadrant (RUQ) pain.
- Diagnostic tools encompass ultrasound, CT scans, and MRIs. Advanced MRI techniques are now highly accurate for diagnosis and staging without biopsies, though they may still be necessary in ambiguous or treatment-guiding cases. Biopsy risks include bleeding and seeding along the needle tract.
- Serum α-fetoprotein (AFP) levels combined with ultrasound improve early stage HCC detection.
Prevention and Treatment
- Prevention focuses on managing chronic hepatitis B (HBV) and C (HCV) infections, as well as lowering alcohol consumption.
- Screening for high-risk individuals (e.g., those with cirrhosis) usually involves a combination of serum AFP and imaging (CT, MRI, or ultrasound).
- Treatment depends on cancer stage, tumor characteristics, blood vessel involvement, patient health, and underlying liver disease.
- Partial liver resection (hepatectomy) is the curative approach for some patients, but many are diagnosed too late for this option given the compromised state of liver function.
- Liver transplantation is a viable option for early-stage liver cancer with impaired function.
- Nonsurgical approaches include percutaneous ablation (using heat or chemicals via needles), chemoembolization (closing off blood supply to tumors with chemotherapy), radioembolization (using radioactive beads), and systemic therapy (drugs to slow tumor growth).
- Ablation can be done percutaneously, laparoscopically, or via open incision, but is limited by the number and location of tumors; is usually for early-stage cancer.
- Complications include infection, bleeding, dysrhythmias, and burns (from heat probes).
- Embolization (TACE and TARE) inserts chemotherapy or radioactive material to block blood supply to tumors.
- Systemic therapies embrace chemotherapy and immunotherapies (monoclonal antibodies, tyrosine kinase inhibitors, and immune checkpoint inhibitors).
- Nursing care prioritizes patient comfort and addresses advanced liver disease complications.
Prognosis
- While liver cancer prognosis is generally poor, it's improving due to early screening programs.
- Cancer often progresses quickly, causing complications from the cancer and declining liver function.
- Without treatment, death often occurs within 6-12 months from hepatic encephalopathy or massive GI bleeding.
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Description
This quiz provides an overview of primary and metastatic liver cancer, focusing on their types, prevalence, risk factors, and implications. Learn about hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and the significance of cirrhosis in liver cancer development. Understand the metastatic potential of liver cancer and its impact on the body.
