Liver Neoplasms Quiz
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Questions and Answers

What imaging modality is commonly used to identify liver neoplasms?

  • MRI (correct)
  • Ultrasound
  • CT (correct)
  • X-ray
  • What is the most frequent type of benign liver neoplasm?

  • Cavernous hemangiomas (correct)
  • Metastatic tumors
  • Hepatic adenomas
  • Focal nodular hyperplasia
  • Which of the following is NOT a characteristic of cavernous hemangiomas?

  • They are the most common benign liver neoplasm.
  • They are often detected incidentally.
  • They are typically asymptomatic.
  • They are always malignant. (correct)
  • What does the term "incidental finding" mean in the context of liver neoplasms?

    <p>A finding that is unrelated to the primary reason for the medical examination. (D)</p> Signup and view all the answers

    Which of the following is a primary cancer that commonly metastasizes to the liver?

    <p>Lung cancer (B)</p> Signup and view all the answers

    Which type of benign liver neoplasm is most commonly associated with oral contraceptives?

    <p>Hepatic Adenomas (C)</p> Signup and view all the answers

    Which of the following is true regarding the treatment of benign liver neoplasms?

    <p>Observation with close monitoring is the primary treatment approach, but surgical intervention may be indicated in certain cases. (B)</p> Signup and view all the answers

    What is the most prevalent type of liver cancer originating from parenchymal cells?

    <p>Hepatocellular Carcinomas (D)</p> Signup and view all the answers

    Which of the following statements is TRUE about liver cancer metastasis?

    <p>Liver is a common metastatic site for cancers arising from the lungs and breasts. (B)</p> Signup and view all the answers

    Which of the following conditions is NOT a benign liver neoplasm?

    <p>Cholangiocarcinomas (B)</p> Signup and view all the answers

    Which of the following is NOT a risk factor associated with the development of Hepatocellular Carcinoma in parts of Asia and Africa?

    <p>Obesity (A), Male Gender (C), Family History (D)</p> Signup and view all the answers

    What is the preferred imaging method for diagnosing Hepatocellular Carcinoma?

    <p>MRI Abdomen with contrast (B)</p> Signup and view all the answers

    At what level of α-feta protein is considered significant in the diagnosis of Hepatocellular Carcinoma?

    <blockquote> <p>200 ng/mL (C)</p> </blockquote> Signup and view all the answers

    Which of the following is NOT a clinical finding associated with Hepatocellular Carcinoma?

    <p>Enlarged Gallbladder (A)</p> Signup and view all the answers

    Which of the following is NOT a risk factor associated with the development of Pancreatic Cancer?

    <p>Cirrhosis (D)</p> Signup and view all the answers

    What percentage of pancreatic cancers are located in the head of the pancreas?

    <p>75% (D)</p> Signup and view all the answers

    What is the clinical sign associated with an enlarged, nontender gallbladder and mild painless jaundice?

    <p>Courvoisier’s sign (C)</p> Signup and view all the answers

    Which of the following is NOT a recommended screening measure for Hepatocellular Carcinoma?

    <p>Liver Biopsy (B)</p> Signup and view all the answers

    What is the approximate 5-year survival rate for Hepatocellular Carcinoma?

    <p>5% (C)</p> Signup and view all the answers

    Which of the following is NOT a common manifestation of Pancreatic Cancer?

    <p>Ascites (C)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for colorectal cancer?

    <p>Prolonged use of aspirin (A)</p> Signup and view all the answers

    Which type of polyp is associated with a higher risk of developing into colorectal cancer?

    <p>Sessile serrated adenoma (A)</p> Signup and view all the answers

    Which symptom is more likely to be present in patients with proximal colon cancer?

    <p>Fecal occult blood (C)</p> Signup and view all the answers

    Which of the following laboratory test is most likely to indicate metastatic colorectal cancer?

    <p>Elevated ALP (B)</p> Signup and view all the answers

    Which of the following features would classify a polyp as 'advanced'?

    <p>Villous features (D)</p> Signup and view all the answers

    What is the recommended approach for screening for colorectal cancer?

    <p>Colonoscopy at age 50 and then every 10 years (A)</p> Signup and view all the answers

    Which of the following is NOT a sign or symptom of colorectal cancer?

    <p>Nausea and vomiting (C)</p> Signup and view all the answers

    Which statement about colorectal cancer is TRUE?

    <p>The majority of colorectal cancers develop from benign polyps. (D)</p> Signup and view all the answers

    A patient presents with an "Apple Core" lesion on a barium study. Which of the following statements is TRUE about this finding and its significance?

    <p>While barium studies are rarely utilized now, an &quot;Apple Core&quot; lesion may be suggestive of colorectal cancer and should be investigated further with colonoscopy or other appropriate tests. (B)</p> Signup and view all the answers

    A patient undergoing colorectal cancer screening has a life expectancy of 8 years. According to the information provided, what is the most appropriate course of action for this patient regarding screening?

    <p>The patient should switch to fecal immunochemical testing (FIT) annually instead of colonoscopy, as their life expectancy is lower than 10 years. (C)</p> Signup and view all the answers

    A patient is diagnosed with stage III colorectal cancer. Which of the following statements regarding treatment is MOST ACCURATE?

    <p>Systemic chemotherapy should be considered for patients with stage III colorectal cancer as it can improve survival rates. (D)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding colorectal cancer screening with fecal immunochemical testing (FIT)?

    <p>FIT is a highly cost-effective screening method, but it is less sensitive than colonoscopy for detecting colorectal cancer. (D)</p> Signup and view all the answers

    A patient with a family history of colorectal cancer has a high risk for developing the disease. What is the recommended screening strategy for this patient?

    <p>The patient should begin screening at a younger age, possibly in their 30s, and follow a customized screening schedule based on their specific risk factors. (D)</p> Signup and view all the answers

    Which of the following statements accurately reflects the prognosis of pancreatic cancer?

    <p>Resection of cancer in the pancreatic head provides the best chance of survival, while tumors in the body or tail have a much worse prognosis. (B), Jaundice and lymph node involvement are poor prognostic indicators and significantly reduce survival rates in pancreatic cancer. (C), Patients with ampullary tumors have the best prognosis, achieving a 5-year survival rate of 20-40% after resection. (D)</p> Signup and view all the answers

    A patient presents with stools that have a silvery appearance. What is the most likely explanation for this symptom based on the provided information?

    <p>This is a strong indicator that the patient may have carcinoma involving the ampulla of Vater. (A)</p> Signup and view all the answers

    What diagnostic tests should be considered when evaluating a suspected case of pancreatic cancer?

    <p>A combination of tumor marker analysis, imaging studies, and stool analysis is essential for a comprehensive diagnosis. (A)</p> Signup and view all the answers

    In the context of pancreatic cancer staging, what does T3 represent?

    <p>A tumor that extends beyond the pancreas but does not involve the celiac axis or superior mesenteric artery. (C)</p> Signup and view all the answers

    What is the rationale behind referring patients with suspected pancreatic cancer to a specialist?

    <p>To ensure access to multidisciplinary expertise and specialized treatment options. (C)</p> Signup and view all the answers

    Why is chemotherapy often disappointing in the treatment of metastatic pancreatic cancer?

    <p>The nature of metastatic pancreatic cancer makes it particularly resistant to conventional chemotherapy drugs. (D)</p> Signup and view all the answers

    What is the primary rationale for performing endoscopic stenting of the bile duct in patients with pancreatic cancer?

    <p>To relieve the symptoms of jaundice caused by bile duct obstruction. (C)</p> Signup and view all the answers

    Which of the following statements regarding the treatment of pancreatic cancer is accurate?

    <p>The best surgical results for pancreatic cancer are achieved at specialized centers with multidisciplinary expertise. (C)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    Cirrhosis Complications

    Cirrhosis often leads to complications affecting liver function and health.

    Liver Imaging

    CT or MRI scans used to visualize liver conditions and detect neoplasms.

    Benign Neoplasms

    Non-cancerous growths in the liver like cavernous hemangiomas and hepatic adenomas.

    Cavernous Hemangiomas

    Most common benign liver tumors, often discovered incidentally during imaging.

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    Malignant Neoplasms

    Cancerous growths in the liver, which can be primary or metastatic from other organ cancers.

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    Hepatic Adenomas

    Benign tumors in the liver, often caused by oral contraceptives.

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    Focal Nodular Hyperplasia

    Another benign liver lesion, usually asymptomatic and not caused by OCPs.

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    Benign Liver Neoplasms Treatment

    Management is based on symptoms and growth rate, often observational.

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    Hepatocellular Carcinomas

    Malignant liver tumors from parenchymal cells, accounting for 85% of liver cancers.

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    Cholangiocarcinomas

    Malignant tumors from ductular cells, less common than hepatocellular carcinomas.

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    CA 19-9 tumor marker

    A marker that may indicate pancreatic cancer, also elevated in pancreatitis.

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    Amylase and Lipase

    Enzymes measured to assess pancreatic function and inflammation.

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    Occult blood in stool

    Invisible blood in stool, can suggest ampulla of Vater carcinoma.

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    TNM Classification

    System used to describe cancer stages: Tumor, Nodes, Metastasis.

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    T1 Tumor

    Tumor limited to the pancreas, less than 2 cm in size.

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    T4 Tumor

    Tumor involving major arteries, inoperable primary tumor.

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    Poor prognosis

    Most pancreatic cancer patients present with advanced, unresectable disease.

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    When to refer

    Refer all pancreatic and ampulla cancer patients to specialists.

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    Colorectal Cancer

    Second leading cause of cancer death in the U.S.

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    Adenomatous Polyps

    Polyps that can develop into colorectal cancer; include several types.

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    Serrated Polyps

    Polyps with a sawtooth appearance that can lead to cancer.

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    Advanced Polyps

    Polyps that are at least 1 cm or have dysplasia, linked to cancer risk.

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    Colonoscopy

    A diagnostic procedure to visualize the colon and diagnose cancer.

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    Colorectal Cancer Risk Factors

    Age, family history, IBD, race, and lifestyle increase cancer risk.

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    CBC and Anemia

    Complete blood count test often shows anemia in colorectal cancer patients.

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    Carcinoembryonic Antigen (CEA)

    Tumor marker measured in colorectal cancer diagnosis, not for screening.

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    Cirrhosis

    Scarring of the liver tissue, which is a primary risk factor for hepatocellular carcinoma.

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    Alpha-fetoprotein (AFP)

    A protein that can be elevated in patients with hepatocellular carcinoma, particularly over 200 ng/mL.

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    Risk factors for Hepatocellular Carcinoma

    Includes male gender, age > 55, obesity, chronic Hep C, and family history.

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    Pancreatic Cancer

    The most common neoplasm of the pancreas, often resulting in late symptoms.

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    Courvoisier's sign

    Enlarged gallbladder with painless jaundice, often indicating pancreatic cancer.

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    Late symptoms of Pancreatic Cancer

    Include upper abdominal pain, weight loss, and possible thrombophlebitis.

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    Chronic Hepatitis B

    A viral infection that significantly increases the risk of liver cancer.

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    Screening recommendations

    Recommended for patients with chronic Hep B, cirrhosis, and Hep C every 6 months.

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    Liver biopsy

    Procedure to diagnose liver cancer but risky if the tumor is resectable.

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    Apple Core Lesion

    A narrowing of the colon seen on barium studies suggesting malignancy.

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    Colonoscopy Usage

    Colonoscopy is the preferred method to detect colon cancer abnormalities.

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    TNM Staging System

    A classification system used to stage colorectal cancer based on tumor size, lymph nodes, and metastasis.

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    Colorectal Cancer Screening

    Average risk individuals should start screening at age 45 and continue until 75 if life expectancy allows.

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    Chemotherapy in Colorectal Cancer

    Systemic chemotherapy improves survival in select colorectal cancer patients based on the disease stage.

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    Study Notes

    Liver Neoplasms

    • Liver neoplasms are often complications of cirrhosis.
    • Diagnosis relies on imaging (CT or MRI) combined with biopsy confirmation.
    • Two categories exist: benign and malignant.

    Benign Liver Neoplasms

    • Cavernous Hemangiomas: The most common benign liver neoplasm. Often an incidental finding on imaging.
    • Masses of small blood vessels. Hormone treatments (OCPs) sometimes increase their size.
    • Typically managed by observation for symptoms or growth. Surgery is rarely necessary.
    • Hepatic Adenomas: Commonly occur in the 3rd and 4th decades of life. Often linked to oral contraceptives (OCPs).
    • Abdominal pain can result from tumor necrosis or hemorrhage.
    • Focal Nodular Hyperplasia: Another benign liver tissue type, occurring across all ages. Typically found in women.
    • Likely not linked to oral contraceptives. Often asymptomatic.

    Malignant Liver Neoplasms

    • Can be primary (originating in the liver) or metastatic (spread from other cancers).
    • The liver is a common metastatic site for cancers elsewhere, like lung and breast.
    • Hepatocellular Carcinomas (HCC): Originate from parenchymal cells. Account for 85% of liver cancers globally.
    • HCC is a significant cause of cancer-related deaths worldwide.
    • Cholangiocarcinomas: Originate from ductal cells. Represent less than or equal to 15% of liver cancers.

    Hepatocellular Carcinoma (HCC)

    • Risk Factors (Western World): Cirrhosis, male gender, age 55+, Hepatitis C infection, Obesity and Diabetes Mellitus, Family history, and Ethnicity (Asian & Hispanic)

    • Risk Factors (Global/Other parts of the world): Alcohol abuse and Hepatitis B infection.

    • Clinical Findings: Cachexia, Weakness, Weight loss, Ascites, Hepatic tenderness, Bruit/friction rub. In some regions like Africa, younger age groups may present with a rapidly growing abdominal mass.

    • Laboratory Findings: Elevated alpha-fetoprotein (AFP) level (> 200 ng/mL) in about 70% of cases. Leukocytosis (increased white blood cell count) is also observed.

    • Imaging: CT or MRI (with contrast) is the preferred imaging choice. Liver biopsy is often diagnostic but carries risk.

    Pancreatic Neoplasms

    • Pancreatic Cancer Symptoms: Obstructive jaundice (may be painless), Enlarged gallbladder(may be painful), Upper abdominal pain (radiating to the back), weight loss, and thrombophlebitis (often late symptoms).
    • Pancreatic Cancer Characteristics: Adenocarcinoma is the most common type, accounting for 75% of cases, which usually occurs in the head of the pancreas. Tumor in the body and tail of the pancreas is 25%. The disease accounts for 2% of all cancers and 5% of cancer deaths.

    Pancreatic Cancer Risk Factors

    • Age
    • Tobacco use (thought to cause 20-25% of cases)
    • Heavy alcohol use
    • Obesity
    • Chronic pancreatitis
    • Diabetes mellitus
    • Prior abdominal radiation
    • Family history
    • Exposure to arsenic and cadmium (possibly gastric ulcer)

    Pancreatic Cancer - Signs and Symptoms/Physical Exam Signs

    • Courvoisier sign: Enlarged gallbladder which is nontender and accompanied by mild painless jaundice.
    • In advanced cases, a hard periumbilical nodule (Sister Mary Joseph's nodule) may be palpable.
    • Elevated CA 19-9 tumor marker can also be elevated with pancreatitis.
    • Amylase and Lipase. Occult blood in the stool; combination of biliary obstruction and bleeding.
    • Appearance: Stools may exhibit a distinctive silver appearance due to the combined effects of biliary obstruction and bleeding

    Pancreatic Cancer - Imaging

    • Transabdominal ultrasound
    • Abdominal CT
    • Endoscopic Ultrasound (EUS)
    • Endoscopic Retrograde Cholangiopancreatography (ERCP)
    • Magnetic Resonance Cholangiopancreatography (MRCP)

    Pancreatic Cancer - Staging

    • TNM classification (Tumor, Node, Metastasis) is used.
    • Tis, T1, T2, T3, T4 represent increasing tumor size and extent.
    • N1 and N2 represent regional lymph node metastasis.
    • M1 signifies distant metastasis.

    Pancreatic Cancer Treatment

    • Surgical resection is ideal if possible, best achieved at multidisciplinary centers specializing in pancreatic cancer treatment.
    • Endoscopic stenting of the bile duct can be used in cases where surgery is not feasible, to relieve jaundice.
    • Chemotherapy generally hasn't shown much success in metastatic pancreatic cancer.

    Pancreatic Cancer Prognosis

    • Generally poor, especially with involvement of the body or tail of the pancreas.
    • 5-year survival rate is 2-5% in advanced cases.
    • Tumors in the ampulla area often have a better prognosis and 5-year survival rates of 20-40%.
    • Jaundice and lymph node involvement are negative prognostic factors.

    Colorectal Cancer

    • Risk Factors: Personal or family history of adenomatous or serrated polyps or colorectal cancer.

    • Symptoms/Signs (Proximal Colon): Fecal occult blood and anemia.

    • Symptoms/Signs (Distal Colon): Bowel habit changes and hematochezia (bloody stools).

    • Diagnosis: Colonoscopy.

    • Characteristics: Colorectal cancer is the second leading cause of cancer death in the United States. Almost all cases are adenocarcinomas, tending to form bulky exophytic masses or annular constricting lesions.

    • Polyps: Adenomatous polyps (tubular, tubulovillous, villous adenoma) and Serrated polyps (hyperplastic, traditional serrated adenoma and sessile serrated adenoma)

    • Advanced Polyps: Advanced polyps include those ≥1 cm in size, with villous features or high-grade dysplasia, or serrated polyps with dysplasia that are associated with increased cancer risk.

    • Risk Factors (cont.): Age, Family history, Inflammatory bowel disease, Race/ethnicity (Black/African American). Diet and lifestyle

    Colorectal Cancer - Signs and Symptoms

    • Obstruction, Constipation, Blood in stool, Abdominal pain.

    • Laboratory Findings (metastatic concerns): Complete blood count (CBC) and anemia. Elevation of Alkaline Phosphatase (ALP) is suggestive of metastatic disease. Carcinoembryonic antigen (CEA) is sometimes checked but not useful for screening.

    Colorectal Cancer - Imaging

    • Colonoscopy (preferred diagnostic procedure for suspected colorectal cancer or abnormalities found in imaging). Barium studies were previously used but are less optimal now.

    Colorectal Cancer - Staging

    • TNM staging system used (Tumor, Node, Metastasis). TNM staging defines the location and extent of the cancer to inform treatment decisions.

    Colorectal Cancer - Treatment

    • Surgical resection is the primary treatment for resectable colorectal cancer.
    • Systemic chemotherapy may improve survival in specific cases, depending on the stage of the cancer.

    Colorectal Cancer - Screening

    • People without a family history should begin screening at age 45, and continue as long as life expectancy is greater than 10 years.
    • Colonoscopy is often the recommended choice every 10 years.
    • Fecal Immunochemical Test (FIT) or CT Colonography are alternatives when colonoscopy is not a suitable option.

    Referral/Admission

    • Patients with cancer involving the pancreas and ampulla of Vater should be referred to specialists.
    • Patients requiring surgery or other interventions should be hospitalized.

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