Liver Neoplasms Quiz

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.