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Path: Liver 5 - Liver, Pancreas, Biliary tract (i) (HCC (dx (radiology (US…
Path: Liver 5 - Liver, Pancreas, Biliary tract (i)
liver tumours
non-neoplastic
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use US, CT, MRCP + context to dx
neoplastic
benign (rare)
hepatic adenoma
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a/w anabolic steroids, OCP
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malignant
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secondary
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carc (lung, breast, rectum, oeso,, bladder, ovary)
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early - few symptoms/effects, ALP raised
late - rising bili, jaundice
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HCC
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presentation
high incidence areas: co-presents with or precedes cirrhosis, in relatively young patients
low incidence areas: presents with decompensated cirrhosis, 3% progress to HCC/yr, vague/changing symptoms
dx
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AFP
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also for yolk sac tumour (type of testicular cancer), as before the liver the yolk sac produce blood in foetal life
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prognosis
depends on stage, degree of liver function impairment (often for if dxed late), co-morbidities
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tumour cells resemble hepatocytes but show pleomorphism (variability in cell/nucleus size/shape/staining)
Cholangiocarcinoma
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a/w PSC, rarely chronic fluke infestation, congenital biliary abnormalities
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typically, palliate obstruction with stent
GB adenocarcinoma
80% a/w longstanding gallstones (but <1% of those with longstandning gallstones get GB adenocarc)
i.e. stones v common, cancer rare
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presents late, vague symptoms, poor prognosis
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