9.Malignant Liver Tumors.pptx notes

Malignant liver tumours student notes

1. Malignant Liver Tumors

2. Hepatocellular/hepatoma It accounts for more than 90% of all primary liver malignancies

3. Risk factors Underlying liver disease – e.g. liver cirrhosis Hepatitis B & C infection – it is common in areas where HBV is endemic Alcohol intake Obesity Hemochromatosis Aflatoxin

4. Clinical features Pruritus Jaundice Splenomegaly Variceal bleeding Cachexia Abdominal distension – due to ascites Hepatic encephalopathy RUQ pain

5. Physical examination Jaundice Ascites Hepatomegaly Asterexis Pedal edema Caput medusae Painless mass in right hypochondriac region Enlarged hemorrhoidal veins

6. Differential diagnosis Cholangiocarcinoma Cirrhosis Hepatic adenoma Secondaries in liver Polycystic disease of liver Amebic liver abscess Hydatid cyst of the liver

7. Investigations Lab FHG – low Hb, thrombocytopenia, UECs – hyponatremia, high creatinine Liver function tests – elevated bilirubin Coagulation profile – prolonged prothrombin time AFP - INCREASED RBS – hypoglycemia HBsAG

8. Investigations Abd Ultrasound – very useful method. It shows hyperechoic mass; can help assess the extent of the tumour Abd CT scan more reliable and ideal shows hypo dense, mosaic, vascular lesion with irregular margin. reveals the size, location and extent, vascularity, portal vein invasion, nodal status, portal vein thrombosis. helps to assess operability MRI Biopsy Ascitic tap when ascites is present for cytology

9. Treatment Depends on the size of the tumor and extent of underlying liver disease For patients without cirrhosis, liver resection with clear margins is the standard Surgical resection is impossible in patients with liver cirrhosis Liver transplantation – it removes the malignant tumor and eliminates possible sites of recurrence in the remaining diseased liver Milan criteria for liver transplantation single tumor <5 cm or up to three tumors all ≤3 cms ; no vascular invasion

10. Treatment… When limited to one lobe, hemihepatectomy is done. Removal of 80% liver is compatible with life Other treatment modalities radiofrequency ablation [RFA] - It is thermal ablation of the tumour by passing 18 G needle into the middle of the tumour and passing electric current of 500 kHz. This creates frictional heat causing sphere of necrosis laser ablation, microwave ablation or freezing (cryoablation) Chemotherapy

11. Chemotherapy intravenous Adriamycin (doxorubicin), cisplatin, carboplatin, mitomycin C, 5 fluorouracil.

12. Thank you