Liver mass

1. SOL Liver

2. Common liver lesions

3. Approach to liver SOL History Clinical examination Lab – Hemogram, LFT, Albumin,INR Serology – ALA , Hydatid Tumor markers – AFP,CEA, CA 19-9

4. Presentation Asymptomatic Nodule on screening in cirrhotic patients Presenting with pain and fever SOL in a known patient of extrahepatic malignancy

5. Algorithm for Solitary SOL of Liver on USG Nagral S , Clinics in GI Surgery

6. Algorithm for Solid lesions on USG Nagral S , Clinics in GI Surgery

7. Algorithm for Multiple Liver SOLs on USG Nagral S , Clinics in GI Surgery

8. Beyond USG – CT Symptomatic lesions – no response to treatment Alterations in LFT Underlying liver disease

9. When MRI ----- HCC vs regenerating nodule vs dysplastic nodule atypical lesions

10. Role of Biopsy Usually not required Diagnostic uncertainty

11. Screening strategy

12. BCLC staging

13. CASE CAPSULE

14. HISTORY 54 yrs gentleman, no comorbidities Frequency, urgency, in complete evacuation No other GI symptoms USG abdomen – hypo echoic liver lesions Lab - normal

15. C olonoscopy Ulcero proliferative lesion in sigmoid colon No synchronous lesions/polyps Biopsy - adenocarcinoma

16. What next ?

17. C hemotherapy FOLFOX + bevaxizumab – 7 cycles FOLFOX – 5 cycles

18. PET CT

19. S urgery Sigmoid colectomy + left lateral segmentectomy + metastectomy ( seg 4b, seg 5, seg 7)