Liver tumours

• Commonest are secondary tumours from the breast, lung and GI tract most commonly
• Primary tumours are less common and can be malignant or benign
• Malignant tumours include;
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Angiosarcoma
  • Hepatoblastoma
  • Fibrosarcoma
  • Leiomyosarcoma
• Benign tumours include;
  • Cyst
  • Haemangiomas
  • Adenoma
  • Folicular nodular hyperplasia
  • Fibroma
  • Leiomyoma

Symptoms

• Fever, malaise, anorexia, weight loss, RUQ pain
• Jaundice is late expect in cholangiocarcinoma

Signs

• Hepatomegaly – comment on smooth, hard or irregular
• Signs of chronic liver disease
• Evidence of decompensation – jaundice, ascites
• Abdominal mass
• Listen for a bruit over the liver

Bloods

• FBC, clotting, LFTs, hepatitis serology, ?-fetoprotein
• US or CT
• ERCP should be performed for suspected cholangiocarcinoma
• Liver biopsy – be careful if it is potentially resectable as tumour can seed the biopsy tract

Liver metastases

• Indicate advance disease
• Sometimes treatment is possible – chemotherapy for lymphomas and germ cell tumours or surgery for single mets from colorectal cancer
• Most often treatment is palliative

Hepatocellular carcinoma

• Accounts for 90% of primary liver cancers
• Common in China and sub-Saharan Africa
• Causes;
  • Viral hepatitis – HepB and HepC
  • Cirrhosis – alcohol, haemochromatosis, PBC
  • Aflatoxin
  • Parasites
  • Anabolic and contraceptive steroids

Management

• Resection – solitary tumours
• Other options are chemotherapy, percutaneous ablation, tumour embolisation
• Prevention is better
• HBV vaccination
• Don’t reuse needles
• Screen blood products
• Reduce exposure to aflatoxins

Cholangiocarcinoma

• This is a biliary tree malignancy that makes up 10% of liver primaries
• Causes;
  • Flukes in the East
  • PSC
  • Congenital bilary cysts
• Symptoms
  • Fever, abdominal pain, malaise
• Tests
  • Raised bilirubin, raised alk phos
  • Most are extrahepatic
• Management
  • 70% are unsuitable for surgical resection
  • Palliative stenting of the obstructed extra-hepatic biliary tree helps

Benign tumours

• Haemangiomas
  • Most common, don’t require treatment
• Adenomas
  • Common
  • Causes include anabolic steroids, OCP and pregnancy
  • Only treat if symptomatic