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38 Cards in this Set

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What is cholangiocarcinoma?
bile duct tumors
What is cholangiogram?
X-Ray of bile ducts by injecting dye
What is an ERCP?
Endoscopic retrograde cholangiopancreatography:

It is used to identify obstructions in the biliary system
What is PTC?
percutaneous transhepatic cholangiography. An X-ray of the bile ducts intra and extrahepatically
What is hepatoma?
hepatocellular carcinoma
What are the risk factors for bile duct cancer?
UC
Bile duct adenoma
Sclerosing Cholangitit
choledochal cysts
hepatolithiasis
caroli's disease
thorotrast (don't see this now, used w/X-rays in 50s)
opisthorcis viverrini (liver fluke)
What is the pathology of bile duct cancer?
adenocarcinoma (95%)
cholangiocarcinoma
How is bile duct cancer grouped? And what are the groups?
Grouped by location:

Perihilar(65%)-Kaltskin's tumor
Intrahepatic (10%)
distal (25%)
What is the most common symptom of bile duct cancer?
painless jaundice
What are the signs and symptoms of bile duct cancer?
RUQ pain (but usually no pain)
hepatomegaly
jaundice
abdominal pain
fatigue
malaise
weight loss (w/advanced disease)
What are the lab results with bile duct cancer?
results are consistent with obstructive jaundice:

high alkaline phosphatase
high unconjugated bilirubin
What imaging test would be performed to diagnose bile duct cancer?
CT scan
ERCP or PTC (also therapeutic)
What are differential diagnosis for bile duct cancer?
1. benign biliary stricture:
sclerosing cholangitis
choleducolithiasis
mirrizzi's syndrom - extrinsic compression of the bile ducts

primary and metastic liver cancer
periampullary cancers
What is the management of bile duct cancer?
SURGERY is the only opportunity for long term care
What are the surgerical options for bile duct cancer?
Whipple (lesions near ampulla)
hepatic resection (lesions in the liver)
hepaticojejunostomies ( lesions in the common bile duct and klatskin tumor)
When is surgery contraindictated?
-distant metastsis (just to palliative surgery)
-invasion into major veseels (portal/hepatic artery)
-bilateral multifocal intrahepatic spread
-unilateral vascular invasion or contra lateral ductal spread
What is the goal of palliative care with bile duct cancer and some ways you can achieve them?
Goal: relieve biliary obstruction and prevent secondary liver failure

-biliary stents -placing with PTC or ERCP
-Laproscopic cholecystectomy
-choledochojejunostomy
In resected bile duct tumors, what is the median survival rate? And in unresested tumors?
18-30 months

6 months
What is the resection rate of distal cholangiocarcinoma?
90%
What are some risks of gallbladder cancer and how prevelent is it?
gallbladder cancer is rare, but some risks are:
gallstones (>1cm in diameter)
calcified gallbladder (porcelain gallbladder-major)
biliary salmonella typhi infection
biliary adenomas
choledochal cyst
What are some signs and symptoms of gallbladder cancer?
typical biliary colic
palpable mass
jaundice (late)
ascites (late)
When are most gallbladder cancers found?
by microscopc exam after routine cholecystectomy
What is the best staging formula to predict outcome? And how does it work?
AJCC

Deeper spread=higher stage
What is the % of gallbladder cancers that have metastasized when found and why is there such a high metastases rate?
70% have metastized because the gallbladder does not have a serosa or submucosa or circular longitudinal muscle layer
What is the best way to manage gallbladder cancer?
surgery
What is the most common reason for liver cancer?
metastases from other cancers (colon being the most frequent)
What is the incidence of liver cancer?
-Rare in W. Europe and N. America
-most common in africa/asia
-males>females
-age>40
-Most common carcinoma <2yo
What is the etiology of liver cancer?
Aflatoxins (byproduct of fungus--seen in grains)
Kwashiorkor
Cirrhosis
Hep B/C (higher rate in asia/africa)
parasitic infestation
vinyl chloride
thorotrast
What is the pathology of liver cancer?
hepatocellular = hepatoma
solitary
diffuse
fibrolamellar
cholangiocarcinoma - intrahepatic
hepatoblastoma (rare)
What are the clinical manifestations of liver cancer? (KNOW THIS)
weight loss
weakness
abdominal pain/mass
portal hypertension
hepatomegaly
jaundice
ascites
(all LATE findings)
What are diagnostic studies that can test for liver cancer?
Liver Function Test
Alpha feto protein
US (works well w/obstruction)
computed tomography
MRI
percutanious needle biopsy
good for difuse spread
NOT use much anymore:
Arteriography
nuclide scanning
What is the 30% rule with liver cancer?
30% require operation
30% can be resected
30% can be long term survivor
What are the treatment options with liver cancer?
surgery
Cantley's line
Chemotherapy
radiation therapy
What are the surgerical option with liver cancer?
Wedge excision
Lobectomy
trisegmentectomy
liver transplant
radiofrequency ablation
cryoablation (liquid nitrogen probes--forms ice ball which destroys tumor. Tumor can't be near vascular structures and are useful with primary or metastastic tumors
What is Cantley's line? And why is it used?
Line from gallbladder fossa to IVC.

good spot to resect b/c that is where the vasculature comes in
What are the different types of chemo therapy?
-Systemic IV
-intra-aterial (put in the hepatic artery)
-percutaneous (alcohol injections)
- infusaid pump (can implant under skin)
- chemo (embolizatin)
What are the different options with radiation therapy?
external beam (cyber knife) - adjusts for breathing to administer radiation

Brachytherapy - put a stent in with a balloon and diffuse a radioactive liquid (doesn't work very well)
What is the prognosis with liver cancer?
w/resection:27-32%
unresected: 0%