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38 Cards in this Set
- Front
- Back
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What is cholangiocarcinoma?
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bile duct tumors
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What is cholangiogram?
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X-Ray of bile ducts by injecting dye
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What is an ERCP?
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Endoscopic retrograde cholangiopancreatography:
It is used to identify obstructions in the biliary system |
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What is PTC?
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percutaneous transhepatic cholangiography. An X-ray of the bile ducts intra and extrahepatically
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What is hepatoma?
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hepatocellular carcinoma
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What are the risk factors for bile duct cancer?
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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) |
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What is the pathology of bile duct cancer?
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adenocarcinoma (95%)
cholangiocarcinoma |
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How is bile duct cancer grouped? And what are the groups?
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Grouped by location:
Perihilar(65%)-Kaltskin's tumor Intrahepatic (10%) distal (25%) |
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What is the most common symptom of bile duct cancer?
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painless jaundice
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What are the signs and symptoms of bile duct cancer?
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RUQ pain (but usually no pain)
hepatomegaly jaundice abdominal pain fatigue malaise weight loss (w/advanced disease) |
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What are the lab results with bile duct cancer?
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results are consistent with obstructive jaundice:
high alkaline phosphatase high unconjugated bilirubin |
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What imaging test would be performed to diagnose bile duct cancer?
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CT scan
ERCP or PTC (also therapeutic) |
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What are differential diagnosis for bile duct cancer?
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1. benign biliary stricture:
sclerosing cholangitis choleducolithiasis mirrizzi's syndrom - extrinsic compression of the bile ducts primary and metastic liver cancer periampullary cancers |
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What is the management of bile duct cancer?
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SURGERY is the only opportunity for long term care
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What are the surgerical options for bile duct cancer?
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Whipple (lesions near ampulla)
hepatic resection (lesions in the liver) hepaticojejunostomies ( lesions in the common bile duct and klatskin tumor) |
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When is surgery contraindictated?
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-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 |
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What is the goal of palliative care with bile duct cancer and some ways you can achieve them?
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Goal: relieve biliary obstruction and prevent secondary liver failure
-biliary stents -placing with PTC or ERCP -Laproscopic cholecystectomy -choledochojejunostomy |
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In resected bile duct tumors, what is the median survival rate? And in unresested tumors?
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18-30 months
6 months |
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What is the resection rate of distal cholangiocarcinoma?
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90%
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What are some risks of gallbladder cancer and how prevelent is it?
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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 |
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What are some signs and symptoms of gallbladder cancer?
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typical biliary colic
palpable mass jaundice (late) ascites (late) |
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When are most gallbladder cancers found?
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by microscopc exam after routine cholecystectomy
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What is the best staging formula to predict outcome? And how does it work?
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AJCC
Deeper spread=higher stage |
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What is the % of gallbladder cancers that have metastasized when found and why is there such a high metastases rate?
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70% have metastized because the gallbladder does not have a serosa or submucosa or circular longitudinal muscle layer
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What is the best way to manage gallbladder cancer?
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surgery
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What is the most common reason for liver cancer?
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metastases from other cancers (colon being the most frequent)
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What is the incidence of liver cancer?
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-Rare in W. Europe and N. America
-most common in africa/asia -males>females -age>40 -Most common carcinoma <2yo |
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What is the etiology of liver cancer?
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Aflatoxins (byproduct of fungus--seen in grains)
Kwashiorkor Cirrhosis Hep B/C (higher rate in asia/africa) parasitic infestation vinyl chloride thorotrast |
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What is the pathology of liver cancer?
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hepatocellular = hepatoma
solitary diffuse fibrolamellar cholangiocarcinoma - intrahepatic hepatoblastoma (rare) |
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What are the clinical manifestations of liver cancer? (KNOW THIS)
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weight loss
weakness abdominal pain/mass portal hypertension hepatomegaly jaundice ascites (all LATE findings) |
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What are diagnostic studies that can test for liver cancer?
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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 |
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What is the 30% rule with liver cancer?
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30% require operation
30% can be resected 30% can be long term survivor |
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What are the treatment options with liver cancer?
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surgery
Cantley's line Chemotherapy radiation therapy |
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What are the surgerical option with liver cancer?
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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 |
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What is Cantley's line? And why is it used?
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Line from gallbladder fossa to IVC.
good spot to resect b/c that is where the vasculature comes in |
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What are the different types of chemo therapy?
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-Systemic IV
-intra-aterial (put in the hepatic artery) -percutaneous (alcohol injections) - infusaid pump (can implant under skin) - chemo (embolizatin) |
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What are the different options with radiation therapy?
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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) |
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What is the prognosis with liver cancer?
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w/resection:27-32%
unresected: 0% |
