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Primary and secondary liver tumours 

Primary and secondary liver tumours
Chapter:
Primary and secondary liver tumours
Author(s):

Graeme J.M. Alexander

, David J. Lomas

, William J.H. Griffiths

, Simon M. Rushbrook

, and Michael E.D. Allison

DOI:
10.1093/med/9780198746690.003.0332
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date: 27 February 2021

A number of benign and malignant tumours arise in the liver. Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. It is usually asymptomatic unless the cancer is advanced. Cross-sectional imaging with contrast with either CT or MRI is sufficient to make a firm diagnosis. Serum α‎-fetoprotein is elevated in most cases. Early diagnosis, perhaps through surveillance, increases the proportion of patients that can be considered for curative treatment, including surgical resection, radiofrequency ablation, or liver transplantation. The presence of symptoms denotes a poor prognosis, with less than 10% of patients surviving 3 years. Cholangiocarcinoma accounts for 7 to 10% of primary liver malignancies. The diagnosis of cholangiocarcinoma can be very difficult to make. Resection results in cure for only a few patients. Palliative approaches include photodynamic therapy, conventional radiotherapy, and high-dose local irradiation. Biliary stents relieve jaundice and may reduce the frequency of episodes of cholangitis. Haemangioma, usually an incidental finding, has a prevalence of 2 to 5% in the population. Focal nodular hyperplasia (prevalence 0.4–0.8%) is found predominantly in fertile women and is typically an incidental finding during abdominal imaging. Biopsy is required if there is diagnostic uncertainty and in particular to differentiate from hepatic adenomas. Interventions include surgery, radiofrequency ablation, transarterial embolization, or a combination of each according to location and patient fitness. Secondary tumours may be a presenting feature but more often are found during staging for primary malignancy or during follow-up. Symptoms include abdominal pain and hepatomegaly and later jaundice and ascites. For most patients with multiple metastases to the liver, the prognosis is poor and treatment palliative.

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