Liver and Biliary Tract Tumors for NP Exam
Liver and Biliary Tract Tumors for the Nurse Practitioner Licensing Exam
Liver Tumors
- Hepatocellular Carcinoma (HCC):
- Epidemiology: The most common primary liver cancer, often linked to cirrhosis from hepatitis B, hepatitis C, alcohol use, and nonalcoholic steatohepatitis (NASH).
- Risk Factors: Chronic viral hepatitis, alcohol use, aflatoxin exposure, and metabolic conditions such as hemochromatosis.
- Clinical Presentation: Often asymptomatic in early stages. Advanced disease presents with weight loss, abdominal pain, jaundice, or signs of decompensated cirrhosis.
- Diagnosis: Multiphasic CT or MRI shows arterial phase enhancement and venous washout. Elevated alpha-fetoprotein (AFP) supports diagnosis.
- Treatment: Surgical resection or liver transplantation for early-stage disease. Transarterial chemoembolization (TACE) and sorafenib for more advanced disease.
- Hepatic Adenoma:
- Epidemiology: A benign tumor linked to oral contraceptive use, occurring primarily in young women.
- Clinical Presentation: Often asymptomatic, but large adenomas may cause abdominal pain or hemorrhage.
- Treatment: Surgical resection for tumors >5 cm or symptomatic lesions due to the risk of rupture or malignancy.
- Focal Nodular Hyperplasia (FNH):
- Epidemiology: A benign liver lesion, often discovered incidentally in women.
- Clinical Presentation: Typically asymptomatic.
- Treatment: No treatment required unless symptomatic.
Biliary Tract Tumors
- Cholangiocarcinoma:
- Epidemiology: Malignancy of the bile ducts, linked to primary sclerosing cholangitis (PSC), liver flukes, and chronic biliary inflammation.
- Clinical Presentation: Painless jaundice, pruritus, and dark urine are hallmark signs.
- Treatment: Surgical resection offers the best prognosis for early-stage disease. Chemotherapy is used for advanced cases.
- Gallbladder Cancer:
- Epidemiology: A rare malignancy associated with chronic gallstone disease and chronic cholecystitis.
- Clinical Presentation: Often asymptomatic until late stages, presenting with right upper quadrant pain, jaundice, and weight loss.
- Treatment: Surgical resection for early-stage disease; chemotherapy and radiation for advanced cases.
Key Points
- Hepatocellular carcinoma (HCC) is the most common liver cancer, often associated with cirrhosis. Early detection relies on imaging and AFP levels, with treatment options including resection and TACE.
- Cholangiocarcinoma presents with painless jaundice and is linked to PSC and chronic biliary inflammation. Surgical resection is the only curative option.
- Gallbladder cancer is rare and associated with gallstones. It often presents late with right upper quadrant pain and jaundice.