Pathology: Primary liver tumour which usually occurs in the presence of cirrhosis
Aetiology: Cirrhosis and Hepatitis B
Symptoms: Abdominal Pain, Weight Loss, Jaundice, Right upper quadrant pain, Malaise
Signs: Cirrhosis, Jaundice, Ascites, Hepatomegaly
Investigations: Bloods: FBC, U&E, Clotting, Raised alfa-fetoprotein
Imaging: Ultrasound Abdomen shows a liver lesion
Treatment: Medical: Chemotherapy, Radiofrequency ablation, percutaneous ethanol injection,
transarterial chemoembolization – tumour blood supply identified and
chemotherapy infused directly through this artery
Surgical: Liver resection or liver transplantation are curative
Complications: Biliary obstruction
Prognosis: Median survival is 6 to 20 months. Resection increases 5 year survival to 40% and
transplantation increases 5 year survival to 75%
Pathology: Cancer that arises from epithelial cells of the bile ducts
Aetiology: Increased incidence in patients with PSC
Usually patients are asymptomatic until they become jaundiced due to obstruction
Symptoms: Jaundice, pruritus, weight loss, abdominal pain
Signs: Painless jaundice and palpable gall bladder
Investigations: Bloods: LFTs show an increased bilirubin and ALP
Tumour Markers: CA 19-9 and CEA may be raised
Imaging: Ultrasound Abdomen or MRCP shows dilated bile ducts. ERCP allows for
tissue biopsy
Treatment: Medical: ERCP to insert stent in bile duct and relieve Obstruction
Surgical: Resection is rarely possible. Radical hepatectomy and bile duct excision is
curative. Liver transplantation.
Complications: Infection of biliary tree and obstruction
Prognosis: Poor, frequently due to late presentation.
2-8 month survival if treated palliatively.
