Malignant liver tumors

American Associatiion of Liver Disease HCC diagnostic criteria

- ?

- main point is that FNA not necessarily required for diagnosis and may track tumor in needle site converting treatable lesion to untreatable

Treatments for HCC

Curative:

- TRansplant

- resection

- Radiofrequency ablation

Palliative

- TASTE (embolization)

- chemotherapy

Best treatment modality HCC:

- Transplant (treats both tumor underlying liver dysfunction)

- resection has 50% 5 year survival (largely from liver disease and risk of 2nd primary)

Factors for HCC resection

- liver function

- tumor characteristics (number, size, multifocality)

Primary liver tumors:

HCC

cholangiocarcinoma

malignant vascular tumors (epitheliod hemangioendothelioma, angiosarcoma)

sarcomas (embryonal sarcoma, ...)

Most common sources of liver mets (hypoattenuating):

Colorectal, Breast, Lung

Hyperattenuating:

- melanoma, renal cell

Treatment goals:

- R0 resection 

- preserve ~25% hepatic parenchyma

- adjuvant or neoadjuvant chemoRT to reduce risk recurrence