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Neoplasm of the Liver
Tumor of the Liver
Tumors of the liver include benign tumors such as hepatic adenomas, hemangiomas and focal nodular hyperplasia and malignant neoplasms such as hepatocellular carcinoma, cholangiocarcinoma, hemangioblastoma, angiosarcoma, hemangioendothelioma and mesenchymal tumors.

Presentation

HCC presents a variable appearance at CT and MRI. [scielo.br]

How do liver abscesses present? Multiple abscesses tend to present more acutely and single ones more indolently. Liver symptoms: Right upper quadrant pain, tenderness, hepatomegaly, possible palpable mass. [brainscape.com]

The most common presentation is an asymptomatic mass. Patients may also present with abdominal pain, nausea, vomiting, weight loss, and/or fever. [cancertherapyadvisor.com]

Typically presenting with mass effect or incidentally on imaging, MCN-L is considered a premalignant transformation, requiring resection. [academic.oup.com]

present, this is referred to as liver adenomatosis. [appliedradiology.com]

Entire Body System

  • Pain

    Doctors will drain them or remove them with surgery if they cause symptoms such as pain. [cancer.ca]

    Symptoms of benign liver masses Hemangiomas Pain often occurs in lesions greater than 5 to 6 centimeters in size Hepatic adenomas Many people experience no symptoms Can be associated with birth control use Focal nodular hyperplasia (FNH) Abdominal pain [upmc.com]

    Side effects can include: fatigue, rash, decreased appetite, diarrhea, pain, bleeding, blistering of hands and feet, and holes in the stomach or intestine. Immunotherapy. [webmd.com]

    But, as the cancer grows, symptoms may include: • Pain in the upper abdomen on the right side; • Pain that may extend to the back and shoulder; • Swollen abdomen (bloating); • Loss of appetite and feelings of fullness; • Weakness or feeling very tired [secure.ssa.gov]

  • Weight Loss

    Anorexia and weight loss. How are liver abscesses treated? US/CT guided drainage of the abscess + abx. A third generation cephalosporin (ceftriaxone) + an anti-amoebic (metronidazole) [brainscape.com]

    Patients typically present with symptoms which may include abdominal, shoulder or back pain, loss of appetite, weight loss, jaundice, and occasionally a palpable mass.The typical treatment is surgical removal of the tumor. [fibrofoundation.org]

    loss, malaise, upper abdominal pain Laboratory Testing Initial testing Viral hepatitis testing if etiology of liver disease is unclear If viral disease confirmed, perform viral load testing Hepatic function testing As a panel or separately Albumin Alkaline [arupconsult.com]

    When this happens, the following symptoms may occur: loss of appetite weight loss dark-colored urine abdominal swelling or bloating jaundice, a yellowing of the skin or the whites of the eyes pain in the right shoulder pain in the upper right abdomen [healthline.com]

    The main presenting manifestations are abdominal mass with pain, swelling and discomfort, weight loss, and anorexia. Splenomegaly, nausea, vomiting, and jaundice are less commonly observed. [orpha.net]

  • Weakness

    Are you feeling weak or tired? Is your appetite down? Have you lost weight ? Your doctor may use tests to help diagnose hepatocellular carcinoma: Blood test. [webmd.com]

    Current techniques each have their strengths and weaknesses. Ultrasound Ultrasound is usually the first screening test carried out if HCC is suspected. [hepctrust.org.uk]

    Targeted drugs attack specific weaknesses in the cancer cells, and they may help slow the progression of the disease in people with advanced liver cancers. Immunotherapy. [mayoclinic.org]

    But, as the cancer grows, symptoms may include: • Pain in the upper abdomen on the right side; • Pain that may extend to the back and shoulder; • Swollen abdomen (bloating); • Loss of appetite and feelings of fullness; • Weakness or feeling very tired [secure.ssa.gov]

    […] weight loss loss of appetite feeling very full after eating, even if the meal was small feeling sick and vomiting pain or swelling in your abdomen (tummy) jaundice (yellowing of your skin and the whites of your eyes) itchy skin feeling very tired and weak [nhs.uk]

  • Inflammation

    What Djouder and his colleagues have observed is that NASH, which is currently untreatable, is the result of several "hits" and that "the first step is DNA damage promoting inflammation caused by the excess of nutrients." [sciencedaily.com]

    We found that both the mRNA and protein expression levels of β-catenin were aberrant in all liver tissues, accompanied by inflammation, steatosis, fibrosis and hepatic neoplasm after 10-week exposure of diethylnitrosamine (dissolved in sesame oil, 0.16 [pubs.rsc.org]

    Peribiliary glands, which are found around the major ducts can be quite atypical when there is inflammation and benign reactive ductular proliferation following inflammation and/or scarring can be extensive and sometimes cytologically atypical. [nature.com]

    With necroptosis, the cell membrane dissolves and the cell content causes inflammation in the environment of the cancer cell. In the case of classical programmed cell death, small vesicles form which are eliminated by the immune system. [presse.inserm.fr]

    In women, estrogen inhibits secretion of IL-6, which is a key biochemical in the process of chronic inflammation that can lead to cancer. The effect has been directly observed in experiments with mice. [everydayhealth.com]

  • Fatigue

    Side effects of sorafenib (Nexavar) include fatigue, rash, high blood pressure, sores on the hands and feet, and loss of appetite. [medicinenet.com]

    Side effects can include: fatigue, rash, decreased appetite, diarrhea, pain, bleeding, blistering of hands and feet, and holes in the stomach or intestine. Immunotherapy. [webmd.com]

    Patients may experience nausea, vomiting, and fatigue. Chemotherapy: Medications are injected into the liver to kill cancer cells. [medicalnewstoday.com]

    Healthy Lifestyles Physical Activity Nutrition and Weight Management Supplement Use Immunizations and Infections Late Effects/Long-Term Psychosocial and Physical Problems Anthracycline-Induced Cardiac Toxicity Anxiety and Depression Cognitive Function Fatigue [nccn.org]

    When signs and symptoms do appear, they may include: Losing weight without trying Loss of appetite Upper abdominal pain Nausea and vomiting General weakness and fatigue Abdominal swelling Yellow discoloration of your skin and the whites of your eyes [mayoclinic.org]

Gastrointestinal

  • Vomiting

    Methods: Chart review and review of current multispecialty literature Results: We present a 61-year-old woman with 2-year history of episodic cholangitis, jaundice, and vomiting. [academic.oup.com]

    Complications of chemotherapy include fatigue, easy bruising, hair loss, nausea and vomiting, swollen legs, diarrhea, and mouth sores. These side effects are usually temporary. [medicinenet.com]

    The following symptoms indicate a more urgent and serious problem: persistent vomiting, meaning vomiting more than twice a day for more than one day blood in vomit recent, unexplained weight loss black bowel movements difficulty swallowing new swelling [healthline.com]

    Patients may also present with abdominal pain, nausea, vomiting, weight loss, and/or fever. [cancertherapyadvisor.com]

    Nausea and vomiting. Anorexia and weight loss. How are liver abscesses treated? US/CT guided drainage of the abscess + abx. A third generation cephalosporin (ceftriaxone) + an anti-amoebic (metronidazole) [brainscape.com]

  • Nausea

    Nausea and vomiting. Anorexia and weight loss. How are liver abscesses treated? US/CT guided drainage of the abscess + abx. A third generation cephalosporin (ceftriaxone) + an anti-amoebic (metronidazole) [brainscape.com]

    Complications of chemotherapy include fatigue, easy bruising, hair loss, nausea and vomiting, swollen legs, diarrhea, and mouth sores. These side effects are usually temporary. [medicinenet.com]

    Symptoms are more likely if they are > 4 cm; symptoms include discomfort, fullness, and, less often, anorexia, nausea, early satiety, and pain secondary to bleeding or thrombosis. These tumors often have a characteristic highly vascular appearance. [msdmanuals.com]

    Patients may also present with abdominal pain, nausea, vomiting, weight loss, and/or fever. [cancertherapyadvisor.com]

    The systemic toxicities of the FUDR HAI were nausea, vomiting, diarrhea and mucositis. The hepatic side effect was not detected. [kjg.or.kr]

  • Diarrhea

    The systemic toxicities of the FUDR HAI were nausea, vomiting, diarrhea and mucositis. The hepatic side effect was not detected. [kjg.or.kr]

    Can be used when CT and MRI results are inconclusive For confirmed HCC Chest CT – evaluate for extrahepatic metastases Bone scan – when skeletal symptoms present Differential Diagnosis Abdominal pain Acute cholecystitis Acute pancreatitis Infectious diarrhea [arupconsult.com]

    Complications of chemotherapy include fatigue, easy bruising, hair loss, nausea and vomiting, swollen legs, diarrhea, and mouth sores. These side effects are usually temporary. [medicinenet.com]

    Side effects can include: fatigue, rash, decreased appetite, diarrhea, pain, bleeding, blistering of hands and feet, and holes in the stomach or intestine. Immunotherapy. [webmd.com]

    Peptic ulcers can cause a burning pain in the stomach, diarrhea, nausea, vomiting and fatty, smelly stools. [rarediseases.org]

  • Dyspepsia

    Abdominal pain can have many sources including but not limited to dyspepsia, peptic ulcer disease, inflammatory bowel disease, and irritable bowel disease. [clinicaladvisor.com]

Cardiovascular

  • Hypertension

    Ensure the best patient encounters and outcomes with 86 new downloadable Patient Teaching Guides online covering Acute Coronary Syndrome, Diabetes Insipidus, Electrical Injury, Pulmonary Hypertension and more! [books.google.ro]

    Of the fibropolycystic liver diseases, patients with congenital hepatic fibrosis and Caroli disease often develop recurrent acute cholangitis and portal hypertension secondary to peribiliary fibrosis (Figure 1). [appliedradiology.com]

    Because of the limitations of organ supply, liver transplantation is generally reserved for patients with unresectable tumors either due to location or presence of portal hypertension. [clinicaladvisor.com]

    Nodular regenerative hyperplasia of the liver: an under-recognized cause of portal hypertension in hematological disorders. Am J Hematol 2004;75(4):225-30. López R, Barrera L, Vera A, Andrade R. [revistagastrocol.com]

Liver, Gall & Pancreas

  • Hepatomegaly

    Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally on ultrasound or other scans (in Imaging Tests of the Liver and Gallbladder ). [msdmanuals.com]

    MRI results are inconclusive For confirmed HCC Chest CT – evaluate for extrahepatic metastases Bone scan – when skeletal symptoms present Differential Diagnosis Abdominal pain Acute cholecystitis Acute pancreatitis Infectious diarrhea Parasitic Viral Hepatomegaly [arupconsult.com]

    ALP isoenzyme test (Medical Encyclopedia) Ascites (Medical Encyclopedia) Diet - liver disease (Medical Encyclopedia) Hepatic encephalopathy (Medical Encyclopedia) Hepatomegaly (Medical Encyclopedia) Liver disease (Medical Encyclopedia) Liver scan (Medical [icdlist.com]

  • Liver Mass

    Benign Liver Mass Overview Benign (noncancerous) liver masses or lesions are relatively common in the liver. [upmc.com]

    Soulen MC: Angiographic evaluation of focal liver masses. Semin Roentegenol 1995, 30 :362–374. CrossRef Google Scholar 46. Adson M: Mass lesions of the liver. Mayo Clin Proc 1986, 61 :362–368. PubMed Google Scholar 47. [link.springer.com]

    They have connections to the biliary tree and are not true liver masses but can be confused with a cystic liver mass. [clinicaladvisor.com]

    Imaging Contrast-enhanced studies using ultrasound, MRI, or CT are most useful in the evaluation of a liver mass Ultrasound : first test Abdominal CT ( confirmatory test ): typically shows a single hypodense lesion with irregular borders and possible [amboss.com]

    (B) Gross pathology showing a large, well-circumscribed mass with surrounding liver parenchyma. (C) Serial sectioning of the mass revealed a cyst-like appearance with clear serous fluid filling the central portion. [frontiersin.org]

  • Hepatic Friction Rub

    Occasionally, a hepatic friction rub or bruit develops. Occasionally, systemic metabolic complications, including hypoglycemia, erythrocytosis, hypercalcemia, and hyperlipidemia, occur. These complications may manifest clinically. [merckmanuals.com]

Psychiatrical

  • Suggestibility

    Suggested Listings for Evaluation: DETERMINATION LISTING REMARKS Meets 13.19 Prognosis is poor based on confirmed diagnosis alone Equals * Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate [secure.ssa.gov]

    This mode of delivery is based upon early reports suggesting that liver tumors primarily receive blood supply via hepatic artery ( 3 ). [academic.oup.com]

    Significant increase in the size of the tumor and in alpha–fetoprotein serum levels suggests a diagnosis of malignant transformation (22,23). [scielo.br]

  • Hunger

    Hypoglycemia can cause a variety of symptoms including confusion, abnormal behavior, blurred vision, double vision, anxiety, heart palpitations, sweating and hunger. [rarediseases.org]

Neurologic

  • Irritability

    Complications of radiation therapy include skin irritation near the treatment site, fatigue, nausea, and vomiting. Chemotherapy : Chemotherapy uses a medicine that kills cancer cells. [medicinenet.com]

    Abdominal pain can have many sources including but not limited to dyspepsia, peptic ulcer disease, inflammatory bowel disease, and irritable bowel disease. [clinicaladvisor.com]

    Indirect effects caused by larger leiomyoma, such as peritoneal irritation, were proposed to be responsible for the CA125 elevation. On the other hand, in the present case, immunostaining for CA125 showed positive staining of the leiomyoma. [jcgo.org]

    Edema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. [en.wikipedia.org]

  • Dizziness

    Infection of the pleural fluid ( empyema ) Shock and death in severe circumstances Call 911 if you have: Any serious injury to the chest Chest pain or shortness of breath Go to the emergency room or call the local emergency number (such as 911) if you have: Dizziness [medlineplus.gov]

    However, traumatic hemothorax can lead to life-threatening complications, such as: Abnormalities of oxygenation and ventilation Bacterial contamination and septic shock, if the condition is left untreated Chest pain Decreased pulse pressure Dizziness [docdoc.com.sg]

  • Vertigo

    Patients with clinical signs and symptoms of catecholamine secretion should be evaluated for blood levels and multiple tumors[7].Symptoms change according to tumor localization; ranging from a neck mass to hearing loss, vertigo or cranial nerve palsy. [kbb-forum.net]

Workup

Workup [ edit ] Upon discovery of a liver tumor, the main issue in the workup is to determine whether the tumor is benign or malignant. Many imaging modalities are used to aid in the diagnosis of malignant liver tumors. [en.wikipedia.org]

Hepatic adenomas are most often diagnosed as a result of imaging done for unrelated pathology or following workup of a palpable abdominal mass (30% patients) [ 88 ]. [intechopen.com]

The upright chest radiograph is the ideal primary diagnostic study in the evaluation of hemothorax (see Workup). [emedicine.medscape.com]

The combination of Hep Par 1 and MOC-31 will allow for the diagnosis of hepatocellular carcinoma in most cases and will guide the selection of immunohistochemical markers for further workup. [archivesofpathology.org]

Biopsy

  • Hepatocellular Carcinoma

    We therefore developed a quantitative immunohistochemical assay and monitored epoxide hydrolase expression in hepatocellular carcinomas (HCC, n = 20), cholangio-cellular carcinomas (CCC, n = 2) and liver metastases (n = 57) of tumours of various origins [ncbi.nlm.nih.gov]

    Aflatoxin B1 acts synergistically with hepatitis B virus in causing hepatocellular carcinoma. [scienceopen.com]

    Expert consensus of the Standardized diagnosis and treatment for Hepatocellular carcinoma. J Clin Hepatol. 2009; 12 (5) 13. Zhang X, Zhou L, Chen B, Hu S, Wachtel MS, Frezza EE. [hepatmon.com]

    NOS, Hepatocellular carcinoma NOS, [M]Hepatocellular carcinoma NOS, carcinoma of liver (diagnosis), hepatocellular carcinoma of liver (diagnosis), hepatocellular carcinoma of liver, liver neoplasm malignant carcinoma, carcinoma of liver, Liver carcinoma [fpnotebook.com]

Treatment

The treatment-related complication rate was 11.4 %. There was no treatment-related death. [aetna.com]

Treatment options differ for each type of cancer and your health is reliant upon receiving the proper cancer treatment. [liverandpancreassurgeon.com]

Treatment is rarely needed. Hemangiomas are usually small and asymptomatic; they occur in 1 to 5% of adults. [msdmanuals.com]

Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. [cancer.net]

Most benign liver tumors do not require treatment. State-of-the-art imaging and an expert opinion are essential to avoid unnecessary surgery and identify those rare cases that do require treatment. [nyp.org]

Prognosis

Prognosis Undifferentiated carcinomas are postulated to have a poorer prognosis than HCC, although evidence from more cases is needed to support this hypothesis. [atlasgeneticsoncology.org]

Prognosis is usually poor. Other primary liver cancers are uncommon or rare. Diagnosis usually requires biopsy. Prognosis is typically poor. Some cancers, if localized, can be resected. Resection or liver transplantation may prolong survival. [merckmanuals.com]

Prognosis The prognosis depends on success rates of resection in resectable tumors. 5-year survival rates are moderate in low stage tumors but these rates drop below 20-30% in advanced disease. [orpha.net]

Prognosis based on Tumor size and location (resectability) Tumor aggressiveness and growth rate Patient general health Liver function – degree of cirrhosis Available treatment options (eg, resection, transplant) Metastatic disease common Common sites [arupconsult.com]

Etiology

It is associated with inflammatory disorders and malformations of the ducts, but most cases are of unknown etiology. [ncbi.nlm.nih.gov]

Etiology Liver cirrhosis (80% of cases) Risk factors independent of cirrhosis Chronic hepatitis B or C virus infection Nonalcoholic steatohepatitis ( NASH ) Hemochromatosis Wilson's disease Alpha-1 antitrypsin deficiency Schistosomiasis Glycogen storage [amboss.com]

The median survival is approximately 6 months, with 5-year survival of 29 Etiology Possible etiologic factors are much less well established than for HCC, and most cases have no known etiology, but it is clear that disorders that cause chronic inflammation [nature.com]

Etiology Etiology is not well known. Epidemiology Undifferentiated carcinoma of the liver is very rare, accounting for less than 2% of all epithelial liver tumors. [atlasgeneticsoncology.org]

Epidemiology

Epidemiology Fifth most common malignancy worldwide Highest incidence in Southeast Asia and Africa Peak incidence in the US: 70–75 years Peak incidence in Africa and Asia: 30–40 years ♂ > ♀ References: [1] Epidemiological data refers to the US, unless [amboss.com]

From Wikimedia Commons, the free media repository Jump to navigation Jump to search Radiology: Ultrasound · X-ray · Computed tomography | Anatomical pathology: Cytopathology · Gross pathology · Histopathology | Other: Epidemiology (Geographic map → World [commons.wikimedia.org]

Chapters feature up-to-date information on the basic mechanisms, epidemiological risk factors, screening and surveillance strategies, diagnosis and treatment. [books.google.com]

The management of the network includes a Scientific Committee, an Executive Board and an Epidemiology and Management Coordinating Centre. http://chc.isped.u-bordeaux2.fr/ [icgc.org]

Pathophysiology

Simple cyst: pathophysiologically they are thought to be congenital. They are of no clinical significance and are often found incidentally. Polycystic liver disease: genetic disease usually associated with mutations of polycystic kidney disease. [brainscape.com]

Etiology The pathophysiology of hepatocellular carcinoma is not well understood. Underlying liver dysfunction is the main predisposing condition (HBV, HCV). [orpha.net]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 96. National Cancer Institute website. [medlineplus.gov]

Amyloidosis and bleeding: Pathophysiology, diagnosis, and therapy. none Am J Kidney Dis. 2006; 47 :947–55. [ PubMed ] [ Google Scholar ] 4. Alwitry A, Brackenbury ET, Beggs FD, Soomro I. [ncbi.nlm.nih.gov]

Pathophysiology. Elsevier Health Sciences. pp. 660–. ISBN 978-0-323-29317-4. ^ Farage MA, Neill S, MacLean AB (2009). "Physiological changes associated with the menstrual cycle: a review". [en.wikipedia.org]

Prevention

[…] toxicology conference in MENA region March 21, 2018 News Emory University School of Medicine seniors participate in Match Day 2018 March 16, 2018 News Emory Genetics Metabolic Nutrition Program launches new website for Medical Nutrition Therapy for Prevention [emoryhealthcare.org]

When doctors discover a large adenoma, they may recommend that it be surgically removed to prevent that possibility. [liverfoundation.org]

Related information Information for Health Professionals –Recommendations on Prevention and Screening for Liver Cancer Cancer Prevention Series (7) - Liver Cancer Prevention and Screening The Viral Hepatitis Preventive Service provides detailed information [chp.gov.hk]

[…] and early detection of cervical cancer: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. [nccn.org]

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