The document discusses liver tumors, categorizing them into benign and malignant types, with hepatocellular carcinoma (HCC) being the most common malignant primary liver cancer. Key factors include etiology, clinical features, diagnostic investigations, and treatment options such as surgical resection and systemic therapies. It also highlights the occurrence of secondary tumors in the liver, emphasizing their frequency and various causative cancers.

1. LIVER TUMOURS

2. CONTENTS
• 1. introduction
• 2. benign tumours
• 3. malignant tumours
• 4.HCC
• etiology
• pathology
• clinical features
• Investigations
• Treatment
• 5. secondaries of the liver

3. INTRODUCTION
• 1) Benign tumours: two times more common than malignant
tumours(20% of population)
• 2) Malignant tumours : AFP and CEA differentiates benign from
malignant
• A) primary tumours : mc primary liver malignancy is HCC
• B) secondaries in the liver(mc overall)

4. Benign tumours
• A) haemangiomas
• B) focal nodular hyperplasia
• C) hepatic adenoma

5. MALIGNANT TUMOURS
A) PRIMARY MALIGNANT TUMOURS
• HEPATIC CA. (HEPATOMA)
• Mc primary liver malignancy
• Cells of origin- hepatocytes
• 5th
most- men
• 7th
most- women

6. ETIOLOGY
• 1. Cirrhotic indv.
• 2.aflatoxin b1(fungus aspergillus)
• 3. Alcoholic , smoking
• 4. infection with HBV, HCV
• 5. metabolic disorders
• 6. environmental chemicals- ddt,nitrite and nitrate
• 7. pre-malignant like hepatic adenoma

7. PATHOLOGY
• Gross : highly vascular lesion
• Types- a) hanging type
• b) pushing type
• c) infiltative type
• VARIANTS OF HCC:
• 1. fibrolamellar hcc [good prognosis]
• 2. mixed hepatocellular cholangio cellular hcc
• 3. clear cell variant
• 4. gaint cell variant[bad prognosis]
• 5. sarcomatoid variant[carcinosarcoma]

8. CLINICAL PRESENTATION
• 1. Sometimes asymptomatic[ incidental finding]
• 2. fever
• 3. loss of wt, appetite
• 4. mass per abd
• 5. splenomegaly &features of portal HTN
• 6. features of chr. Liver diseases like gynecomastia
• 7. jaundice
• 8. paraneoplastic syndromes[1%]
• 9. metastatic features- direct[ diaphragm and surrounding structures], lymphatic,
haematogenous(bone, lungs, adrenals)

10. INVESTIGATIONS
• 1. usg abd- shows hyperechoic mass, mosaic pattern with thin halo
and lat shadows
• 2. CECT abd – hypodense, mosaic, vascular lesion with irregular
margin
• 3. tumour biomarkers
• A)AFP->100 iu significant[45%], insensitive in early detection of
tumours
• B) PIVKA 2 levels elevated in 50%
• 4. LFT: total bilirubin, enzyme levels

12. 5. CT angiography – to look for vascular invasion[portal vein]

13. TREATMENT
• 1. SURGICAL
• A) resection of tumours( highest chanced survival)
• Hepatectomy or hemihepatectomy
• B) orthotopic liver transplation- milan criteria for liver transplantation
• -1 lesion< 5 cm
• -upto 3 lesions <3cms
• -IVO extrahepatic manifestation
• - no vascular invasion

14. • 2)ABLATIVE PROCEDURES:
• 1. ethanol inj.
• 2. acetic acid inj.
• 3. thermal ablation:
• -cryotherapy- freeze and thaw technique, laparotomy/ lap/per
cutaneous route
• -RFA: uses heat( high freq alternate current)- heat- stink effect
• - microwave ablation

15. • 3)TRANSARTERIAL
• . TAE- transarterial embolization using gel foam
• .TRACE- transarterial chromoembolization using lipiodal, doxorubicin, mitomycin,
cisplatin
• Indicated in- multinodular tumours, preserved LFT(child’s a,b)
• No metastasis
• TARE- transarterial radioembolization- yttrium-90, iodine-131
• 4) RADIOTHERAPY
• Ext beam radiotherapy

16. • 5) SYSTEMIC
• Chemotherapy- sorafenib- macrovascular dis
• anti-pd1: nivolumab
• Hormonal- tamoxifen(serms)
• Immunotherapy
• c/I for surgery- extrahepatic metastasis, bilobar tumours, main bile
duct involvement, tumour thrombus in main portal vein & Ivc

17. SECONDARIES OF LIVER
• Mc liver malignancy overall
• Primary: secondary- 1:20
• Can be multiple – in one lobe/ in both lobes of liver
CAUSES:
1. Abdominal 2. Extra-abdominal
Ca.stomach Melanoma
Ca.Colon ca. breast, bladder
Ca.Pancreas ca. prostate
Ca.Small bowel testicular & adrenal
Ca.Rectum
carcinoids

18. THANK YOU