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Title: LIVER AND BILE CANCER
Description: A review of liver and bile cancer, describing the liver functions, its anatomy and imuune system and the primary liver cancer types and metastatic profile. Review focuses on hepatocellular carcinoma and Hepatitis B&c.
Description: A review of liver and bile cancer, describing the liver functions, its anatomy and imuune system and the primary liver cancer types and metastatic profile. Review focuses on hepatocellular carcinoma and Hepatitis B&c.
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LIVER FUNCTION AND ANATOMY
The liver is a site of biosynthesis, metabolism and storage
...
The liver is divided into 2 lobes; each lobe is divided by connective
tissue into ~100,000 liver lobules
...
A lobule has a portal tract at each corner
...
The sinusoids of the liver are capillaries with gaps between the
endothelial cells to allow exchange of solutes from hepatocytes
•Blood flows from the portal tracts to the central veins through
sinusoids, where hepatocytes can absorb and release materials
• Kupffer cells are specialized macrophages located in the liver
lining the walls of the sinusoids
Role in Metabolism
• Selectively absorbs, secretes, stores or modifies all nutrients
absorbed into the intestine
• Regulates blood glucose levels by converting to glycogen for
storage or breaking down glycogen to glucose
• Regulates lipid and amino acid metabolism
• Detoxifies potentially harmful agents
• Stores vitamins A, D, E, K and iron
Role in Blood Regulation
• Removes dead cells, debris and microorganisms
• Removes hormones, antibodies, toxins
• Makes plasma proteins
Makes bile, which aids digestion and absorption
The bile is made by hepatocytes, secreted into the bile canaliculi
which extend outwards from the central veins to the bile ducts in
the portal tracts
...
A
common sign of liver damage
• Hepatitis (inflammation of the liver) - caused mainly by viruses,
poisons, autoimmune disease or hereditary conditions
...
LIVER CANCER
Primary liver cancer
• Hepatocellular carcinoma
• Angiosarcoma
• Hepatoblastoma
• Benign liver tumours
Cancer of the biliary tract
• Bile duct cancer (cholangiocarcinoma)
• Gallbladder cancer
• Hilar cancer
Metastatic liver cancers are usually from the gastrointestinal and
biliary tract
HEPATOCELLULAR CARCINOMA
Fifth most common cancer worldwide; third most common cause of
cancer-related death; 0
...
HBV also, but can
also
be transmitted through household contact
HBV and HCV infect hepatocytes as well as other cell types
HBV and HCV are not cytopathic; liver damage is caused by the
immune system trying to eliminate the virus
Some patients clear HBV and HCV, but others develop persistent
infection and chronic hepatitis
There is an effective vaccine for HBV, but not HCV
Most people infected with HCV develop chronic infection whereas
a minority of people infected with HBV develop chronic infection
Other Primary Liver Cancers are
Angiosarcoma – rare vascular cancer seen 15-20 years after
exposure to polyvinyl chloride (PVC)
• Hepatoblastoma – childhood cancer affecting hepatic epithelial
cells
• Benign liver tumours – haemangioma (endothelial cells of blood
vessels), adenoma (epithelial cells of blood vessels) and focal
nodular hyperplasia (hepatocytes)
CANCER OF THE BILE DUCTS
Cancers of epithelial cells that line the biliary tract (biliary tree)
Caused by liver fluke and gallstones which cause sclerosing
cholangitis; also aflatoxins and ulcerative colitis
...
85% are adenocarcinomas (cholangiocarcinoma)
...
5-4
...
Screening for liver metastasis required for patients
with other cancers
• Tumour cells retain the characteristics of the original cells
• Diagnosed by imaging and liver function tests; treated by
resection, chemotherapy, radiotherapy, thermal ablation, alcohol
injection, liver transplantation
• Liver metastasis is usually fatal and plays a major role in
morbidity and mortality from many cancers
THE LIVER IMMUNE SYSTEM
The liver receives 2 litres of blood (one third of the total blood
volume) every minute
...
• The liver is a tolerogenic organ
...
Liver transplantation
increases chance of graft acceptance for other organs
• Antigens introduced to the body through the hepatic portal vein
are tolerated by the immune system
The liver has a unique repertoire of immune cells
The hepatic sinusoids contain large numbers
of immune cells:
• Antigen-presenting cells – dendritic cells, macrophages,
sinusoidal endothelial cells
• Phagocytes – Kupffer cells
• Innate lymphocytes – natural killer cells, CD56+ T cells, NKT
cells, γδ T cells
• Adaptive immune system – T cells and B cells
Title: LIVER AND BILE CANCER
Description: A review of liver and bile cancer, describing the liver functions, its anatomy and imuune system and the primary liver cancer types and metastatic profile. Review focuses on hepatocellular carcinoma and Hepatitis B&c.
Description: A review of liver and bile cancer, describing the liver functions, its anatomy and imuune system and the primary liver cancer types and metastatic profile. Review focuses on hepatocellular carcinoma and Hepatitis B&c.