Hepatobiliary tumours

Greater use and sensitivity of radiological imaging including ultrasound, computed tomography and magnetic resonance imaging has meant that an increasing number of hepatobiliary tumours are identified incidentally, leading to diagnostic and therapeutic difficulties. They can be classified by their anatomical location, biological behaviour and cell of origin. Haemangiomas are the most common benign tumour of the liver. They have no potential for malignant transformation, and can therefore be treated conservatively. Liver cell adenoma has a strong association with the oral contraceptive pill and most would recommend resection because of potential for rupture, malignant transformation and misdiagnosis. Focal nodular hyperplasia has no risk of malignancy and can also be treated conservatively if asymptomatic, although avoidance of oral contraception is recommended. Hepatocellular carcinoma accounts for 90% of all primary liver malignancy and usually occurs on a background of chronic liver disease. Surgical resection may be possible in well compensated cirrhotics, but transplantation treats the underlying cirrhosis as well as removing all tumours. Most tumours can metastasize to the liver and the detection of liver metastases is generally associated with a poor prognosis. However, colorectal liver metastases are curable with liver resection and therefore screening following resection of a primary colon cancer is essential. Both gall bladder cancer and hilar cholangiocarcinoma have a poor prognosis because they are often advanced at presentation, with invasion of local vital structures as well as perineural and lymphatic spread. Radical resection can potentially be curative, but often only palliative treatment to relieve biliary obstruction is possible.