LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4
Chapter 20•Cancer of the Gastrointestinal Tract 257ANSWERS
Answer 20.3.1. The answer is D.
No adjuvant therapies have been shown to affect survival or delay pro-
gression thus far.Answer 20.3.2. The answer is D.
The Milan criteria for selection of patients appropriate for liver trans-
plantation include patients with solitary tumors less than or equal to
5 cm, patients with multifocal disease with less than or equal to 3 tumor
nodules each less than or equal to 3 cm in size, patients with Child-Pugh
B or C cirrhosis, patients who are not candidates for primary liver resec-
tion, and patients who have tumors with no evidence of macrovascular
invasion.Answer 20.3.3. The answer is D.
Multiple clinical staging systems for hepatic tumors have been described.
The most widely used is the American Joint Committee on Cancer/Tumor-
Node-Metastasis. A staging system based entirely on clinical grounds that
incorporate the contribution of the underlying liver disease was originally
developed by Okuda et al. Adverse prognostic signs are as listed. Patients
with Okuda stage III (advanced), namely, with three or more positive
features, have a dire prognosis because they usually cannot be curatively
resected and the condition of their liver typically precludes chemotherapy.
The American Association for the Study of Liver Diseases has endorsed the
use of the Barcelona Clinic Liver Cancer system for staging of HCC. This
has now been validated both internally and externally in several studies.Answer 20.3.4. The answer is A.
Various paraneoplastic syndromes have been described to occur in
patients with hepatocellular cancer. Most of these are biochemical abnor-
malities without associated clinical consequences. The most important
ones include hypoglycemia (also caused by end-stage liver failure),
erythrocytosis, hypercalcemia, hypercholesterolemia, dysfibrinogenemia,
carcinoid syndrome, increased thyroxin-binding globulin, sexual changes
(gynecomastia, testicular atrophy, and precocious puberty), and por-
phyria cutanea tarda. Pathogenesis of hypoglycemia is unclear but may
be related to production by the tumor of insulin-like growth factor I.Answer 20.3.5. The answer is D.
Primary biliary cirrhosis is associated with an increased risk of cholan-
giocarcinoma.Answer 20.3.6. The answer is C.
A combination of ultrasonography and serum AFP levels is used for
the screening of high-risk populations for HCC. Although screening