Liver tumours
How hepatocytes, bile ducts and vessels give rise to liver tumours: haemangioma, focal nodular hyperplasia and adenoma; hepatocellular carcinoma in the injured liver; cholangiocarcinoma; and metastases, the commonest liver malignancy.
By the end, you can
- Relate the liver’s cell types and dual blood supply to the tumours that arise from each.
- Distinguish haemangioma, focal nodular hyperplasia and hepatocellular adenoma by origin, appearance and risk.
- Explain how chronic hepatitis B and C, alcohol, MASLD and aflatoxin lead to hepatocellular carcinoma, usually through cirrhosis.
- Compare hepatocellular carcinoma, fibrolamellar carcinoma and cholangiocarcinoma in background, microscopy, markers and spread.
- Explain why metastases are the commonest malignant liver tumours and how liver tumours cause their findings.
- Recognise the classic appearances, imaging patterns, staging and tests of liver tumours, and explain how resection, ablation, chemoembolisation, transplantation and systemic drugs act on them.
What it is
Liver tumours are masses that arise in the liver from hepatocytes, bile duct epithelium or blood vessels, or reach it from elsewhere. Benign lesions (haemangioma, focal nodular hyperplasia and hepatocellular adenoma) are common and often found by chance; the main primary cancers are hepatocellular carcinoma and cholangiocarcinoma, but metastases are far commoner than either.
4 types to tell apart
- Benign lesions
- Haemangioma (vessels), focal nodular hyperplasia (a hyperplastic response of hepatocytes, not a neoplasm) and hepatocellular adenoma (a true benign neoplasm of hepatocytes).
- Hepatocellular carcinoma
- From hepatocytes, mostly in cirrhosis from hepatitis B or C, alcohol or MASLD; fibrolamellar carcinoma is a rare variant of young people with a normal liver.
- Cholangiocarcinoma
- Adenocarcinoma of bile duct epithelium: intrahepatic, perihilar or distal, linked to chronic inflammation of the ducts.
- Metastases
- Secondary deposits, most often from the bowel, stomach and pancreas through the portal vein; the commonest malignant tumours of the liver.
US spelling: tumours → tumors, haemangioma → hemangioma.
Normal function
Hepatocytes, bile ducts and two blood supplies
The liver is built of plates of one cell thick, with blood flowing past them in the sinusoids. Each portal tract brings blood from two sources: the , about three-quarters of the inflow, draining the gut, spleen and pancreas, and the , carrying the rest, rich in oxygen. Hepatocytes rarely divide in a healthy liver but regenerate briskly after injury.
Bile made by hepatocytes flows outwards to the of the portal tracts, lined by cuboidal cholangiocytes, which join into larger ducts towards the hilum. Each cell type has its own tumours: hepatocytes give rise to adenoma and hepatocellular carcinoma, cholangiocytes to cholangiocarcinoma, and the endothelium of the vessels to haemangioma and, rarely, angiosarcoma.
The dual supply matters too. Because the portal vein carries blood from the gut, cancers of the bowel, stomach and pancreas seed the liver first; most primary liver cancers, by contrast, draw their blood mainly from the artery, a difference imaging exploits.
Underlying change · Step 1 of 5
Benign lesions: a vascular tumour, a hyperplasia and an adenoma
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 5
Hepatocellular carcinoma: chronic injury and cirrhosis
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 5
How HCC looks, grows into veins and spreads
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 4 of 5
Cholangiocarcinoma: cancer of the bile ducts
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Metastases, effects on the liver, grade and stage
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .