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Diagnostic and Staging Workup

  • Patients usually present with an isolated liver mass. Diagnostic dilemma with “metastasis of unknown primary”
  • Rule out potential sites of primary disease. This may include upper/lower GI endoscopy and/or PET scan in conjunction with tumor markers as appropriate
  • A percutaneous liver biopsy may be necessary
  • Initial investigations should include:
    • Liver imaging: Triphasic CT scan or contrast-enhanced MRI
    • Cholangiography either by MRCP or ERCP. (ERCP and stenting may be preferable for symptomatic patients)
    • Metastatic work-up/imaging to rule out potential site of primary cancer:  CT chest/abdomen/pelvis
    • CEA and CA 19-9 
    • Laparoscopy may be considered for staging
  • Obtaining a definitive tissue diagnosis is frequently not possible. If a lesion is potentially resectable, surgery should be considered even in the absence of a tissue diagnosis

SOURCE: Diagnostic and Staging Workup ( )
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