THE WORKUP of a patient with a possible hepatic malignant neoplasm may be generated by one or more of a variety of situations. In an asymptomatic patient, the liver disease may be detected by physical examination, from radiological studies, or from laboratory tests. More commonly, nonspecific symptoms or signs or both of malignant neoplasm or of liver disease are present. In the management of an established extrahepatic primary malignant neoplasm, evidence for metastatic disease must be sought.
The following review suggests an orderly approach to establish whether or not the disease process is in the liver; whether it is neoplastic or not; and if so, whether it is benign or malignant. If it is malignant, one should ascertain whether it is primary or metastatic, characterize the extent of involvement in the liver (solitary, multiple, diffuse), and determine if it is resectable or nonresectable. If the patient has metastatic disease of
Viamonte M, Schiff E. Diagnostic Approach to Hepatic Malignant Neoplasms. JAMA. 1977;238(20):2191–2193. doi:10.1001/jama.1977.03280210083035
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