LIVER CANCER

Definition: Malignant cells growing in the tissues of the liver Rapidly fatal Ranked second after Liver Cirrhosis as a leading cause of fatal hepatic disease Approximately 30% to 70% of patients with hepatomas have cirrhosis Complications: Gastrointestinal Hemorrhage, Progressive Cachexia, Liver Failure

Types: (a) Primary liver cancer - cancer that forms in the tissues of the liver usually associated with chronic liver diseases, Hepatitis B and C Infections, and cirrhosis types: Hepatocellular carcinoma (most common) : Cholangiocellular carcinoma : combined hepatocellular and cholangiocellular carcinoma (b) Secondary liver cancer - cancer that spreads to the liver from another part of body particularly from the digestive system, breast and lung called Liver Metastases malignant tumors are likely to reach the liver by way of the portal system or lymphatic channels, or by direct extension from an abdominal tumor Causes: immediate cause is unknown : environmental exposure to carcinogens : Hepatitis B and C Viruses Clinical Manifestations: 1. Severe Pain in the epigastrium or right upper quadrant related to tumor size and increased pressure on surrounding tissue 2. Weight loss, weakness and anorexia related to increased tumor growth needs 3. Bruit, hum, or rubbing sound if tumor involves a large part of the liver 4. Mass in the right upper quadrant with a tender nodular liver on palpation 5. Jaundice present if the larger bile ducts are occluded 6. Dependent edema - secondary to tumor invasion and obstruction of portal vein 7. Ascites if the nodules obstruct the portal veins or if tumor is seeded in the peritoneal cavity

Assessment and Diagnostic Test Findings: 1. Needle or Open Biopsy confirms the cell type 2. Blood Chemistry reveals elevated serum glutamic-oxaloacetic transaminase, alkaline phosphatase, lactic dehydrogenase, and bilirubin which indicates abnormal liver function 3. Alpha-fetoprotein Analysis serves as tumor marker that reveals elevated levels 4. X-ray, liver scans, CT scans, MRI reveals possible metastasis 5. Serum Electrolyte Studies reveal hypernatremia and hypercalcemia 6. Serum Laboratory Studies reveal hypoglycemia, leukocytosis, or hypercholesterolemia Medical Management: 1. Radiation Therapy 2. Chemotherapy 3. Percutaneous Biliary Drainage or Transhepatic Drainage used to bypass biliary ducts obstructed by liver, pancreatic, or bile duct tumors establish biliary drainage, relieve pressure and pain from the buildup of bile behind the obstruction, and decrease pruritus or jaundice complications: sepsis, leakage of bile, hemorrhage, re-obstruction of the biliary system 4. Laser Hyperthermia used to treat hepatic metastasis 5. Immunotherapy lymphocytes with antitumor reactivity are administered 6. Ultrasound-guided Injection of alcohol for multiple small lesions for tumor necrosis Surgical Management: 1. Lobectomy removal of the lobe of the liver 2. Local Ablation 3. Liver Transplantation Nursing Care: Control edema and ascites restrict sodium, fluids and protein intake - weigh the patient daily, record intake and output Administer aspirin suppositories to relieve fever (avoid acetaminophen) Administer antibiotics for infection Provide meticulous skin care; turn the patient frequently Assess for signs of respiratory difficulty as a result of ascites and for signs of portal hypertension Observe for early signs of mental changes Manage pain and comfort needs Note: When all tx plans failed, concentrate on patients comfort; provide psychological support