Cancer of the Liver

Hepatic tumors may be malignant or benign. Benign liver tumors were

uncommon until the widespread use of oral contraceptives. With the use of oral
contraceptives, benign tumors of the liver occur most frequently in women in
their reproductive years.

Primary Liver Tumors

• Few cancers originate in the liver. Primary liver tumors usually are
associated with chronic liver disease, Hepatitis B and C infections and
cirrhosis. Hepatocellular carcinoma (HCC) is by far the most common type
of primary liver cancer.

• HCC is usually non-resectable because of rapid growth of metastasis other

types of primary liver cancer include cholangiocellular carcinoma and
combined hepatocellular and cholangiocellular carcinoma.

• Cigarette smoking has also been identified as a risk factor, especially when
combind with alcohol use. Aflatoxin a metabolite of the Fungus Aspergillus
flavus is also a risk factor for HCC.

Liver Metastases

Metastases from other primary sites are found in the liver in about half of all
advance cancer cases, malignant tumors are likely to reach the liver eventually,
by way of the portal system or lymphatic channels or by direct extension from an
abdominal tumor, liver is an ideal place for these malignant cells to thrive. The
first evidence of cancer in an abdominal organ is the appearance of liver
metastases.

Clinical Manifestations:

- Pain

- Continous dull ache in the right upper quadrant, epigastrium or back.

- Weight loss

- Loss of strength
 - Anorexia

- Anemia

- Liver may be enlarged and irregular on palpation

- Jaundice

- Ascites

Assessment Findings

- Increased serum levels of bilirubin, alkaline phosphate, AST, GGT and

lactate

Denydrogenase

- Leukocytosis

- Erythrocytosis

- Hyper calcemia

- Hypoglycemia

- Hypocholesterolemia

(These are present on laboratory assessment)

- Elevated serum levels of alpha fetoprotein (AFP) and corcinoembryonic

antigen (CEA)

Diagnostic Procedures

- X-ray

- CT scan

- MRI

- Laparoscopy

- Liver scan
 - Ultrasound

- Arteriography

- PET

• Confirmation of a tumors histology can be made by biopsy under

imaging guidance (CT scan or Ultrasound)

Medical Management

Radiotherapy

The use of external beam radiation for the treatment of liver tumors has
been limited by the radiosensitivity of normal hepatocytes more effective
methods of delivering radiation of the liver include (a.) intravenous or intra
arterial injection of anti-bodies that are tagged with radioactive isotopes and
specifically attack tumor (b.) percutaneous placement of high intensity source for
interstitial radiation therapy (delivering directly to the tumor cell)

Chemotherapy

Chemotherapy is use to improve quality and pro long life. It may be used
adjucnt therapy after surgical resection of hepatic tumor. Systemic chemotherapy
and Regional infusion chemotherapy are two methods used to administer
antineoplastic agents to patients with primary and metastatic hepatic tumor.

Percutaneous Biliary Drainage

Percutaneous Biliary or transhepatic drainage is used to bypass biliary

ducts obstructed by liver, pancreatic, or bile duct tumor in patients with
inoperable tumors or in those considered poor surgical risks. Under fluoroscopy,
a catheter is inserted through the abdominal wall and past the obstruction into
duodenum, such procedures are used to reestablish biliary drainage, relieve
pressure and pain from the buildup of bile behind the obstruction, decrease
pruritus and jaundice so the patient is comfortable and quality of life and survival
are improved.
 For several days, the catheter is opened to external drainage the bile is
observed close for amount, color and presence of blood and debris.
Complications of percutaneous biliary drainage include sepsis, leakage of bile,
hemorrhage and re obstruction of the biliary system by the debris in the catheter
or from encroaching tumor so the patient in observed for

- Fever

- Chills

- Bile drainage

- Changing vital signs

- Evidence of biliary obstruction including increase pain pruritus and

reccurence of jaundice.

Lobectomy

Removal of a lobe of the liver, is the most common surgical procedure for
excising a liver tumor.

Cryosurgery

Tumors are destroyed by liquid nitrogen at 196 degrees celsius to destroy

diseased tissue, two or three freeze and thaw cycles are administer by probes
during open laparotomy.

Liver Transplantation

Removing the liver and replacing it with a healthy donor organ. The patient
with small tumors may have a good prognosis after transplantation, but
recurrence is common with tumor greater than 8 cm in diameter or those that are
multifocal or have vascular invasion.

Nursing Management

- Constant infusion of 10% glucose may be required in the first 48 hours

to present a precipitous fall in blood glucose level resulting from
decreased gluconeogenesis.
- Because of extensive blood loss and IV fluids. The patient requires
constant close monitoring and care for two to three days.

- The patient undergoing cryosurgery is monitored closely for

hypothermia, hemorrhage or bile leak, myoglobinuria can occur
allopurinol to bind/aid in the excretion of toxic products.