Cancer Of The Liver

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.

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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.

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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

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

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Weight loss

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Loss of strength

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Anorexia

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Anemia

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Liver may be enlarged and irregular on palpation

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Jaundice

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Ascites

Assessment Findings -

Increased serum levels of bilirubin, alkaline phosphate, AST, GGT and lactate Denydrogenase

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Leukocytosis

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Erythrocytosis

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Hyper calcemia

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Hypoglycemia

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Hypocholesterolemia

(These are present on laboratory assessment) -

Elevated serum levels of alpha fetoprotein (AFP) and corcinoembryonic antigen (CEA)

Diagnostic Procedures -

X-ray

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CT scan

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MRI

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Laparoscopy

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Liver scan

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Ultrasound

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Arteriography

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PET

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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

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Chills

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Bile drainage

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Changing vital signs

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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.

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Because of extensive blood loss and IV fluids. The patient requires constant close monitoring and care for two to three days.

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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.