Cancer of the Liver
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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 - Xray - 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. DOWNLOAD