Liver cancer

Anatomy of the Liver

• The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.

There are two distinct sources that supply blood to the liver, including the following:• oxygenated blood flows in from the hepatic artery• nutrient-rich blood flows in from the hepatic portal veinThe liver consists of two main lobes, both

of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine).

• Functions of the liver:• production of bile, which helps carry away waste and break down fats in the small intestine during

digestion• production of certain proteins for blood plasma• production of cholesterol and special proteins to help carry fats through the body• conversion of excess glucose into glycogen for storage (glycogen can later be converted back to

glucose for energy)• regulation of blood levels of amino acids, which form the building blocks of proteins• processing of hemoglobin for use of its iron content (the liver stores iron)• conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is

excreted in the urine)• clearing the blood of drugs and other poisonous substances• regulating blood clotting• resisting infections by producing immune factors and removing bacteria from the bloodstream• When the liver has broken down harmful substances, its by-products are excreted into the bile or

blood. Bile by-products enter the intestine and ultimately leave the body in the form of feces. Blood by-products are filtered out by the kidneys, and leave the body in the form of urine.

Development of Cancer

• Cancer is uncontrolled replication of damaged cells. This condition usually produces a mass

called a tumor. Cancer is a direct result of either a mutation of the cellular DNA or some sort of damage to the cellular DNA. For the cancerous cells actually develop into tumor, it must be able to grow and to replicate itself .A cancerous cell that connot grow or make a copy of itself will die or lick dormant for an extended period.

Pathophysiology

• > Carcinogenesis is a multistage process that begins when a carcinogen causes a genetic change or damages the DNA in a normal cell. This makes the cell more vulnerable to other genetic changes. This stage is called "initiation." If the process ended here, and the cancerous cell did not grow and replicate, no cancer would form.

• > The next stage of carcinogenesis is called "promotion." This occurs when the initiated cell is exposed to an agent that enhances its growth into a larger mass.

• > When a tumor actually forms, it has all of the same basic needs as a normal cell. Because the tumor cells are genetically damaged, they are inefficient and rob normal cells of important oxygen and nutrients. In addition, a malignant tumor grows uncontrollably and can eventually interfere with the function of vital organs, such as the liver

• Metastatic tumors form when large progressive tumors shed tumor cells. These tumor cells must be able to grow and function apart from the primary tumor

• Move throughout the body, usually through the circulatory system or the lymphatic system.

• Often lodge in a blood capillary, where they may or may not grow. The tumor cells that actually grow are somehow more suited to the new location.

• Tend to mutate more quickly than normal cells, giving them a greater ability to adapt to their environment as well as a greater ability to resist therapy.

• More likely to infect places they can easily reach. Because the liver is close to or actually connected to several significant organs, and because the liver plays an important role in blood circulation by acting as a filter, metastatic liver cancer occurs in over 75% of all terminal cancer patients.

Types of liver cancer

• Advanced kidney cancer – carcinoma

• Liver cancer - liver metastasis from testicular cancer

• Liver cancer - liver, bile-duct carcinoma

• Liver cancer - liver adenocarcinoma (white)

• What actually causes genetic mutataion or DNA damage is not yet completely understood but several factors are considered:

• Liver cancer - primary liver cancer tumor with others (white)

• Causes:– Primary liver cancer (hepatocellular carcinoma)

• alcohol abuse • chronic infection with diseases such as hepatitis B and C• hemochromatosis (too much iron in the liver)• cirrhosis (a scarring condition of the liver. • Other risk factors include: • SEX ( Men are more likely to get hepatocellular cancer than women)• Anabolic steroids ( Male hormones used by athletes to increase muscle can slightly increase

liver cancer risk with long-term use) • Birth control pills

Liver Cancer Symptoms• Liver cancer is sometimes called a "silent disease" because in an early stage it often does not

cause symptoms. But, as the cancer grows, symptoms may include: • Pain in the upper abdomen on the right side; the pain may extend to the back and shoulder• Swollen abdomen (bloating)• Weight loss• Loss of appetite and feelings of fullness• Weakness or feeling very tired• Nausea and vomiting• Yellow skin and eyes, and dark urine from jaundice• Fever

Assessment and Diagnostic findings

• history and physical examination • x-ray studies, liver scans, CT scan, ultrasound studies, MRI, arteriography, and laparoscopy (to

determine the extent of the cancer)• positive emission tomograms (to evaluate a wide range of metastatic tumors) • laboratory result includes; • * increased serum levels of bilirubin, alkaline phosphatase, AST, GGT and lactic dehydrogenase

may occur.• * increased WBC(leukocytosis)• * increased RBC(erythrocytosis)• * hypercalcemia• * hypoglycemia• * hypochlolesterolemia• * elevated alpha fetoprotein(30-40%)

Medical Management• Radiation Therapy• Chemotherapy• Percutaneous Biliary Drainage• Non Surgical Treatments• Laser Hyperthermia• Immunotherapy• Transcatheter Arterial Embolization• Surgical Management• Lobectomy• Cryosurgery• Liver transplantation

Nursing Management

• .* Watch out for potential problem related to cardiopulmonary involvement include vascular complications and respiratory and liver dysfunction.

• * Careful attention to metabolic abnormalities• * Patient undergo cryosurgery should monitored closely for:• > Hypothermia• > hemorrhage or bile leak• > myoglobinuria may occur as a result of tissue necrosis

•

.Nursing diagnosis

• Activity intolerance related to fatigue and weakness

Planning

• Patient will report decrease in fatigue and increased ability to participate in activities

Intervention

• Assess level of activity tolerance and degree of fatigue and malaise • Assist with activities and hygiene • Assist with selection and pacing of desired activities and exercise• Encourage rest when fatigued felt• Advice diet high in carbohydrates with protein intake

Rationale

• provide baseline for further assessment and criteria for assessment of effectiveness of interventions• promotes exercise and hygiene within patient’s level of tolerance• stimulates patient’s interest in selected activities• conserve energy• provides calories for energy and protein for healing

•

Evaluation

• improved nutritional status by increased weight without fluid retention• identifies foods in carbohydrates and within protein requirements• report improved appetite

Nursing diagnosis

• > Imbalanced Nutrition less than body requirements related to abdominal distention and loss of appetite

Planning

• to meet nutritional requirementsIntervention

• Assess dietary intake and nutritional status through diet history • Advice diet high in carbohydrates with protein intake • Advice patient of low sodium foods• Provide smaller, frequent meals• Elevate the head of the bed during meals

Rationale

• to identify deficits in nutritional intake and adequacy of nutritional state• provides calories for energy, sparing protein for healing • to prevent edema and ascites formation• decrease feeling of fullness, bloating• reduce discomfort from abdominal distension and decreas sense of fullness produced by pressure of abdominal

contents and ascites on the stomach •