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.
evelopment 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 or some sort of
damage to the cellular . For the cancerous cells actually develop into tumor, it must be able
to grow and to replicate itself . cancerous cell that connot grow or make a copy of itself will die
or lick dormant for an extended period.
PathophysioIogy
> Carcinogenesis is a multistage process that begins when a carcinogen causes a genetic change
or damages the in a normal cell. This makes the cell more vulnerable to other genetic
changes. This stage is called "initiation." f 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. n 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
dvanced 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
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:
$ ( Men are more likely to get hepatocellular cancer than women)
3aboIic steroids ( Male hormones used by athletes to increase muscle can slightly increase
liver cancer risk with long-term use)
Birth co3troI piIIs
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
ausea and vomiting
Yellow skin and eyes, and dark urine from jaundice
Fever
ssessment and iagnostic
findings
history and physical examination
x-ray studies, liver scans, CT scan, ultrasound studies, MR, 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, ST, 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 rainage
on Surgical Treatments
Laser Hyperthermia
mmunotherapy
Transcatheter rterial Embolization
Surgical Management
Lobectomy
Cryosurgery
Liver transplantation
:rsi3g Ma3ageme3t
.* 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

.ursing diagnosis
ctivity intolerance related to fatigue and weakness
Planning
Patient will report decrease in fatigue and increased ability to participate in activities
ntervention
ssess level of activity tolerance and degree of fatigue and malaise
ssist with activities and hygiene
ssist with selection and pacing of desired activities and exercise
Encourage rest when fatigued felt
dvice 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
ursing diagnosis
> mbalanced utrition less than body requirements related to abdominal distention and loss of appetite
Planning
to meet nutritional requirements
ntervention
ssess dietary intake and nutritional status through diet history
dvice diet high in carbohydrates with protein intake
dvice 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