Natividad, Michael John Ortega, Shane Desiree T.

Liver Cancer
*Liver cancer can be a primary cancer, meaning it starts in the liver, or a secondary cancer, meaning it starts in another part of the body and spreads to the liver. Secondary liver cancers are more common than primary liver cancers. *The liver is the largest organ inside the body. It is located on the right side of the abdomen and protected by the ribcage. The liver will function normally with only a small portion of it in working order. Its functions include: Destroying harmful substances, such as alcohol, and getting rid of waste products Converting food containing fats and sugars to energy that is used by the body Producing bile to help with the digestion of food.

Facts:
Most liver cancer patients die within a year of diagnosis. The five-year survival rate for the disease (if untreated) is less than five percent, but even with treatment, the five-year survival rate is still a low 35 percent. The liver is the second most common organ involved by metastatic disease, after the lymph nodes. Liver cancer most commonly spreads to the lungs and bones.

Epidemiology Liver cancer is only the eighth most common form of cancer worldwide, but in the Philippines, Department of Health (DOH) and Philippine Cancer Society statistics show that it is the third most common form of cancer among men and sixth among women.

Hepatic Lymph nodes

Possible sites of Liver Metastasis

Two types of cancer that affect the liver: 1. Primary cancer first begins in the liver and may spread to other organs. The most common primary cancer is hepatocellular carcinoma. 2. Metastasized cancer of the liver comes originally from another part of the body. Cancer cells can easily travel from another affected organ to the liver because of the role the liver plays in filtering the blood. Some of the most common cancers that spread to the liver are from the colon, pancreas, stomach, lung, and breast.

Risk Factors in Developing Liver Cancer: Gender -Men are more likely to develop liver cancer than are women. Age -In North America, Europe and Australia, liver cancer most commonly affects older adults. In developing countries of Asia and Africa, liver cancer diagnosis tends to occur at a younger age between 20 and 50. Chronic infection with Hepatitis B Virus or Hepatitis C Virus -Long-term hepatitis B and hepatitis C infection are linked to liver cancer because they often lead to cirrhosis. Hepatitis B can lead to liver cancer without cirrhosis.

Cirrhosis -Cirrhosis is a disease in which liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. Certain inherited liver diseases -Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson's disease. Type 2 diabetes -has been linked with an increased risk of liver cancer, usually in patients who also have other risk factors such as heavy alcohol use and/or chronic viral hepatitis. This risk may be increased because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems. Nonalcoholic fatty liver disease -is a condition where fat builds up in the liver, causing inflammation and damage similar to that caused by heavy alcohol consumption.

Exposure to aflatoxins -Consuming foods contaminated with fungi that produce aflatoxins greatly increases the risk of liver cancer. Crops such as corn and peanuts can become contaminated with aflatoxins. Excessive alcohol consumption -Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer. Obesity -Being obese (very overweight) increases the risk of developing liver cancer. This is probably because it can result in fatty liver disease and cirrhosis.

Signs and Symptoms Symptoms often don't appear in the early stages of liver cancer. There are few nerves through the liver, so someone with this type of cancer does not feel pain. Symptoms are the same for both primary and secondary liver cancer. In later stages, liver cancer can cause an ache in the upper abdomen or back. Rather than feeling pain in the liver, it is felt in the surrounding area due to distension (swelling), irritation or inflammation of the liver.

Other symptoms include loss of appetite, weakness and loss of weight (particularly loss of muscle in the arms and legs), nausea, fever and jaundice (yellowing of the skin and whites of the eyes). The abdomen may also be swollen. Others: Itching all over the body hard lump just below the rib cage dark-coloured urine clay-coloured bowel movements

Diagnosis of Liver Cancer To make the diagnosis, a thorough medical history must be taken, followed by a physical examination. Liver cancer is usually diagnosed with a number of different tests, which may include:

Blood tests that measure tumor markers -- substances elevated in the presence of a particular cancer -- can aid diagnosis. Liver cancers secrete a substance called alpha fetoprotein (AFP) that is normally present during pregnancy but goes away after birth. An elevated AFP in adults may indicate liver cancer. Alpha-fetoprotein blood (AFP) test - can be helpful in determining if a liver mass might be cancer. A low or normal value on this test means it is less likely you have liver cancer, while a high value makes it more likely. Imaging with ultrasound and CT scans may reveal existing tumors, but only a biopsy will distinguish a benign tumor from a malignant one. Laparoscopy - through a small incision, the doctor inserts a small, thin tube called a laparoscope, which allows viewing of the liver and surrounding organs Angiography - a dye is injected into the veins and its progress through the liver is tracked by Xray Chest X-rays to see if the cancer has spread to the lungs. Liver function tests (LFTs): to let doctors know the condition of your liver before starting your treatment and it assess the condition of the part of your liver not affected by the cancer

Blood chemistry tests and other tests: Blood chemistry tests check the levels of a number of minerals and other substances in the blood, some of which might be affected by liver cancer Treatments Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

The goal of any treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or spreading. In some cases only comfort care is appropriate. In this situation, the goal of treatment is not to remove or slow the disease but to help relieve symptoms, making you as comfortable as possible.

Liver cancer treatment options may include:

Surgery to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.

Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for certain people with early-stage liver cancer. Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells. Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.

Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, chemotherapy drugs are injected into the hepatic artery the artery from which liver cancers derive their blood supply and then the artery is blocked. This serves to cut blood flow to the cancer cells and to deliver chemotherapy drugs to the cancer cells. Radiation therapy. This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. During radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body. Radiation therapy for liver cancer may involve a technique called stereotactic radiosurgery that simultaneously focuses many beams of radiation at one point in the body. Radiation side effects may include fatigue, nausea and vomiting.

Targeted drug therapy. Sorafenib (Nexavar) is a targeted drug designed to interfere with a tumor's ability to generate new blood vessels. Sorafenib has been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment. More studies are needed to understand how this and other targeted therapies may be used to control advanced liver cancer.

Nursing Diagnosis: Imbalanced Nutrition less than requirements related to nausea and vomiting. Anticipatory grieving related to altered role functioning. Disturbed body image related to changes in appearance, function and roles secondary to treatment.

Risk for infection related to immunodeficiency secondary to treatment Risk for injury related to impaired immune defences secondary to treatment Fatigue related to immune system compromise secondary to treatment. Acute Pain related to disease progression and infiltration of surrounding organs and Tissues Fear related to threat to death Knowledge deficit related to disease management and treatment options. Impaired skin integrity related to surgical interventions

Goals: The client will remain free from infection. The client will maintain adequate nutrition The client will be able to discuss anxiety related to body changes, hair loss The client will have adequate pain relief The client will remain free from complications.

Nursing Interventions: Assess and monitor vitals, Pain levels, coping mechanism, nausea, appetite, intake and output Assess blood return prior to administering antineoplastic agents Monitor signs and symptoms of infection Encourage client to express fears and concerns related to diagnosis Avoid sick personnel visitors Report any increase in temperature, rash, pain, diarrhea as may indicate infection Monitor for complications related to diagnosis and treatment.

Prevention Reduce your risk of cirrhosis Drink alcohol in moderation, if at all. Use caution with chemicals. Follow instructions on chemicals you use at home or at work. Get vaccinated against hepatitis B . Take measures to prevent hepatitis C No vaccine for hepatitis C exists, but you can reduce your risk of infection.. Seek safe, clean shops when getting a piercing or tattoo. Ask your doctor about liver cancer screening Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam once or twice each year.