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LIVER CANCER (cont) Diagnostic Findings        History of Physical examination Result of lab and X-ray studies PET scans

Liver scans CT scans Ultrasound, MRI, arteriography, laparoscopy and biopsy Blood tests.  Increased WBC counts  Increased RBC counts Hypercalcemia Hypogycemia Hypocholesterolemia Elevated levels of serum alpha fetoprotein (AFP)

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Medical Management Chemotherapy  Regional perfusion of liver with infusions given directly into hepatic artery may reduce pain or slow tumor growth and may produce fewer side effects than those incurred with systemic chemotherapy which is not known to prolong life.  During Surgery:  Surgeon may implant a chemotherapy infusion pump  A pump, filled percutaneously deliver medications continuously into hepatic artery.  With metastatic growths, the oncologist may prescribe systemic chemotherapy to reduce tumor size and pain.  Chemotherapeutic Agents include:  5 –fluorouracil (5-FU)  Doxorubicin(Adriamycin) for single dose therapy  5 FU with Carmustine (BCNU) semustine (methyl CCNU) or streptozocin for combination therapy Radiation Therapy  Disappointing result  Most primary tumors that metastasize to the liver are resistant to radiation therapy, while the healthy liver is highly susceptible to radiation damage.  Sometimes radiation therapy will be administered at the time of surgery and is called Intraoperative Radiation. Radiation may also be used as palliative treatment to shrink tumors and relieve pain.  Chemoembolization

bleeding problem. ultimately leading to tumor cell death. Surgical Management `  RESECTION . Ethanol Injection  Injection of 100% absolute alcohol into tumors can be beneficial as it is highly toxic to liver tumors. edema. The lack of blood deprives the tumor of needed oxygen and nutrients and eventually causes cells to die. The tumor blood supply is stopped with small pieces of material that have been saturated with chemotherapy drugs. The procedure lasts 10 . Nursing Management  Assess: Metabolic malfunctions. administer medication at prescribe time and dosage  Assist client and family members to gain knowledge about condition and to offer support necessary for them to cope with uncertainty and fear associated with cancer.indicated for tumors that are small and confined to one liver segment or lobe . Interstitial Laser Photocoagulation  This technique involves the insertion of a thin optical fiber into the center of the liver tumor and a laser light is emitted from the tip. hypoproteinemia.Tumors up to 4 centimeters (approximately 2 inches) in diameter can be effectively destroyed with this technique.100 °C). inability to biotransform endogenous and exogenous wastes. Radiofrequency Ablation  This is a new technique that destroys liver tumors by heating them to high temperatures (80 .Embolization is the process of injecting a foreign substance into the tumor to stop the blood flow. Since clinical experience with this technique are few.15 minutes and the patient goes home on the same day.  The patient undergoing radiofrequency ablation receives IV sedation and grounding pads are placed on the legs. pain. It is injected into the center of the tumor through the skin (percutaneously) or at the time of surgery. ascites.  The alcohol causes cells to dry out and cellular protein to disintegrate.  This treatment is administered to patients who refuse surgery or who have severe liver disease that prevents them from having liver surgery. jaundice and endocrine complication  Prepare diagnostic stage for various procedure  Assess carefully postop. The exposed cells will then undergo thermal necrosis. more studies are required before this treatment can be recommended. Complications  If there is pain. A thin needle is inserted into the tumor and electrical current is passed through the tip of the needle which becomes very hot and destroys the tumor.

Cryosurgery is the destruction of abnormal tissue using sub-zero temperatures. Indications  Primary and Secondary Cirrhosis  Hepatitis (usually adult)  Primary sclerosing cholangitis (adult)  Biliary atresia (pediatric)  Alpha₁ . Liver Transplantation  Feasible form of intervention for variety of end stage liver disease  Duration – 8 hours or 6. The tumor is not removed and the destroyed cancer is left to be reabsorbed by the body. kidney.affected segment or lobe is remove surgically (called segmentectomy) .I haemorrhage from varices Progressive cachexia Hepatic failure Prognosis  Poor  3-6 months survival Cryosurgery Cryosurgery is a new technique that can destroy tumors in a variety of sites (brain.. liver).5 hours to perform. Initial results in properly selected patients with unresectable liver tumors are equivalent to those of resection. prostate.18 hours  Surgery may be:  Orthotopic – involving removal of diseased liver and insertion of donor liver  Heterotopic – diseased liver is left in and the transplanted liver is inserted alongside it.Chiari syndrome ( hepatic vein thrombosis)  Alcohol cirrhosis Contraindications  Life threthening systemic disease  Uncontrolled extrahepatic bacterial/ fungal infections  Pre-existing advanced cardio/pulmo disease . breast.can take 2 .antitrypsin deficiency ( usually pedia)  Confined hepatic malignancy ( adult/ pediatric)  Wilson’s Disease  Budd. Contraindication  Stress of surgery  Presence of liver disease too extensive for surgery to be beneficial Complication     Tumor rupture G.

infection and occlusion of vessels  Immunosuppressive therapy which started before surgery. Multiple uncorrectable. . must be continued on regular schedule post op.week after Sx • 3-4 mo.  Postoperative Care  Monitor for rejection. Be able to resume normal life • 85% survival rate Nursing Management • Preoperative Care  Chose for transplantation  Waiting List  Physical and Psychological evaluation  Diagnostic test  Nutritional Assessment  Meet transplant team  Make sure that donor and recipient match in: organ size. cardiovascular. family members are coping with situation. Bilirubin. clotting factor. albumin. to prevent rejection of new liver  Constant monitoring of respiratory. life threatening congenital anomalies  Metastastic malignancy of liver  Active alcoholism/ drug abuse  Cholangiocarcinoma  HIV Complications        Cardio and pulmonary problems Infection Rejection Hemorrhage Atelectasis Failure of anastomosis Acute renal failure S/Sx of Acute Rejection  Fever  Tachycardia  Right upper quadrant/ flank pain  Increase jaundice Outcome • Discharge. neuro and hemodynamic status  Monitor liver function through assessment of serum transaminases ( ALT. AST). blood and tissue type  Focus on assessing pt. level of knowledge and information  Ascertain how pt. and pt.

 Monitor fluid and electrolytes status. blood glucose level and pH  WOF fluid overload  Monitor wound drains and bile drains for patency and note bile characteristics  Assess needs of family member and SO. stress and anxious. . who may travel long distance from home and may be feeling powerless.