Name: Elisha Asli C.

Suratos

Block: NE

Objectives: At the end of the session, SNs are expected to:

1. Identify basic information about liver and colon cancer.

2. Craft nursing management of the diseases utilizing the nursing process / framework.
3. Identify nursing interventions from the nursing management to apply in caring for
patients with cancer.

NOTES ON COLON & LIVER CANCER

COLON CANCER

What is Colorectal Cancer?

Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is
the development of cancer from the colon or rectum (parts of the large intestine)

Causes & Risk Factors

Doctors aren't certain what causes most colon cancers. In general, colon cancer begins when
healthy cells in the colon develop changes (mutations) in their DNA. A cell's DNA contains a set
of instructions that tell a cell what to do. Healthy cells grow and divide in an orderly way to keep
your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells
continue to divide — even when new cells aren't needed. As the cells accumulate, they form a
tumor. With time, the cancer cells can grow to invade and destroy normal tissue nearby. And
cancerous cells can travel to other parts of the body to form deposits there (metastasis).

Factors that may increase your risk of colon cancer include:

 Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon
cancer are older than 50. The rates of colon cancer in people younger than 50 have been
increasing, but doctors aren't sure why.

 African-American race. African-Americans have a greater risk of colon cancer than do

people of other races.

 A personal history of colorectal cancer or polyps. If you've already had colon cancer or
noncancerous colon polyps, you have a greater risk of colon cancer in the future.

 Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as

ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.

 Inherited syndromes that increase colon cancer risk. Some gene mutations passed
through generations of your family can increase your risk of colon cancer significantly. Only
 a small percentage of colon cancers are linked to inherited genes. The most common
inherited syndromes that increase colon cancer risk are familial adenomatous polyposis
(FAP) and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal
cancer (HNPCC).

 Family history of colon cancer. You're more likely to develop colon cancer if you have a
blood relative who has had the disease. If more than one family member has colon cancer
or rectal cancer, your risk is even greater.

 Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical
Western diet, which is low in fiber and high in fat and calories. Research in this area has
had mixed results. Some studies have found an increased risk of colon cancer in people
who eat diets high in red meat and processed meat.

 A sedentary lifestyle. People who are inactive are more likely to develop colon cancer.
Getting regular physical activity may reduce your risk of colon cancer.

 Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.

 Obesity. People who are obese have an increased risk of colon cancer and an increased
risk of dying of colon cancer when compared with people considered normal weight.

 Smoking. People who smoke may have an increased risk of colon cancer.

 Alcohol. Heavy use of alcohol increases your risk of colon cancer.

 Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous
cancers increases the risk of colon cancer.

Prevention

 Screening colon cancer

Doctors recommend that people with an average risk of colon cancer consider colon
cancer screening around age 50. But people with an increased risk, such as those with a
family history of colon cancer, should consider screening sooner. Several screening
options exist — each with its own benefits and drawbacks. Talk about your options with
your doctor, and together you can decide which tests are appropriate for you.

 Lifestyle changes to reduce risk of colon cancer

You can take steps to reduce your risk of colon cancer by making changes in your
everyday life. Take steps to:
 o Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and
whole grains contain vitamins, minerals, fiber and antioxidants, which may play a
role in cancer prevention. Choose a variety of fruits and vegetables so that you get
an array of vitamins and nutrients.

o Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the
amount of alcohol you drink to no more than one drink a day for women and two
for men.

o Stop smoking. Talk to your doctor about ways to quit that may work for you.

o Exercise most days of the week. Try to get at least 30 minutes of exercise on
most days. If you've been inactive, start slowly and build up gradually to 30
minutes. Also, talk to your doctor before starting any exercise program.

o Maintain a healthy weight. If you are at a healthy weight, work to maintain your
weight by combining a healthy diet with daily exercise. If you need to lose weight,
ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly
by increasing the amount of exercise you get and reducing the number of calories
you eat.

 Colon cancer prevention for people with a high risk

Some medications have been found to reduce the risk of precancerous polyps or
colon cancer. For instance, some evidence links a reduced risk of polyps and colon cancer
to regular use of aspirin or aspirin-like drugs. But it's not clear what dose and what length
of time would be needed to reduce the risk of colon cancer. Taking aspirin daily has some
risks, including gastrointestinal bleeding and ulcers.

These options are generally reserved for people with a high risk of colon cancer. There
isn't enough evidence to recommend these medications to people who have an average
risk of colon cancer.

If you have an increased risk of colon cancer, discuss your risk factors with your doctor to
determine whether preventive medications are safe for you.

Early Detection, Diagnosis, and Staging

Finding cancer early, when it's small and hasn't spread, often allows for more treatment
options. Some early cancers may have signs and symptoms that can be noticed, but that's not
always the case.
 Screening is the process of looking for cancer or pre-cancer in people who have no
symptoms of the disease. Regular colorectal cancer screening is one of the most powerful tools
against colorectal cancer.

Screening can often find colorectal cancer early, when it's small, hasn't spread, and might
be easier to treat. Regular screening can even prevent colorectal cancer. A polyp can take as
many as 10 to 15 years to develop into cancer. With screening, doctors can find and remove
polyps before they have the chance to turn into cancer.

Tests to Diagnose and Stage Colorectal Cancer

If you have symptoms that might be from colorectal cancer, or if a screening test shows
something abnormal, your doctor will recommend one or more of the exams and tests below to
find the cause.

Medical history and physical exam

Your doctor will ask about your medical history to learn about possible risk factors,
including your family history. You will also be asked if you’re having any symptoms and, if so,
when they started and how long you’ve had them.

As part of a physical exam, your doctor will feel your abdomen for masses or enlarged
organs, and also examine the rest of your body. You may also have a digital rectal exam (DRE).
During this test, the doctor inserts a lubricated, gloved finger into your rectum to feel for any
abnormal areas.

 Tests to look for blood in your stool

 Blood tests
o Complete blood count
o Liver enzymes
o Tumor markers
 Diagnostic colonoscopy
 Proctoscopy
 Biopsy
 Imaging tests to look for colorectal cancer
 Computed tomography (CT or CAT) scan
 Ultrasound
 Magnetic resonance imaging (MRI) scan
 Chest x-ray
 Positron emission tomography (PET) scan
 Angiography

Colorectal Cancer Stages:

How is the stage determined?

The staging system most often used for colorectal cancer is the American Joint Committee on
Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

 The extent (size) of the tumor (T): How far has the cancer grown into the wall of the
colon or rectum? These layers, from the inner to the outer, include:
 The inner lining (mucosa), which is the layer in which nearly all colorectal cancers
start. This includes a thin muscle layer (muscularis mucosa)
 The fibrous tissue beneath this muscle layer (submucosa)
 A thick muscle layer (muscularis propria)
 The thin, outermost layers of connective tissue (subserosa and serosa) that cover
most of the colon but not the rectum
 The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph
nodes?
 The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph
nodes or distant organs such as the liver or lungs?

Numbers or letters after T, N, and M provide more details about each of these factors.
Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories
have been determined, this information is combined in a process called stage grouping to assign
an overall stage. For more information see Cancer Staging.

AJCC Stage Stage Stage description

grouping
0 Tis The cancer is in its earliest stage. This stage is also known as
N0 carcinoma in situ or intramucosal carcinoma (Tis). It has not
M0 grown beyond the inner layer (mucosa) of the colon or rectum.
I T1 or T2 The cancer has grown through the muscularis mucosa into the
N0 submucosa (T1), and it may also have grown into the
M0 muscularis propria (T2). It has not spread to nearby lymph
nodes (N0) or to distant sites (M0).
IIA T3 The cancer has grown into the outermost layers of the colon
N0 or rectum but has not gone through them (T3). It has not
M0 reached nearby organs. It has not spread to nearby lymph
nodes (N0) or to distant sites (M0).
IIB T4a The cancer has grown through the wall of the colon or rectum
N0 but has not grown into other nearby tissues or organs (T4a). It
M0 has not yet spread to nearby lymph nodes (N0) or to distant
sites (M0).
IIC T4b The cancer has grown through the wall of the colon or rectum
N0 and is attached to or has grown into other nearby tissues or
M0 organs (T4b). It has not yet spread to nearby lymph nodes (N0)
or to distant sites (M0).
IIIA T1 The cancer has grown through the mucosa into the
N2a submucosa (T1). It has spread to 4 to 6 nearby lymph nodes
M0 (N2a). It has not spread to distant sites (M0).
T3 or T4a The cancer has grown into the outermost layers of the colon
N1/N1c or rectum (T3) or through the visceral peritoneum (T4a) but
M0 has not reached nearby organs. It has spread to 1 to 3 nearby
 lymph nodes (N1a or N1b) or into areas of fat near the lymph
nodes but not the nodes themselves (N1c). It has not spread
to distant sites (M0).
OR
T2 or T3 The cancer has grown into the muscularis propria (T2) or into
IIIB N2a the outermost layers of the colon or rectum (T3). It has spread
M0 to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant
sites (M0).
OR
T1 or T2 The cancer has grown through the mucosa into the
N2b submucosa (T1), and it might also have grown into the
M0 muscularis propria (T2). It has spread to 7 or more nearby
lymph nodes (N2b). It has not spread to distant sites (M0).
T4a The cancer has grown through the wall of the colon or rectum
N2a (including the visceral peritoneum) but has not reached nearby
M0 organs (T4a). It has spread to 4 to 6 nearby lymph nodes
(N2a). It has not spread to distant sites (M0).
OR
T3 or T4a The cancer has grown into the outermost layers of the colon
N2b or rectum (T3) or through the visceral peritoneum (T4a) but
M0 has not reached nearby organs. It has spread to 7 or more
nearby lymph nodes (N2b). It has not spread to distant sites
IIIC (M0).
OR
T4b The cancer has grown through the wall of the colon or rectum
N1 or N2 and is attached to or has grown into other nearby tissues or
M0 organs (T4b). It has spread to at least one nearby lymph node
or into areas of fat near the lymph nodes (N1 or N2). It has not
spread to distant sites (M0).
IVA Any T The cancer may or may not have grown through the wall of the
Any N colon or rectum (Any T). It might or might not have spread to
M1a nearby lymph nodes. (Any N). It has spread to 1 distant organ
(such as the liver or lung) or distant set of lymph nodes, but
not to distant parts of the peritoneum (the lining of the
abdominal cavity) (M1a).
IVB Any T The cancer might or might not have grown through the wall of
Any N the colon or rectum (Any T). It might or might not have spread
M1b to nearby lymph nodes (Any N). It has spread to more than 1
distant organ (such as the liver or lung) or distant set of lymph
nodes, but not to distant parts of the peritoneum (the lining of
the abdominal cavity) (M1b).
IVC Any T The cancer might or might not have grown through the wall of
Any N the colon or rectum (Any T). It might or might not have spread
M1c to nearby lymph nodes (Any N). It has spread to distant parts
of the peritoneum (the lining of the abdominal cavity), and may
or may not have spread to distant organs or lymph nodes
(M1c).

The following additional categories are not listed in the table above:
  TX: Main tumor cannot be assessed due to lack of information.
 T0: No evidence of a primary tumor.
 NX: Regional lymph nodes cannot be assessed due to lack of information.

Medical Management

Local treatments:

Local treatments treat the tumor without affecting the rest of the body. These treatments are
more likely to be useful for earlier stage cancers (smaller cancers that haven't spread), but they
might also be used in some other situations. Types of local treatments used for colorectal cancer
include:

 Surgery for Colon Cancer

o Polypectomy and local excision
o Colectomy
o Colostomy or ileostomy
 Surgery for Rectal Cancer
o Polypectomy and local excision
o Transanal excision (TAE)
o Transanal endoscopic microsurgery (TEM)
o Low anterior resection (LAR)
o Proctectomy with colo-anal anastomosis
o Abdominoperineal resection (APR)
o Pelvic exenteration
o Diverting colostomy
o Surgery for rectal cancer spread
o Colostomy or ileostomy
 Ablation and Embolization for Colorectal Cancer
o Radiofrequency ablation
o Microwave ablation (MWA)
o Ethanol (alcohol) ablation
o Cryosurgery (cryotherapy or cryoablation)
o Arterial embolization
o Chemoembolization
o Radioembolization
 Radiation Therapy for Colorectal Cancer
o External-beam radiation therapy (EBRT)
o Internal radiation therapy (brachytherapy)
o Radioembolization
Systemic treatments:

Colorectal cancer can also be treated using drugs, which can be given by mouth or directly
into the bloodstream. These are called systemic treatments because they can reach cancer cells
throughout almost all the body. Depending on the type of colorectal cancer, different types of
drugs might be used, such as:

 Chemotherapy for Colorectal Cancer

o Chemotherapy (chemo) is treatment with anti-cancer drugs that may be injected
into a vein or taken by mouth. These drugs travel through the bloodstream and
reach most parts of the body. Chemo is often used to treat colorectal cancer.
 Targeted Therapy for Colorectal Cancer
o Drugs that target blood vessel formation (VEGF)
 Bevacizumab (Avastin)
 Ramucirumab (Cyramza)
 Ziv-aflibercept (Zaltrap)
o Drugs that target cancer cells with EGFR changes
 Cetuximab (Erbitux)
 Panitumumab (Vectibix)
o Drugs that target cells with BRAF gene changes
 BRAF inhibitors: encorafenib (Braftovi)
o Other targeted therapy drugs
 Regorafenib (Stivarga)

 Immunotherapy for Colorectal Cancer

o Immunotherapy is the use of medicines to help a person’s own immune system
better recognize and destroy cancer cells. Immunotherapy can be used to treat
some people with advanced colorectal cancer.
 Immune checkpoint Inhibitors
 PD-1 inhibitors: pembrolizumab (Keytruda) & nivolumab (Opdivo)
 CTLA-4 inhibitor: ipilimumab (Yervoy)

Nursing Process

The Patient With Colorectal Cancer *Using the nursing process, you may base your answers on
this part to a case (actual or case studies found in books or other sources).

Case:

William Cunningham is a 65-year-old retired railroad employee, husband, and father of three
grown children. For the past 3 months, Mr. Cunningham has noticed small amounts of blood and
occasional mucous in his stools. He has a sensation of pressure in the rectum, and notices that
his stools are smaller in diameter, about the size of pencil. After palpating a mass on digital
examination of the rectum, the physician orders a colonoscopy. A large sessile lesion is found in
the rectum and biopsied. The pathology report shows the lesion to be adenocarcinoma. Mr.
Cunningham is scheduled for an abdominoperineal resection and sigmoid colostomy.

Assessment:

Madonna Hart, RN, completes the admission assessment. Mr. Cunningham states that
his bowel habits have recently changed, but denies pain or other symptoms. Physical assessment
findings include T 98.4°F (36.9°C), P 82, R 18, and BP 118/78. He is 70 inches (178 cm) tall and
weighs 185 lb (84 kg). Laboratory findings are normal except for the previous pathology report of
adenocarcinoma of rectal lesion. Mr. Cunningham states, “I really don’t want a colostomy, but if
that is what it takes to get rid of this, I’m ready to get it over with.

Diagnosis:

 Acute Pain related to surgical intervention

 Risk for Impaired Skin Integrity (Peristomal) related to fecal drainage and pouch
adhesive
 Risk for Constipation/Diarrhea related to effects of surgery on bowel function
 Disturbed Body Image related to colostomy
 Risk for Sexual Dysfunction related to wide rectal incision, radiation therapy, and
colostomy

Collaborative problems/potential complications:

Potential complications may include the following:

 Wound opening
 Skin irritation
 Bowel blockage caused by scar tissue
 Development of a hernia at the incision
 Narrowing of the colostomy opening

Planning and Goals:

 Report pain within an acceptable range that allows ease of movement and ambulation.
 Perform colostomy care using correct technique.
 Demonstrate willingness to discuss changes in sexual function.
 Wear clothing to enhance physical and emotional self-esteem.

Nursing Interventions:

 Provide analgesia as ordered, evaluating its effectiveness.

 Discuss foods that cause odor and gas.
 Teach colostomy care.
 Maintain consistent nursing personnel assignment to facilitate trust.
 Refer to the local United Ostomy Association.
  Provide a list of local medical supply companies for ostomy supplies.
 Provide for privacy when teaching and discussing concerns about ostomy

Evaluation:

On discharge, Mr. Cunningham is able to empty and rinse out his colostomy pouch. He is
changing the pouch and caring for surrounding skin appropriately. Ms. Hart has given him verbal
and written instructions on colostomy care. He verbalizes understanding of phantom rectal pain,
and the importance of avoiding rectal suppositories. He expresses an understanding of the need
to avoid heavy lifting, and the importance of follow-up care. Ms. Hart has referred Mr. Cunningham
to a home health agency in his community for further questions and follow-up care.

LIVER CANCER

What is Liver Cancer?

Liver cancer is a type of cancer that starts in the liver. Cancer starts when cells in the body
begin to grow out of control.

Primary liver cancer

A cancer that starts in the liver is called primary liver cancer. There is more than one kind
of primary liver cancer.

 Hepatocellular carcinoma (HHC)

o This is the most common form of liver cancer in adults. Hepatocellular
cancers can have different growth patterns:
 Some begin as a single tumor that grows larger. Only late in the
disease does it spread to other parts of the liver.
 A second type seems to start as many small cancer nodules
throughout the liver, not just a single tumor. This is seen most often
in people with cirrhosis (chronic liver damage) and is the most
common pattern seen in the United States
 Intrahepatic cholangiocarcinoma (bile duct cancer)
o About 10% to 20% of cancers that start in the liver are intrahepatic
cholangiocarcinomas. These cancers start in the cells that line the small
bile ducts (tubes that carry bile to the gallbladder) within the liver. Most
cholangiocarcinomas, however, actually start in the bile ducts outside the
liver.
 Angiosarcoma and hemangiosarcoma
o These are rare cancers that begin in cells lining the blood vessels of the
liver. People who have been exposed to vinyl chloride or to thorium dioxide
(Thorotrast) are more likely to develop these cancers. Some other cases
are thought to be caused by exposure to arsenic or radium, or to an
 inherited condition known as hereditary hemochromatosis. In about half of
all cases, no likely cause can be identified.
 Hepatoblastoma
o This is a very rare kind of cancer that develops in children, usually in those
younger than 4 years old. The cells of hepatoblastoma are similar to fetal
liver cells. About 2 out of 3 children with these tumors are treated
successfully with surgery and chemotherapy, although the tumors are
harder to treat if they have spread outside the liver.

Secondary liver cancer (metastatic liver cancer)

Most of the time when cancer is found in the liver it did not start there but has spread
(metastasized) from somewhere else in the body, such as the pancreas, colon, stomach, breast,
or lung. Because this cancer has spread from its original (primary) site, it is called a secondary
liver cancer. These tumors are named and treated based on their primary site (where they
started).

 Benign liver tumors. Ssometimes grow large enough to cause problems, but they
do not grow into nearby tissues or spread to distant parts of the body. If they need
to be treated, the patient can usually be cured with surgery.
o Hemangioma
 The most common type of benign liver tumor, hemangiomas, start
in blood vessels. Most hemangiomas of the liver cause no
symptoms and do not need treatment. But some may bleed and
need to be removed with surgery.
o Hepatic adenoma
 Hepatic adenoma is a benign tumor that starts from hepatocytes
(the main type of liver cell). Most cause no symptoms and do not
need treatment.
o Focal nodular hyperplasia
 Focal nodular hyperplasia (FNH) is a tumor-like growth made up of
several cell types (hepatocytes, bile duct cells, and connective
tissue cells). Although FNH tumors are benign, they might cause
symptoms.

Both hepatic adenomas and FNH tumors are more common in women than in men.

Causes & Risk Factors

Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's
DNA is the material that provides instructions for every chemical process in your body. DNA
mutations cause changes in these instructions. One result is that cells may begin to grow out of
control and eventually form a tumor — a mass of cancerous cells.

Factors that increase the risk of primary liver cancer include:

  Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus
(HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
 Cirrhosis. This progressive and irreversible condition causes scar tissue to form in
your liver and increases your chances of developing liver cancer.
 Certain inherited liver diseases. Liver diseases that can increase the risk of liver
cancer include hemochromatosis and Wilson's disease.
 Diabetes. People with this blood sugar disorder have a greater risk of liver cancer
than those who don't have diabetes.
 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.
 Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the
risk of liver cancer.
 Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on
crops that are stored poorly. Crops, such as grains and nuts, can become
contaminated with aflatoxins, which can end up in foods made of these products.
 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.
 Tobacco use. Smoking increases the risk of liver cancer. Former smokers have a
lower risk than current smokers, but both groups have a higher risk than those who
never smoked.
 Gender. Hepatocellular carcinoma is much more common in men than in women.
Much of this is probably because of behaviors affecting some of the risk factors
described below. The fibrolamellar subtype of HCC is more common in women.
 Race/ethnicity. In the United States, Asian Americans and Pacific Islanders have
the highest rates of liver cancer, followed by Hispanics/Latinos, American
Indians/Alaska Natives, African Americans, and whites.

Assessment and Diagnostic Findings

Symptoms of liver cancer and liver metastases include a loss of appetite, unexplained
weight loss, fever, fatigue, weakness, nausea, dark urine, and jaundice, which is yellowing of the
skin or eyes. These symptoms are similar to those associated with other liver conditions, such as
cirrhosis, fatty liver disease, or hepatitis B or C. If liver cancer is advanced, signs and symptoms
may also include abdominal pain and internal bleeding.

Diagnostic tests:

 Blood tests. The doctor may draw blood to determine whether there is high levels of alpha-
fetoprotein, which can be a sign of liver cancer. High levels of this protein can indicate if
other forms of liver disease are present. For this reason, the doctor may also perform
imaging tests, such an ultrasound or CT or MRI scan, to see whether you have a tumor.
  Ultrasound. An ultrasound uses sound waves to create images of structures in the body
on a computer monitor. This test may give the doctor a first look at a liver tumor and help
determine whether further scans are necessary.
 CT Scans. If an ultrasound reveals a suspicious tumor in the liver, the doctor may order a
CT scan. A contrast agent, an iodine-based dye, is injected into a vein to enhance the CT
images, and a specialist takes X-rays of the liver as the contrast agent moves through the
blood vessels, highlighting any tumors. These X-ray images are sent to a computer to
create cross-sectional images of the liver from different angles. A CT scan may indicate
whether cancer has spread to other organs in the abdomen or chest.
 MRI Scans. MRI scan uses a magnetic field and radio waves to create images of
structures in the body from different angles. A contrast agent called gadolinium is injected
into a vein before the scan to enhance images of the blood vessels and other body
structures. An MRI scan may reveal whether you have a liver tumor.
 Angiography. Angiography can be used to show the arteries that supply blood to a liver
cancer, which can help doctors decide if a cancer can be removed and to help plan the
operation.
 Biopsy. A biopsy is the removal of a sample of tissue to see if it is cancer. Sometimes, the
only way to be sure that liver cancer is present is to take a biopsy and look at it in the
pathology lab. But in some cases, doctors can be fairly certain that a person has liver
cancer based on the results of imaging tests such as CT and MRI scans. In these cases,
a biopsy may not be needed.

Medical Management *Research the internet to locate information on nonsurgical and surgical
management of the patient with liver cancer.

Surgical Management

The best option to cure liver cancer is with either surgical resection (removal of the tumor
with surgery) or a liver transplant. If all cancer in the liver is completely removed, you will have
the best outlook. Small liver cancers may also be cured with other types of treatment such as
ablation or radiation.

 Partial hepatectomy: Surgery to remove part of the liver. Only people with good
liver function who are healthy enough for surgery and who have a single tumor that
has not grown into blood vessels can have this operation.
 Liver transplant: When it is available, it may be the best option for some people
with liver cancer. Liver transplants can be an option for those with tumors that
cannot be removed with surgery, either because of the location of the tumors or
because the liver has too much disease for the patient to tolerate removing part of
it. In general, a transplant is used to treat patients with small tumors (either 1 tumor
smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not grown
into nearby blood vessels.

Non-surgical treatment
  Ablation for Liver Cancer
o Radiofrequency ablation (RFA)
o Microwave ablation (MWA)
o Cyroablation (cryotherapy)
o Ethanol (alcohol) ablation
 Embolization Therapy for Liver Cancer
o Trans-arterial embolization (TAE)
o Trans-arterial chemoembolization (TACE)
o Drug-eluting bead chemoembolization (DEB-TACE)
o Radioemboliation (RE)
 Radiation Therapy for Liver Cancer
o External beam radiation therapy (EBRT)
o Stereotactic body radiation therapy (SBRT)
o Radioembolization
 Targeted Drug Therapy for Liver Cancer
o Kinase inhibitors
 Sorafenib (Nexavar) & lenvatinib (Lenvima)
 Regorafenib (Stivarga) & cabozantinib (Cabometyx)
o Monoclonal antibodies
 Bevacizumab (Avastin)
 Ramucirumab (Cyramza)
 Immunotherapy for Liver Cancer
o Immune checkpoint inhibitors
 PD-1 & PD-L1 inhibitors
 CTLA-4 inhibitor
 Chemotherapy for Liver Cancer
o Gemcitabine (Gemzar)
o Oxaliplatin (Eloxatin)
o Cisplatin
o Doxorubicin (pegylated liposomal doxorubicin)
o 5-fluorouracil (5-FU)
o Capecitabine (Xeloda)
o Mitoxantrone (Novantrone)

Nursing Management

The Patient with Liver Cancer

Assessment

People with HCC may experience no symptoms, particularly when the tumor is detected early as
part of a screening program. When symptoms or signs do occur, they include:
  Pain, especially at the top right of the abdominal area, near the right shoulder blade, or in
the back
 Unexplained weight loss
 A hard lump under the ribs on the right side of the body, which could be the tumor or a
sign that the liver has gotten bigger
 Weakness or fatigue

Diagnosis

 Acute pain related to side effects of various cancer therapy agents

 Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolic state
associated with cancer
 Grieving related to anticipated loss of physiological well-being (e.g., loss of body part;
change in body function); change in lifestyle

Planning and Goals

 Report maximal pain relief/control with minimal interference with ADLs.

 Follow prescribed pharmacological regimen.
 Demonstrate use of relaxation skills and diversional activities as indicated for individual
situation.
 Demonstrate stable weight/progressive weight gain toward goal with normalization of
laboratory values and be free of signs of malnutrition.
 Verbalize understanding of individual interferences to adequate intake.
 Participate in specific interventions to stimulate appetite/increase dietary intake.
 Identify and express feelings appropriately.
 Continue normal life activities, looking toward/planning for the future, one day at a time.
 Verbalize understanding of the dying process and feelings of being supported in grief
work.

Nursing Interventions

 Give analgesics as ordered and encourage the patient to identify care measures that
promote comfort.
 Provide patient with a special diet that restricts sodium, fluids, and protein and that
prohibits alcohol.
 To increase venous return and prevent edema, elevate the patient’s legs whenever
possible.
 Keep the patient’s fever down.
 Provide meticulous skin care.
 Turn the patient frequently and keep his skin clean to prevent pressure ulcers.
 Prepare the patient for surgery, if indicated.
 Provide comprehensive care and emotional assistance.
 Monitor the patient for fluid retention and ascites.
 Monitor respiratory function.
  Explain the treatments to the patient and his family, including adverse reactions the patient
may experience.

Evaluation

Patient will be able to achieve desired outcome and goals.

References:

https://www.cancer.org/cancer/colon-rectal-cancer/.html

https://www.cancer.org/cancer/liver-cancer.html

https://www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-
20353659