3.

4 Liver Cancer
BSN 3A
CELLULAR
NCM
Dr. Ruby L. Mediona | 10/21/22
ABERRATIONS
S/Y 2022-2023 | First Semester 112
OUTLINE • Incidence increases with age
I. Introduction C. Distant Metastasis • Metastatic liver carcinoma is more than 20 times
II. Pathophysiology D. Stage Grouping more common than primary carcinoma
III. Causes VIII. Treatments • Liver metastasis occurring as a solitary lesion (the
IV. Signs and Symptoms A. Surgery Resection first sign of recurrence after remission)
V. Complications B. Radiation Therapy
VI. Diagnostic Tests C. Chemotherapy II. PATHOPHYSIOLOGY
VII. TNM Staging for D. Liver
Liver Tumors Transplantation • 90% primary liver tumors originate in the
A. Primary Tumor IX. Nursing Care parenchymal cells and are hepatomas; others
B. Regional Lymph Management originate in the intrahepatic bile ducts
Nodes (cholangiomas)
• 30-70% of patients with hepatomas also have
LEGEND cirrhosis
• Liver is one of the common sites of metastasis from
Lecturer Book Presentation other primary cancers; cells metastasize to the
gallbladder, mesentery, peritoneum, and diaphragm
   by direct extension

Lecture Objectives III. CAUSES

At the end of the lecture, the student should be able to:
1. Determine the pathophysiology, causes, signs,
and symptoms, as well as complications of liver
cancer;
2. Enumerate the diagnostic tests and treatments;
and
3. Identify the nursing care management for
patients living with liver cancer.
I. INTRODUCTION
• Immediate cause unknown
• Environmental exposure to carcinogens (chemical
compound, aflatoxin – mold that grows on rice and
peanuts)
• Possibly androgens and oral estrogens
• Hepatitis B and C viruses
IV. SIGNS AND SYMPTOMS

Figure 3. Acute Liver Pain

Figure 1. Gallblader • Mass in the upper right quadrant

Figure 2. Liver Cancer
• Malignant cells growing in the tissues of the liver
• Rapidly fatal, usually within 6 months
• After cirrhosis, the leading cause of fatal hepatic
disease
• Responsible for roughly 2% of all cancers in the US
and for 10% to 50% in Africa and parts of Asia
• Most prevalent in men (particularly in those older
than age 60)
ARCILLA, CAJUDAY, CHAVEZ, JOB, MANRIQUE
• Tender, nodular liver on palpation (secondary to
tumor cell growth)
• Severe pain in the epigastrium or right upper
quadrant (related to tumor size and increased
pressure on surrounding tissue)
• Bruit, hum, or rubbing sound (if tumors involve a
large part of the liver)
• Weight loss, weakness, anorexia, fever (related to
increased tumor growth needs)
• Occasional jaundice or ascites
• Occasional evidence of metastasis (through venous
system to the lungs, from lymphatics to the regional
lymph nodes, or by direct invasion of the portal
veins)
• Dependent edema (secondary to tumor invasion and
obstruction of portal vein)
V. COMPLICATIONS
• GI hemorrhage
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 [NCM 112] MS CELLULAR ABERRATIONS – 3.4 LIVER CANCER

• Progressive cachexia VII. TNM STAGING FOR LIVER TUMORS

• Liver failure

Figure 6. Progression of Liver Damage

Figure 4. Cachexia
(https://healthjade.com/cachexia/) A. PRIMARY TUMORS (T)

VI. DIAGNOSTIC TESTS • TX = Primary tumor cannot be assessed

• To = No evidence of primary tumor
• T1 = Solitary tumor without vascular invasion
• T2 = Solitary tumor with vascular invasion or
multiple tumors none more than 5 cm
• T3 = Multiple tumors more than 5 cm or tumor
involving a major branch of the portal or hepatic
vein(s)
• T4 = Tumor(s) with direct invasion of adjacent
organs other than the gallbladder or with perforation
of visceral peritoneum

B. REGIONAL LYMPH NODES (N)

• NX = Regional lymph nodes cannot be assessed

• N0 = No regional lymph node metastasis
• N1 = Regional lymph node metastasis
Figure 5. Butterfly Needle
C. DISTANT METASTASIS (M)
• Needle or open biopsy
→ Confirms the cell type • MX = Distant metastasis cannot be assessed
• Liver function studies • M0 = Distant metastasis cannot be assessed
→ Indicates abnormal liver function (aspartate • M1 = Distant metastasis
aminotransferase, alanine
aminotransferase, alkaline phosphatase,
lactic dehydrogenase, and bilirubin) D. STAGE GROUPING
• Liver scan
→ May show filling defects STAGE I T1 N0 M0
• Arteriography STAGE II T2 N0 M0
→ May define large tumors STAGE IIIA T3 N0 M0
• Alpha-fetoprotein analysis IIIB T4 N0 M0
→ Elevated levels IIIC Any T N1 M0
• Chest x-ray STAGE IV Any T Any N M1
→ Possible metastasis
• Serum electrolyte studies
→ Hypernatremia and hypercalcemia
• Serum laboratory studies
→ Hypoglycemia, leukocytosis, or
hypocholesterolemia

VIII. TREAMENTS
A. SURGERY RESECTION
• Lobectomy or partial hepatectomy

B. RADIATION THERAPY
• Palliative (for unresectable tumors)

ARCILLA, CAJUDAY, CHAVEZ, JOB, MANRIQUE 2

 [NCM 112] MS CELLULAR ABERRATIONS – 3.4 LIVER CANCER

C. CHEMOTHERAPY tract, and sodium polystyrene sulfonate to lower

• Intravenous fluorouracil, methotrexate, potassium levels
streptozocin, lomustine, or doxorubicin
• Regional infusion of fluorouracil or floxuridine Provide meticulous skin care
(catheters are placed directly into the hepatic artery • Turn the patient frequently and keep his skin
or left brachial artery for continuous infusion for 7 to clean to prevent pressure ulcers
21 days, or permanent implantable pumps are used • Apply lotion to prevent chafing, and administer
on an outpatient basis) an antipruritic for severe itching
D. LIVER TRANSPLANTATION
Frequently irrigate the transhepatic catheter
• For a small subset of patients
• With prescribed solution (if used to relieve
• Used to treat life-threatening, end-stage liver
obstructive jaundice)
disease for which no other form of treatment is
• Monitor vital signs frequently for any indication
available
of bleeding or infection
• Procedure involves total removal of the diseased
liver and its replacement with a healthy liver in the
same anatomic location After surgery
→ orthotopic liver transplantation (OLT) • Watch for intraperitoneal bleeding and sepsis
• Success depends on successful immunosuppression (may precipitate coma)
• Complications: • Monitor for renal failure by checking urine
→ Immediate postoperative complications output, BUN, and creatinine levels hourly
▪ Bleeding
▪ Infection When all treatments have failed
▪ Rejection • Concentrate on keeping the patient comfortable
→ Other potential complications and free from pain
▪ vascular thrombosis • Provide as much psychological support as
▪ stenosis
possible
→ May occur
▪ Disruption
▪ infection or Patient care should emphasize comprehensive
▪ obstruction of the biliary anastomosis and supportive measures and emotional support
impaired biliary drainage

IX. NURSING CARE MANAGEMENT

Control Edema and Ascites
• Monitor the patient’s diet References
→ Restrict sodium, fluids, and protein; no alcohol Lecture III.4 Liver Cancer.pdf
• Weigh the patient daily
→ Record intake and output accurately
• Watch for signs of ascites, peripheral edema,
orthopnea, or dyspnea on exertion
• Measure and record abdominal girth daily (if
present)

Monitor Respiratory Function

• Note any increase in respiratory rate or shortness of
breath
• Watch for signs of hypoxemia

Administer Aspirin Suppositories

• Relieve fever
• Avoid acetaminophen which can’t be
metabolized by the diseased liver

Administer Antibiotics
• For Infection

Watch for signs of encephalopathy

• Such as confusion, restlessness, irritability,
agitation, delirium, asterixis, lethargy, and coma
• Lactulose therapy may provide palliative
treatment

Monitor serum ammonia levels, vital signs, and

neurologic status
• Administer sorbitol to induce osmotic diarrhea,
neomycin to reduce bacterial flora in the GI

ARCILLA, CAJUDAY, CHAVEZ, JOB, MANRIQUE 3