CANCER OF THE LIVER

Presented by: Nurse Paolo Rafael D.

Esguerra, USRN

HEPATOCYTE

HEPATIC BLOOD SUPPLY

HEPATIC BLOOD SUPPLY

HEPATIC BLOOD SUPPLY

CLASSIFICATION OF PRIMARY
LIVER CANCER

Origin

Benign

Malignant

Hepatocyte

Adenoma

Hepatocellular
Carcinoma

Bile Duct

Cholangioma

Carcinoma

BENIGN LIVER TUMORS

Hepatic adenomas are benign
tumor of the liver.
Most commonly seen in
women in their 30s and 40s.
Nearly 90% of cases
associated with oral
contraceptive use.
A benign may rupture, with
consequent hemorrhage.

PRIMARY LIVER TUMORS

Highly associated with Chronic
liver disease, HBV, HCV and
liver cirrhosis
Hepatocellular
carcinoma(HCC) is the most
common type of primary liver
tumor

LIVER METASTASES
50% of all advanced cancer
cases metastasized to the liver
(Bacon and Di Bisceglie, 2000)
Malignant tumors reach the
liver through the portal
system(Advanced Colon
Cancer), lymphatic
channels(Breast Cancer, Lung
Cancer), or by direct extension
of an abdominal tumor

POSSIBLE CAUSE OF
CANCER

RISK FACTORS

Previous HBV or HVB infection

Liver Cirrhosis
Cigarette Smoking
Exposure or Ingestion of
Alfatoxins

RISK FACTORS

THE DEFECT
Gene p53
A tumor-suppressor gene
responsible for monitoring
the health of the cell and
integrity of the cellular DNA
Controls cellular replication
by causing the cell to pause
indefinitely until errors are
corrected, or to undergo
apoptosis

DIAGNOSTIC EXAMS
Serological Exams
Increased Bilirubin, Alkaline
phosphatase, SGPT, SGOT, LDH
CBC (leukocytosis,
erythrocytosis)
Hypercalcemia, Hypoglycemia,
Hypocholesterolemia
Increased serum Alphafetoprotein (AFP) and
carcinoembryonic antigen (CEA)

DIAGNOSTIC EXAMS
X-ray

Ultrasound

DIAGNOSTIC EXAMS
MRI

CT Scan

LIVER BIOPSY

NURSING MANAGEMENT

ASSESSMENT
VERABIZATIONS OF
WEAKNESS
UNEQUAL HAND GRIP
STRENGTH
DECREASED
PERFORMANCE OF
ADLs

NURSING DIAGNOSIS

ACTIVITY
INTOLERANCE
RELATED TO FATIGUE

PLANNING

PATIENT REPORTS
DECREASE IN
FATIGUE AND
EXHIBITS INCREASED
ABILITY TO
PARTICIPATE IN
ACTIVITIES

INTERVENTION
Assess level of activity and
degree of fatigue when
performing routine ADLs
Provide assistance in
performing ADLs
Provide an activity schedule
with proper rest periods
throughout the day
Encourage to adhere to a high
carbohydrate, high protein diet

EVALUATION
Exhibits increased interest
in activities
Actively participates in
activities and gradually
increase exercise within
physical limits
Reports increase in
strength and well-being

ASSESSMENT
BMI < 18.5
CACHEXIA
WEIGHT LOSS
ANOREXIA

NURSING DIAGNOSIS

IMBALANCED
NUTRITION:LESS THAN
BODY REQUIRMENTS

PLANNING

Maintain positive
nitrogen balance,
and prevent further
loss of muscle mass

INTERVENTION
Assess dietary intake and
nutritional status
Provide diet high in CHO and CHON
consistent with liver function
Assist patient in identifying foods
low in Na
Elevate head of bed during meals
Provide oral hygiene before meals
Offer small frequent meals (at
least 6 small meals)

EVALUATION
Exhibits improved nutritional
status (increased weight
without fluid retention)
Reports increased in
appetite
Reports normal
gastrointestinal function
with regular bowel function

ASSESSMENT
Patient complaints of RUQ
abdominal pain and/or
discomfort
(+) Facial grimace and
guarding behavior

NURSING DIAGNOSIS
ACUTE PAIN RELATED
TO CONTINUOUS
LIVER TUMOR
GROWTH

PLANNING

To alleviate pain and

promote comfort

INTERVENTION
Maintain bed rest when the
patient experience abdominal
discomfort
Teach non-pharmacologic
techniques to alleviate pain
(relaxation techniques, guided
imagery, massage)
Provide optimal pain relief
through administration of pain
medications as indicated

EVALUATION
Patient verbalizes relief of
pain or discomfort
Increased ability to
perform ADLs