Hepatocellular

Carcinoma
Presented by:
Mary Ann T. Atienza
Krissa Marie C. Paña
(BSN-IV)
Presented to:
Mrs. Thelma S. Villota
(Clinical Instructor)
 OVERVIEW:
• Incidence and mortality:
• Liver cancer is the 3rd leading sites for both
gender.
• Male: 2nd leading site
• Female: 9th leading site

• Incidence increases at age 40.

Liver –  a large, meaty organ that sits on the right
side of the belly. Weighing about 3 pounds, the
liver is reddish-brown in color and feels rubbery to
the touch. Normally you can't feel the liver,
because it's protected by the rib cage.
In humans, it is located in the right upper quadrant
of the abdomen, below the diaphragm.
The liver has two large sections, called the right and the left
lobes. The gallbladder sits under the liver, along with parts of
the pancreas and intestines.

The liver and these organs work together to digest, absorb, and
process food.

The liver's main job is to filter the blood coming from the
digestive tract, before passing it to the rest of the body.

The liver also detoxifies chemicals and metabolizes drugs. As

it does so, the liver secretes bile that ends up back in the
intestines. The liver also makes proteins important for blood
clotting and other functions.
Factors that can damage the liver and cause liver cancer:
 Sleeping too late and waking up too late.
 Do not defecate in the morning.
 A diet that is too excessive.
 Do not eat breakfast.
 Too much consumption of drugs.
 Consuming too much preservatives, additives, food coloring, and
artificial sweetener.
 Unhealthy cooking oil. As much as possible reduce cooking oil use
when frying food. Do not consume fried foods when you are tired,
except if the body is fit.
 Consuming raw food (very mature) also adds to the burden of liver.
Fried vegetables should be eaten right away, not stored.
 Alcohol.
 Descent.
 Hepatitis B, C.
 DEFINITION:
Hepatocellular carcinoma (HCC) is the most
common type of primary liver cancer.
It develops within the hepatocytes, and usually
confines itself to the liver and spreads to other
organs.
It is most often in people with chronic liver
diseases, such as cirrhosis caused by hepatitis B
or hepatitis C infection.
 CAUSES:
Infection:
 75-80% of HCC cases are related to HBV (50-55%) or
HBC Infections (25-30%).

 Cirrhosis
 Heavy Drinking
 Obesity
 DM Type 2
 Iron storage disease
 Aflatoxin
Sign and Symptoms:
Pain in the upper right part of your belly
A lump or feeling of heaviness in your upper belly
Bloating or swelling in your belly
Loss of appetite and feelings of fullness
Weight loss
Weakness or deep fatigue
Nausea and vomiting
Yellow skin and eyes
Pale, chalky bowel movements and dark urine
Fever
 Risk Factors:
Modifiable:
Lifestyle:
Smoking
Alcohol Abuse

Infection:
Hepa A, B, C
HBV infection

Cancer or tumor growths

Liver cancer
Bile duct cancer
Liver adenoma
Immune system abnormality:
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

Non-modifiable:
Genetics:
Higher hepatic DNA Hemochromatosis
Wilson's disease
Alpha-1 antitrypsin deficiency
 Agents Known To Be Associated with the development of HCC:

Infections Cirrhosis Environmental Metabolic diseases

Hepatitis B virus Alcohol induced Aflatoxins Hemochromatosis

Hepatitis C virus Autoimmune Pyrrolizidine alkaloids Alpha1-antitrypsin

deficiency

Thorotrast Wilson’s disease

N-nitrosylted Galactosemia
compounds

Cittrullinemia

Hereditary tyrosinemia

Familial cholestatic
 PATIENT’S ACCOUNT:
Name: Patient X
Age: 90 years old
Birthdate: April 16, 1930 (China)
Address: Bulacan, Bulacan
Civil Status: Married
Educational Background: N/A

Admission v/s:
T – 38.1 °C

C
PR – 68 bpm
R - 24 cpm
BP - 120/90 mmHg
Weight - 69 kg. Height – 5’7
CC: loss of appetite
D: hepatocellular carcinoma

Latest v/s:
T – 36.5 C
PR – 75 bpm
R - 22 cpm
BP - 120/80 mmHg
U - 3D
S -0
PHYSICAL ASSESSMENT:
 FAMILY HISTORY:
- Confidential
 PAST HEALTH HISTORY:
1999:
S/P cholecystectomy, gastrojejunonostomy,
sphincteronomy and stone extraction (Chinese
general Hospital)
2000:

Diagnosed with Liver Metastasis; Chinese General

Hospital then ERCP at Metropolitan Hospital
revealed aerobilia advised liver supplements and
annual MRI of whole abdomen, done annually.
2003: S/P Myocardial Infarction admitted
Chinese General Hospital for 1 week, Angiogram:
Phil Heart Center
2014: diagnosed with Hematoma, asymptomatic
underwent RFA of liver tumor on 04/21/2015
then quarterly MRI of upper abdomen latest was
10/25/2016
January 2020: history of fall for 3 episodes from
the bed observed to have lost of appetite
Feb. 09, 2020: admitted at Our Lady of Mount
Carmel Medical Center Pampanga due to loss of
appetite and body weakness, no fever, no cough
 PRESENT HEALTH HISTORY:

Dr. Guinto: T/C Aspiration Pneumonia

Dra. Villamayor: HAP, fever to
Malignancy Multifocal HCCA
Dr. Reyes: Hepatocellular Carcinoma
Anatomy:
Pathophysiology:
Liver cancer occurs due to damage to the liver
parenchyma cells that are directly caused by the usual
primary liver disease or indirectly by the obstruction of
bile flow or hepatic circulation disorder that causes liver
dysfunction. Liver parenchymal cells will react to the
elements of the most toxic through glycogen
replacement with fatty infiltration of lipids that occurs
with or without necrosis or cell death. This situation is
often accompanied by inflammatory cell infiltration and
growth of fibrotic tissue. Cell regeneration can occur if
the disease course is not too toxic to liver cells.
Resulting in downsizing and subsequent fibrosis would
be liver cancer.
 MEDICATIONS:
DRUG DOSAGE CLASSIFICATION INDICATION
NAME

Atorvastatin 10mg OD Lipid-Lowering Agents a statin medication used to prevent

cardiovascular disease in those at high risk and
treat abnormal lipid levels.

Clopidogrel 7mg OD antiplatelet used to prevent blood clots, chest pain,

peripheral artery disease (poor circulation in
your legs), a heart attack, or stroke.

Dilzem 30mg BID calcium channel blockers used to treat high blood pressure, angina, and
certain heart arrhythmias.

Daflon 500mg OD potent venotropic hemorrhoidal disease & chronic venous

insufficiency.
Insulin 28 units SC Insulin glargine injection DM
(Lantus) OD
Telmisartan 40mg OD angiotensin receptor HPN, heart failure, and diabetic kidney disease.
(Mecardis) blockers (ARBs)
DRUG NAME DOSAGE CLASSIFICATION INDICATION

Pantoprazole 40mg OD Proton pump inhibitor stomach ulcers, short-term

(protonix) treatment of erosive esophagitis
due to gastroesophageal reflux
disease
Phospholipids BID Lipids used for Liver diseases, Leg pain
(Livolin) due to blocked arteries, High
cholesterol, Arthritis, High blood
pressure, Neurological disorders,
Migraine and other conditions. 

Pregbalin 75mg OD Gabapentiniod epilepsy, neuropathic pain,

(Lyrica) fibromyalgia, restless leg
syndrome, and generalized anxiety
disorder.
Ursofalk 250mg BID Anticholelithic primary biliary cirrhosis (PBC)
and for the dissolution of
radiolucent gallstones in patients
with a functioning gall bladder.
 DIAGNOSTIC PROCEDURES:

MRI of the Upper Abdomen

Chest X- ray
Ultrasound whole Abdomen
Cranial CT scan
LABORATORY RESULTS:
CBC RESULT Normal Range

Hgb 10.70 g/dL 13.0-18.0

Hmtc 29.70% 40-50

RBC 3.40 fL 4.5-6.2

MCV 87.40 fL 79.0-92.2

MCH 31.50 pg 25.7-32.2

MCHC 36 g/dL 32.3-36.5

RDW 13.70% 11.6-14.4

WBC 17.15x10 ^qL 4.0-10

Neutrophil 76% 55-65

Lymphocyte 7% 25-35
Monocyte 15% 3-6
Eosinophil 2% 2-4
MPV 11.90 fL 9.4-12.4
Platelet Count 38x10^q/L 150-450

PCT 0.17
PDW 14.90
Protein 48 mg/L <6
SGPT 15 7-56 u/L
SGOT 35 5-40 u/L
Triglyceride 65 150 mg/dL
HDL 19 60 mg/dL
LDL 37 100-129 mg/dL
 TREATMENT:
Radiation
Chemotherapy
Alcohol injection
Targeted therapy
Immunotherapy
Cryoablation and radiofrequency ablation
Surgery to remove part of your liver
Liver transplant
DIET:
 NURSING CARE PLAN:

Life-threatening:
1. Pain (acute / chronic) related to a build up of fluid in the abdominal cavity
(ascites)
2. Ineffective breathing pattern related to a decrease in lung expansion (emphasis
ascites and diaphragm).
3. Risk for infection r/t weak immune system

Actual:
4. Imbalanced Nutrition: less than body requirements related to inadequate
nutritional intake, abdominal distention, feeling sick to the stomach and anorexia

5. Activity intolerance related to fatigue, lethargy and malaise (not feeling well).

Potential:
6. Anxiety related to enlargement of the abdomen.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Fluid volume After 8 hours Monitor V/S Established

“Napansin ko na excess r/t of nursing baseline data
lumalaki ang compromised interventions, Measure I/O Reflects
tiyann ko” as regulatory patient will circulating volume
verbalized by the mechanism demonstrate status, developing
patient. secondary to stabilized fluid shifts, and in
cirrhosis of fluid volume response to therapy
Objective: the liver as and BP elevations are
manifested by abdominal Monitor BP usually associated
-Pallor pallor, weak girth with fluid volume
-weak in in appearance, excess
appearance jaundice, Indicative of
-jaundice abdominal Assess pulmonary
-abnormal distention, respiratory congestion/edema
distention noted edema, status
-irritability noted irritability,
-abnormal girth and
of 41 abdominal
girth of 41
Monitor Reflects
abdominal girth accumulation of
fluid (ascites)
Provide Decreases
occasional ice sensation of
chips if NPO thirst, especially
when fluid intake
is restricted

Restrict sodium Sodium may be

and fluids as restricted to
ordered minimize fluid
retention in
extravascular
spaces.
Restriction may
be necessary to
prevent
delusional
hyponatremia
Administer
medications as
indicated:
• Diuretics Used with caution
to control edema and
ascites, block effect
of aldosterone, and
increase water
excretion while
sparing potassium
• Potassium Serum and cellular
potassium are
usually depleted
because of liver
Assist with disease
paracentesis Done to remove
procedure ascites fluid
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective Short term: Establish To gain client’s Partially

“Nahihirapan Airway rapport and relatives trust achieve:
akong Clearance After 1 hour of To obtain
huminga” as related to nursing Monitor V/S baseline data After 2
verbalized by retained intervention, To decrease days of
the patient secretions in the patient will Suction secretion retained nursing
the bronchi be able to secretions PRN in the bronchi interventio
Objectives: secondary to maintain To open or n the
-inability to pneumonia airway maintain open patient O2
expectorate patency, clear Position head airway in at rest inhalation
phlegm breath sounds. appropriate for or compromised removed
-behavioral condition such individual and
changes Long term: as fowler’s To maintain demonstrat
-adventitious position clear open airway e
sound After 1 day of Assist with behaviors
(crackles) nursing procedure such to improve
-DOB intervention, as To mobilize or
the client will administering secretion maintain
be able to O2 clear
expectorate Encourage airway
retained deep breathing clearance
exercises
Secretions
and maintain
normal
breathing
Assessment:
Subjective: “wala akong gana kumain” as
verbalized by the patient.

Objective:
• weak in appearance
• Irritability
• Loss of appetite
• WBC result = 17.15
• Platelet count = 38
• Temp: 38.1 °C
Diagnosis:
 Risk for Infection r/t weak immune system

Planning:
 Short term:
 at the end of the shift, patient will remain free of
signs/symptoms of infection such as WBC & platelet
count, temperature from 39.1 °C maintain to 37.5°C
 Long term:
• after 1 week of nursing intervention the patient will
be free of signs/symptoms of infection such as WBC &
platelet count will be normal, and temperature from
39.5°C maintain to ≤37.5°C.
Interventions:
 encourage the patient to eat healthy foods that can
enhance the immune function and take necessary
vitamins needed.
 increase oral fluid intake
 limit visitors if the patient is immunocompromised and
render reverse isolation.
 check the presence of elevated temperature and give
paracetamol as prescribed.
 assess the patient for any signs of possible infection
(fever, redness, swelling, pain, purulent discharges).
 Assess and monitor patient’s nutritional status by
checking signs of weight loss.
Rationale:
  It enhances the immune function of the body.
  It will let the patient urinate frequently so as to flush
the microorganisms present in the body.
  It will prevent transmission of pathogens from visitors
which may aggravate the infection.
   Fever is one sign of infection and it needs immediate
interventions to prevent worsening of the illness.
  It determines the presence of infection and will let the
nurse provide immediate and appropriate nursing
interventions.
 Weight loss is one of the possible effects of an
underlying infection.
 Prognosis:
Overall prognosis for survival is poor, with a
5-year relative survival rate of 18.4%. By
stage, the relative 5 year survival is 32.6% in
patients diagnosed with localized disease,
10.8% with regional disease, and 2.4% with
distant disease.
As many patients die of liver failure as from
tumor progression.
Thank you