LIVER CANCER

Cancer of the Liver

 Liver
cancer is the formation of malignant
tumor in the liver.

 Most
malignancies identified in the liver are
metastatic lesions from other sites.
Epidemiology
 Primary liver cancer is the fifth most common
cancer in the world and the third most common
cause of cancer mortality

 Hepatocellular carcinomas (HCCs) are malignant

tumors of liver parenchymal cells

 It is twice as common in men as in women

 The mean age at diagnosis is 50 to 60 years old.

Risk Factors
 Gender
 Race/Ethnicity
 Chronic Viral Hepatitis
 Cirrhosis
 Inherited metabolic diseases
 Heavy Alcohol use
 Tobacco use
 Obesity
 Type 2 Diabetes
 Aflatoxins
 Anabolic Steroids
Signs and Symptoms
Abdominal Pain
Fatigue
Anorexia
Weight Loss
 Fever
Abdominal swelling
Pathophysiology
Chronic Exposure to
Factors

Chronic Irritation of
Liver Cell

Chronic Liver Prolonged

Injury Inflammation

Cell
Mutation

Rapid Uncontrollable
proliferation of anaplastic
Angiogenesis
 Tumor Growth in
the Liver

Altered Liver
Function

Loss of Upper Abdominal White,

jaundice
appetite abdominal pain swelling chalky stool

Weight Nausea General

loss &vomiting weakness &
fatigue
Incidence and Mortality in the U.S.
1.3% of estimated incident cancer cases
are in the liver and intrahepatic bile duct

Higher incidence for African Americans

and Asians than whites

5 year survival rate is approximately 6.9%

Incidence and Mortality throughout
the World
One of the most common malignancies
in eastern Asia and sub-Saharan Africa
Incidence up to 90.0/100,000 in some
parts of the world
44% of the world’s cases occur in China
Progression of Liver Damage
Progression of Liver Damage
 Healthy Liver
 Fibrotic Liver – The continuous inflammation of
the Liver caused by Hepatitis B can lead to
fibrosis – a formation of scar tissue within the
liver.
 Cirrhotic Liver – In cirrhosis of the liver, scar
tissue replaces normal, healthy tissue blocking
the flow of the blood through the liver and
preventing it from working as it should.
 LiverCancer ( HCC ) – Liver cancer is the
formation of malignant tumor in the liver.
Classification
 Hepatocellular Carcinoma accounts for more
than 90% of the adult primary cancers of the liver.

 Theseare primarily Adenocarcinomas, arising

from parenchymal liver cells or hepatocytes.

 Tumors arising from intrahepatic bile ducts,

called Cholangiocarcinomas, account for only
10% of liver cancers. Other rare liver tumors
include hepatoblastomas.
Diagnosing Liver Cancer

 MRI
 Transcutaneous ultrasonography
 Ultrasound
 Blood Test
 Percutaneous Liver Biopsy
 Serum Tumor Marker (AFP)
TNM Classification and
Staging for Primary Liver
Cancers, including
Intrahepatic Bile Duct
Carcinomas
 Primary Tumor (T)
Tx Primary tumor cannot be assessed
T0 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
Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be

assessed
N0 No regional lymph node
metastasis
N1 Regional lymph node metastasis
 Distant Metastasis (M)
*MX Distant metastasis cannot be
assessed
*M0 No distant metastasis
*M1 Distant metastasis
 STAGE GROUPING:
Stage 1 T1 N0 M0
Stage II T2 N0 M0
Stage IIIA T3 N0 M0
Stage IIIB T4 N0 M0
Stage IIIC Any T N1 M0
Stage IV Any T Any N M1
Metastasis
 Common sites for distant metastases from HCC,
which usually develop late in the disease course,
are the lung, bone and the adrenal glands.
Medical Treatment Modalities
 The Child Pugh Scoring system frequently used to evaluate
liver function.
 Partial or Total Hepatectomy and liver transplantation are
surgical options for HCC.
 Partial Hepatectomy is performed for early stage disease
in patient with adequate liver function.
 Cryosurgery has become popular in treating unresectable
primary and metastatic liver lesions. This procedures
involves the ultrasound guided insertion of probes into the
liver.
 Liver Transplantation
 Chemotherapy
 Radiation Therapy
Child Pugh Scoring
Disease Related Complications HCC

 Portal
HPN, Ascites, Hemorrhage from tumor, abd
pain and Jaundice
 Surgery- pain, weakness, fatigue, liver failure,
bleeding and infection
 RadiationTherapy – Fatigue, skin reactions and
upset stomach
 Chemotherapy - Nausea, vomiting, fatigue, low
blood count, bleeding after minor cuts,
headaches, hair loss, and dark skin and fingernails
Post operative Nursing Care
Monitor for bleeding
Monitor for infections
Monitor for respiratory complications
and organ failure is essential.
Pain Management
Nutritional Support
Prevention
 Antioxidants

Antioxidants protect cells from damage caused by

unstable molecules known as free radicals that is associated
with cancer.
Antioxidants are provided by a healthy diet that
includes a variety of fruits and vegetables.

 Practice safe sex

 Vaccines

Cancer vaccines are designed to boost the body’s natural

ability to protect itself through the immune system.
Thank you!