LIVER CANCER

PATHOPHYSIOLOGY

PREDISPOSING FACTOR
Alcohol Abuse
Viral Hepatitis
Metabolic Liver Disease

Adenocarcinomas
Rises at the Epithelial Cell

Vascular invasion, particularly of

the portal system,

Enlargement of primary
mass

Encroaches on hepatic function or

metastasizes

Spread to the lungs.

To Adrenal Glands
Bones
Gastrointestinal tract
gallbladder

Cachexia, gastrointestinal
or esophageal varices
bleeding, liver failure with
hepatic coma

DEATH
ASSESSMENT:
1. The early manifestations of malignancy of the liver include pain, a continuous dull
ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of
strength, anorexia, and anemia may also occur.
2. The liver may be enlarged and irregular on palpation.
3. Jaundice is present only if the larger bile ducts are occluded by the pressure of
malignant nodules in the hilum of the liver. Ascites develops if such nodules
obstruct the portal veins or if tumor tissue is seeded in the peritoneal cavity.
4. The liver cancer diagnosis is based on clinical signs and symptoms, the history
and physical examination, and the results of laboratory and x-ray studies.
Increased serum levels of bilirubin, alkaline phosphatase, AST, GGT, and lactic
dehydrogenase may occur. Leukocytosis (increased white blood cells),
erythrocytosis (increased red blood cells), hypercalcemia, hypoglycemia, and
hypocholesterolemia may also be seen on laboratory assessment.
5. X-rays, liver scans, CT scans, ultrasound studies, MRI, arteriography, and
laparoscopy may be part of the diagnostic workup and may be performed to
determine the extent of the cancer. Positive emission tomograms (PET scans)
are used to evaluate a wide range of metastatic tumors of the liver.

6. Confirmation of a tumor’s histology can be made by biopsy under imaging

guidance (CT scan or ultrasound) or laparoscopically. Local or systemic
dissemination of the tumor by needle biopsy or fine-needle biopsy can occur but
is rare. Some clinicians believe that these procedures should not be performed if
the tumor is thought to be resectable; rather, for primary HCC diagnosis should
be confirmed by frozen section at the time of laparotomy.

Nursing Implementations:

Teaching Patients Self-Care. The nurse instructs the patient to recognize and report the
complications and side effects of the chemotherapy that may occur and the actions and
desired andundesirable effects of the specific chemotherapy regimen.

The nurse also emphasizes the importance of follow-up visits to assess the patient and
the tumor’s response to chemotherapy and radiation therapy.

If the patient is receiving chemotherapy on an outpatient basis, the nurse explains the
patient’s and family’s role in managing the chemotherapy infusion and in assessing the
infusion/insertion site.

If the patient has had surgery to treat liver cancer, potential problems related to
cardiopulmonary involvement include vascular complications and respiratory and liver
dysfunction. Metabolic abnormalities require careful attention. A constant infusion of
10% glucose may be required in the first 48 hours to prevent a precipitous fall in the
blood glucose level resulting from decreased gluconeogenesis. Because extensive
blood loss may occur as well, the patient will receive infusions of blood and IV fluids.
The patient requires constant, close monitoring and care for the first 2 or 3 days, similar
to postsurgical abdominal and thoracic nursing care.

The patient undergoing cryosurgery is monitored closely for hypothermia, hemorrhage,

or bile leak; myoglobinuria can occur as a result of tissue necrosis and is minimized by
hydration, diuresis, and at times medications (allopurinol) to bind to and aid in the
excretion of toxic products. If the patient will receive chemotherapy or radiation therapy
in an effort to relieve symptoms, he or she may be discharged home while still receiving
one or both of these therapies. The patient may also go home with a biliary drainage
system in place. The need for teaching is great because of the need for the patient to
participate in care and the family’s role in care at home.