ONCOLOGY

1. LIVER CANCER
RATHEESH R L

2. • Liver cancer, also known as hepatic
cancer and primary hepatic cancer,
is cancer that starts in the liver.
• Cancer which has spread from elsewhere to
the liver, known as liver metastasis, is more
common than that which starts in the liver.

3. CAUSES AND RISK FACTORS
OF LIVER CANCER
• Anabolic steroids - used by athletes and weight
lifters. These male hormones, if used regularly
and for long enough, can raise the risk of
developing liver cancer, as well as some other
cancers.
Aflatoxins - a substance made by a fungus and
may be found in moldy wheat, groundnuts, corn,
nuts, soybeans and peanuts. For liver cancer risk
to increase there needs to be long-term
exposure. This is more of a problem in less
wealthy countries.

4. • Cirrhosis - when liver cells are damaged and
replaced with scar tissue. People
with cirrhosis of the liver have a higher risk of
developing liver cancer.
• Diabetes - patients with diabetes, especially if
they also have hepatitis, or regularly consume
a lot of alcohol, are more likely to develop
liver cancer.

5. • Family history - people whose mother, father,
brother, or sister had liver cancer are at a
higher risk of developing it themselves,
compared to others.
• Obesity - obesity raises the risk of developing
many cancers, including liver cancer.

6. • Liver disease and inherited liver disease -
people with hepatitis B or C have a
significantly higher risk of developing liver
cancer, compared to other healthy individuals.
According to the American Cancer
Society, hepatitis C is the most common cause
of liver cancer in the USA. The Society
mentions that some inherited liver diseases
also increase the risk of liver cancer.

7. • Low immunity - people with weakened
immune systems, such as those
with HIV/AIDS have a risk of liver cancer that is
five times greater than other healthy
individuals.

8. • Gender - a higher percentage of males get liver
cancer compared to females. Some experts
believe this is not due to gender, but to lifestyle
characteristics. On average, males tend to smoke
and abuse alcohol more than females.
• Smoking - individuals with hepatitis B or C have a
higher risk of liver cancer if they smoke.

9. STAGES OF CANCER
Liver cancer is categorized into four stages:
• Stage 1 - the tumor is just in/on the liver and no
where else
• Stage 2 - either there are several small tumors
with little increase in size, but all within the liver,
or one tumor that has reached a blood vessel

10. • Stage 3 - either there are various large tumors,
or there is just one that has reached the main
blood vessel(s). Cancer may have also reached
the gallbladder
• Stage 4 - metastasis. The liver cancer has
spread to other parts of the body.

11. Symptoms
Most people don't have signs and symptoms in
the early stages of primary liver cancer. When
signs and symptoms do appear, they may
include:
– Losing weight without trying
– Loss of appetite
– Upper abdominal pain
– Nausea and vomiting

12. – General weakness and fatigue
– Abdominal swelling
– Yellow discoloration of your skin and the whites of
your eyes (jaundice)
– White, chalky stools

13. Diagnosis of liver cancer
• HCC screening - high risk individuals for HCC
should have regular screenings for liver cancer.
Liver cancer, if not diagnosed early is much
more difficult to remove. The only way to
know whether you have liver cancer early on
is through screening, because symptoms are
either slight or nonexistent.

14. • High risk people include those with hepatitis C
and B, patients with alcohol-related cirrhosis
and other alcohol abusers.

15. • Blood test - AFP (alpha fetoprotein), a type of
protein, is produced by liver tumors and can
be detected in a blood test
• Imaging scans - either an MRI or CT scan
• Biopsy - a small sample of tumor tissue is
removed and analyzed. The analysis can reveal
whether the tumor is cancerous (malignant)
or non-cancerous (benign).

17. Surgery
• In the early stages, when the tumor is small
and occupies just a small part of the liver, it
can be surgically removed (surgical resection).
• Even if part of the liver is removed during this
procedure, the patient's health should not be
significantly undermined

18. • Liver transplant - candidates for a liver
transplant cannot have a tumor larger than 2
inches (5cm), according to the NHS. If the
tumor is larger, the risk of the cancer coming
back is too high, says the NHS.

19. • Ablative therapy - substances are injected
directly into the tumor, such as alcohol. Lasers
and radio waves can also be used
• Radiation therapy (radiotherapy) - radiation is
directed at the tumor(s), killing a significant
number of them. Patients may experience
nausea, vomiting and fatigue.

20. • Chemotherapy - medications are injected into
the liver to kill cancer cells
(chemoembolization). In chemoembolization
the blood supply to the tumor is blocked
surgically or mechanically and anticancer
drugs (chemotherapy) are administered
directly into the tumor

21. Targeted drug therapy
• Targeted drugs work by interfering with
specific abnormalities within a tumor.
• They have been shown to slow or stop
advanced hepatocellular carcinoma from
progressing for a few months longer than with
no treatment.

22. • More studies are needed to understand how
targeted therapies, such as the drug sorafenib
(Nexavar), may be used to control advanced
liver cancer.

23. Alternative medicineS
Ask doctor about alternative treatments that
may help you cope with pain, such as:
• Acupressure
• Acupuncture
• Deep breathing
• Listening to music (music therapy)
• Massage

24. PREVENTION
• Alcohol: long-term, regular high alcohol intake
significantly increases the risk of cirrhosis of
the liver, which in turn makes the likelihood of
developing liver cancer much greater. It stands
to reason, therefore, that moderating one's
alcohol intake (or giving up completely) can
significantly reduce the risk of developing liver
cancer.

25. • Hepatitis B: The following individuals should
seriously consider receiving the hepatitis
vaccine: drug addicts who share needles,
individuals who engage in unprotected sex
with partners who may be at risk of having
hepatitis B, nurses, doctors, dentists and other
individuals whose occupations raise their risk
of becoming infected.

26. • Hepatitis C: Although there is no sure way of
protecting oneself from hepatitis C, using a
condom during sex may help reduce the risk
of infection.
• Body pierceings and tattoos - make sure the
establishment is reputable and new or very
well sterilized needles are being used. If you
have any doubt about the place, go
somewhere else.

27. • Use caution with chemicals. Follow
instructions on chemicals you use at home or
at work.

28. NURSING MANAGEMENT
• Give analgesics as ordered and encourage the
patient to identify care measures that
promote comfort.
• Provide patient with a special diet that
restricts sodium, fluids, and protein and that
prohibits alcohol.
• To increase venous return and prevent edema,
elevate the patient’s legs whenever possible.

29. • Provide meticulous skin care.
• Turn the patient frequently and keep his skin
clean to prevent pressure ulcers.
• Prepare the patient for surgery, if indicated.
• Provide comprehensive care and emotional
assistance.
• Monitor the patient for fluid retention and
ascites.

30. • Keep the patient’s fever down.
• Monitor respiratory function.
• Explain the treatments to the patient and his
family, including adverse reactions the patient
may experience.