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LIVER CANCER (cont)

Diagnostic Findings

 History of Physical examination


 Result of lab and X-ray studies
 PET scans
 Liver scans
 CT scans
 Ultrasound, MRI, arteriography, laparoscopy and biopsy
 Blood tests.
 Increased WBC counts
 Increased RBC counts
 Hypercalcemia
 Hypogycemia
 Hypocholesterolemia
 Elevated levels of serum alpha fetoprotein (AFP)

Medical Management

Chemotherapy
 Regional perfusion of liver with infusions given directly into hepatic artery may
reduce pain or slow tumor growth and may produce fewer side effects than those
incurred with systemic chemotherapy which is not known to prolong life.
 During Surgery:
 Surgeon may implant a chemotherapy infusion pump
 A pump, filled percutaneously deliver medications continuously into hepatic
artery.
 With metastatic growths, the oncologist may prescribe systemic
chemotherapy to reduce tumor size and pain.

 Chemotherapeutic Agents include:

 5 –fluorouracil (5-FU)
 Doxorubicin(Adriamycin) for single dose therapy
 5 FU with Carmustine (BCNU) semustine (methyl CCNU) or streptozocin for
combination therapy

Radiation Therapy
 Disappointing result
 Most primary tumors that metastasize to the liver are resistant to radiation therapy,
while the healthy liver is highly susceptible to radiation damage.
 Sometimes radiation therapy will be administered at the time of surgery and is
called Intraoperative Radiation. Radiation may also be used as palliative
treatment to shrink tumors and relieve pain.

Chemoembolization
Embolization is the process of injecting a foreign substance into the tumor to stop
the blood flow. The lack of blood deprives the tumor of needed oxygen and nutrients and
eventually causes cells to die. The tumor blood supply is stopped with small pieces of
material that have been saturated with chemotherapy drugs.

Ethanol Injection

 Injection of 100% absolute alcohol into tumors can be beneficial as it is highly toxic
to liver tumors. It is injected into the center of the tumor through the skin
(percutaneously) or at the time of surgery.
 The alcohol causes cells to dry out and cellular protein to disintegrate, ultimately
leading to tumor cell death.
 This treatment is administered to patients who refuse surgery or who have severe
liver disease that prevents them from having liver surgery.

Radiofrequency Ablation
 This is a new technique that destroys liver tumors by heating them to high
temperatures (80 - 100 °C).Tumors up to 4 centimeters (approximately 2 inches) in
diameter can be effectively destroyed with this technique.
 The patient undergoing radiofrequency ablation receives IV sedation and grounding
pads are placed on the legs. A thin needle is inserted into the tumor and electrical
current is passed through the tip of the needle which becomes very hot and
destroys the tumor. The procedure lasts 10 - 15 minutes and the patient goes home
on the same day.

Interstitial Laser Photocoagulation

 This technique involves the insertion of a thin optical fiber into the center of the liver
tumor and a laser light is emitted from the tip. The exposed cells will then undergo
thermal necrosis. Since clinical experience with this technique are few, more
studies are required before this treatment can be recommended.

Nursing Management
 Assess: Metabolic malfunctions; pain; bleeding problem; ascites; edema; inability
to biotransform endogenous and exogenous wastes; hypoproteinemia; jaundice
and endocrine complication
 Prepare diagnostic stage for various procedure
 Assess carefully postop. Complications
 If there is pain, administer medication at prescribe time and dosage
 Assist client and family members to gain knowledge about condition and to offer
support necessary for them to cope with uncertainty and fear associated with
cancer.

Surgical Management
`
 RESECTION
- indicated for tumors that are small and confined to one liver segment or
lobe
- affected segment or lobe is remove surgically (called segmentectomy)
- can take 2 - 5 hours to perform.

Contraindication
 Stress of surgery
 Presence of liver disease too extensive for surgery to be beneficial
Complication

 Tumor rupture
 G.I haemorrhage from varices
 Progressive cachexia
 Hepatic failure

Prognosis
 Poor
 3-6 months survival

Cryosurgery

Cryosurgery is a new technique that can destroy tumors in a variety of sites


(brain, breast, kidney, prostate, liver). Cryosurgery is the destruction of abnormal tissue
using sub-zero temperatures. The tumor is not removed and the destroyed cancer is left to
be reabsorbed by the body. Initial results in properly selected patients with unresectable
liver tumors are equivalent to those of resection.

Liver Transplantation
 Feasible form of intervention for variety of end stage liver disease
 Duration – 8 hours or 6- 18 hours
 Surgery may be:
 Orthotopic – involving removal of diseased liver and insertion of donor liver
 Heterotopic – diseased liver is left in and the transplanted liver is inserted
alongside it.

Indications
 Primary and Secondary Cirrhosis
 Hepatitis (usually adult)
 Primary sclerosing cholangitis (adult)
 Biliary atresia (pediatric)
 Alpha₁ - antitrypsin deficiency ( usually pedia)
 Confined hepatic malignancy ( adult/ pediatric)
 Wilson’s Disease
 Budd- Chiari syndrome ( hepatic vein thrombosis)
 Alcohol cirrhosis

Contraindications
 Life threthening systemic disease
 Uncontrolled extrahepatic bacterial/ fungal infections
 Pre-existing advanced cardio/pulmo disease
 Multiple uncorrectable, life threatening congenital anomalies
 Metastastic malignancy of liver
 Active alcoholism/ drug abuse
 Cholangiocarcinoma
 HIV
Complications

 Cardio and pulmonary problems


 Infection
 Rejection
 Hemorrhage
 Atelectasis
 Failure of anastomosis
 Acute renal failure

S/Sx of Acute Rejection


 Fever
 Tachycardia
 Right upper quadrant/ flank pain
 Increase jaundice

Outcome
• Discharge- week after Sx
• 3-4 mo. Be able to resume normal life
• 85% survival rate

Nursing Management
• Preoperative Care
 Chose for transplantation
 Waiting List
 Physical and Psychological evaluation
 Diagnostic test
 Nutritional Assessment
 Meet transplant team
 Make sure that donor and recipient match in: organ size, blood and tissue
type
 Focus on assessing pt. level of knowledge and information
 Ascertain how pt. and pt. family members are coping with situation.

 Postoperative Care
 Monitor for rejection, infection and occlusion of vessels
 Immunosuppressive therapy which started before surgery, must be
continued on regular schedule post op. to prevent rejection of new liver
 Constant monitoring of respiratory, cardiovascular, neuro and hemodynamic
status
 Monitor liver function through assessment of serum transaminases ( ALT,
AST). Bilirubin, albumin, clotting factor.
 Monitor fluid and electrolytes status, blood glucose level and pH
 WOF fluid overload
 Monitor wound drains and bile drains for patency and note bile
characteristics
 Assess needs of family member and SO, who may travel long distance from
home and may be feeling powerless, stress and anxious.

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