Diagnostic Findings
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.
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.
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
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
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.