AHN, nursing, disease

1. Khyber Medical University
Cancer of liver

2. Objectives
• At the end of this presentation the student will be
able to:
• Define liver cancer.
• Describe Pathophysiology of liver cancer.
• Enlist signs, symptoms and causes of liver cancer.
• Discuss medical diagnosis and treatment of liver
cancer.
• Make nursing diagnosis and nursing intervention for
liver cancer.

3. Liver cancer
• Liver cancer or hepatic
cancer (from the Greek hēpar,
meaning liver) is a cancer that
originates in the liver. Liver
cancers are malignant tumors
that grow on the surface or
inside the liver.
• Liver cancers should not be
confused with liver metastases,
which are cancers that originate
from organs elsewhere in the
body and migrate to the liver.

4. Causes of liver cancer
• Liver cancer is often caused by damage to the liver
due to:
• Cirrhosis (scarring of the liver tissue from alcohol)
• Hepatitis B or C.
• Inflammation of the liver that is long-term (chronic)
• Iron overload in the body (hemochromatosis)

5. Pathophysiology
• Hepatic carcinoma, like any other cancer, develops
when there is a mutation to the cellular machinery
that causes the cell to replicate at a higher rate.
• In particular, chronic infections of hepatitis
B and/or C can aid the development of hepatic
carcinoma by repeatedly causing the body's own
immune system to attack the liver cells, some of
which are infected by the virus.

6. Cont….
• While this constant cycle of damage followed by
repair can lead to mistakes during repair which in
turn lead to carcinogenesis, this hypothesis is more
applicable, at present, to hepatitis C.
• Chronic hepatitis C causes liver cancer through the
stage of cirrhosis.

7. Signs & Symptoms
• Abdominal pain or tenderness, especially in
the upper-right part
• Easy bruising or bleeding
• Enlarged abdomen
• Yellow skin or eyes (jaundice)

8. Diagnosis
 Physical examination may show an enlarged,
tender liver.
 Tests include:
• Abdominal CT scan
• Abdominal ultrasound
• Liver biopsy
• Liver enzymes (liver function tests)
• Liver MRI.

9. Treatment
• Surgery or a liver transplant can successfully
treat small or slow-growing tumors if they are
diagnosed early.
• Chemotherapy delivered straight into the liver
with a catheter can help, but it will not cure
the disease.
• Radiation therapy in the area of the cancer
may also be helpful.

10. Complications
• Gastrointestinal bleeding.
• Liver failure.
• Spread to nearby organs.
• Tumor rupture.
• Bone marrow damage.
• Constipation.
• Diarrhea.
• Hair loss.
• Increased risk of infection.

11. Nursing Diagnoses
• Activity intolerance R/T fatigue, lethargy, and
malaise.
• Imbalanced nutrition R/T abdominal distention
and anorexia.
• Impaired skin integrity R/T jaundice and edema.
• High risk for injury R/T altered clotting
mechanisms.
• Disturbed body image R/T changes in
appearance, sexual dysfunction, and role
function.

12. Cont…
• Chronic pain R/T enlarged tender liver and ascites
• Ineffective breathing pattern R/T restriction of
thoracic excursion secondary to ascites and
abdominal distention

13. Nursing interventions
• Give analgesics as ordered to relieve pain.
• 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.
• Keep the patient’s fever down.
• Turn the patient frequently and keep his skin clean to
prevent pressure ulcers.
• Prepare the patient for surgery, if indicated.

14. Cont…
• Provide comprehensive care and emotional
assistance.
• Monitor the patient for fluid retention and ascites.
• Monitor respiratory function.
• Explain the treatments to the patient and his family,
including adverse reactions the patient may
experience.

15. References
• Garcia-Tsao G, Lim JK; Members of Veterans Affairs
Hepatitis C Resource Center Program. Management
and treatment of patients with cirrhosis and portal
hypertension: recommendations from the Department
of Veterans Affairs Hepatitis C Resource Center
Program and the National Hepatitis C Program. Am J
Gastroenterol. 2009;104:1802-1829.
• Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman
L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia,
Pa: Saunders Elsevier; 2011:chap 156.
• Mehta G, Rothstein KD. Health maintenance issues in
cirrhosis. Med Clin North Am. 2009;93:901-915