Unit 3: Liver Cancer Flashcards
What is the most prevalent type of Liver Cancer?
Hepatocellular carcinoma
Risk Factors for Primary Liver Cancer
- diseases that cause long-term inflammation of the liver
- chronic infection w/ Hepatitis B or C
- several-year history of heavy alcohol drinking (more than 2 alcoholic drinks a day for several years)
- Other: autoimmune disorders, hemochromatosis, obesity, hx of diabetes, or as a by-product of mold found in certain foods
Pathophysiology
Because of the inflammation, necrosis, fibrosis, and ongoing liver regeneration associated w/ chronic disease, cirrhotic changes occur and increase the risk of HCC development
Risk Factor: Hemochromatosis
- excess build up of iron in the body
- can be a genetic disorder
- can be a result of massive transfusions, chronic alcohol use, or hemolytic anemia
Risk Factor: Obesity
tend to accumulate fat in the liver, which leads to chronic liver damage, inflammation, and nonalcoholic steatohepatitis (NASH)
Risk Factor: By-product of Mold
By-product of the mold Aspergillus flavus found in peanuts, soy, rice, corn, and wheat stored in hot and humid environments can cause genetic mutations in the liver and has been associated w/ liver cancer
Clinical Manifestations of Liver Cancer
- often asymptomatic until liver becomes enlarged or the patient demonstrates clinical manifestations of liver dysfunction
- b/c the tumor typically impairs normal functions of the liver; exhibit abdominal pain, weight loss, anorexia, weakness, fatigue, jaundice, and ascites
Diagnosis of Liver Cancer
- routine screening for liver cancer is indicated in high-risk patients, including those w/ cirrhosis, viral hepatitis, hemochromatosis, alpha I-antitrypsin deficiency, and a hx of chronic alcohol abuse
- w/ cirrhosis, cross-sectional imaging studies q 6 to 12 months, along with assessment of alpha-fetoprotein measurements
- in pts suspected w/ metastasis to the liver, ultrasound and contrast CT of the liver is useful in identifying tumor growth
- liver biopsy may be performed to determine type and stage of cancer
Treatment
- Combination of chemotherapy and radiation
- Selective internal radiation therapy for those patients w/ liver cancer that cannot be treated surgically
- Systemic chemotherapy
- Hepatic arterial infusion
- Transcatheter arterial chemoembolization
- Ablation therapies
- Cryotherapy
Selective Internal Radiation Therpay
- considered for patients w/ liver cancer that cannot be treated surgically
- includes delivering radiation directly into the liver via a catheter placed in the hepatic artery by an interventional radiologist
Hepatic Arterial Infusion
- allows for a more direct, targeted approach to delivery of chemotherapeutic agents to the liver
- involves placement of a catheter into the hepatic artery by an interventional radiologist
- fewer side effects compared to systemic administration of chemotherapy
Transcatheter Arterial Chemoembolization
- involves cannulation by an interventional radiologist of the feeding artery of the tumor
- high doses of chemotherapy are administered via the catheter, and then the artery is occluded with gel foam coils to prevent systemic toxicity
Radiofrequency Ablation Procedures
radiofrequency ablation that uses energy waves to heat and kill tumor cells
Cryotherapy
uses liquid nitrogen to freeze and kill tumor cells
Surgical Management
- dependent on the degree of normal liver function and whether it is primary or secondary cancer
- surgical options for metastatic disease are palliative for symptoms relief of pain and distention
- in patients w/ small, single liver tumors with normal liver function, a partial hepatectomy may be performed to remove the tumor
- Liver transplantation may be an option in patients with small, single primary liver cancer
Connection Check: The nurse assesses for which clinical manifestations in the patient diagnosed with liver cancer? A. Periumbilical pain B. Anorexia C. Hemoptysis D. Fatigue E. Jaundice
B. Anorexia
D. Fatigue
E. Jaundice
Nursing Management: Assessment and Analysis
clinical manifestations in patients with liver cancer are directly associated with the degree of liver dysfunction
- pain in RUQ w/ extension to the back or shoulder
- Fluid accumulation in peritoneal cavity (ascites)
- Anorexia
- Weakness
- SOB
- Jaundice of skin, sclera
- Elevated serum liver enzymes, bilirubin
Nursing Diagnoses for Liver Cancer
- Pain associated w/ pressure caused by the presence of a tumor
- Activity intolerance associated w/ fatigue and weakness
- Risk for ineffective coping associated w/ changes in health status and chronic disease
Nursing Assessments For Liver Cancer
- Shortness of breath (SOB)
- Vital Signs
- Pain
- Abdominal swelling and bloating
- Weakness and feelings of extreme tiredness
- Weight loss
- Appetite and feelings of fullness, nausea, and vomiting
- Skin color and eyes
- Urine Color
- Abdominal girth measurements daily
- Liver enzymes and look for trends in laboratory values
Assessments: Shortness of breath
- fluid accumulation in the peritoneal cavity pushes up on the diaphragm and causes SOB
- patients can experience hypoxia from intrapulmonary arteriovenous shunting and commonly develop pleural effusions
Assessments: Vital Signs
- increased respiratory rate and SOB d/t increased pressure on the diaphragm
- elevated fever associated w/ infection
Assessments: Pain
pain in the upper abdomen on the right side that may extend to the back or shoulder is associated w/ tumor size and location
Assessments: Abdominal swelling and bloating
ascites or protein-rich fluid accumulation in the peritoneal cavity occurs b/c of impaired sodium and water retention d/t to inflammation of the liver, resulting in decreased production of plasma proteins (albumin) and to the presence of the tumor
Assessments: Weakness and feelings of extreme tiredness
associated w/ poor nutritional intake secondary to abdominal fullness and lack of appetite
Assessments: Weight loss
decreased appetite causes poor nutritional intake
Assessments: Appetite and feelings of fullness, nausea, and vomiting
GI symptoms can be associated w/ size of tumor, accumulation of ascites, and compression on the stomach, leading to feeling of early satiety and decreased appetite
Assessment: Skin color and eyes
jaundice develops, causing yellowish skin and scleral yellowing secondary to elevated bilirubin levels d/t tumor obstructing bile ducts
Assessment: Urine color
increased serum bilirubin levels being filtered by the kidneys leads to dark, amber urine
Assessment: Abdominal Girth measurements daily
measure and document abdominal girth daily at the level of the umbilicus to determine fluid accumulation
Assessment: Liver enzymes and look for trends in laboratory values
all liver enzymes can be elevated b/c of abnormal functioning of the liver
Nursing Actions
- Administer pain medications such as NSAIDs, narcotics via oral route, IV, subcutaneous, topical patches, or narcotic-coated lollipops
- Nerve Blocks
- Administer antibiotics and antipyretics
- Apply elastic wraps/bandages or support stockings to lower extremities and elevate the legs
- Restrict fluid intake; sodium restriction and protein restriction
Actions: Administer pain medications such as NSAIDs, narcotics via oral route, IV, subcutaneous, topical patches, or narcotic-coated lollipops
- provides symptomatic relief
- pain therapy is patient specific
- combination of therapies may be indicated depending on severity of symptoms
Actions: Nerve Blocks
injected locally directly into the nerves of the abdomen to provide relief of pain
Actions: Antibiotics and Antipyretics
- antibiotics used if patient has an infection
- antipyretics used to treat temperature elevations
Actions: Apply elastic wraps/bandages or support stocking to lower extremities and elevate the legs
- help prevent edema and promote venous return
- leg elevation increases venous return ad prevents peripheral edema
Actions: Restrict fluid intake; sodium restriction and protein restriction
- fluid restriction helps prevent edema
- sodium restriction prevents accumulation of salts
- sodium retention and protein restriction may prevent symptoms of encephalopathy
Nursing Teachings
- Provide education on the importance of eating and maintaining an exercise regimen
- Provide education about procedures, diagnostic tests, interventions, or treatments
- Teach about therapies used to control pain, alleviate symptoms for palliative therapy
Teachings: Education on the importance of eating and maintaining an exercise program
- proper diet and exercise helps to maintain nutrition and strength and range of motion and conditioning
- importance of limited salt intake
Evaluating Care Outcomes
- progosis for pts w/ liver cancer depends on the age of the patient, stage of cancer, and whethe or not it is primary or secondary
- once diagnosed, the course of treatment is determined for either cure if diagnosed early in the disease or treatment of symptoms
- surgical options may be curative or palliative to control pain d/t tumors
- care outcomes: preventing complications of fluid retention and decreased nutritional intake
