Liver Cancer ACC RNSG 1247

Risk factors 4 th most common cancer in the world Most common primary liver cancer is hepatocellular carcinoma Cirrhosis – primary risk factor Other risk factors: hepatitis C and B Metastatic – more common than primary

Etiology & Pathophysiology Liver is a common site of cancer metastasis from other parts of the body due to high blood flow rate and extensive capillary network. Liver cells become enlarged and mishappen by cancer cells. May lead to hemorrhage and necrosis

Clinical manifestations Early manifestations are similar to cirrhosis: hepato/splenomegaly, jaundice, weight loss, ascites, edema Other S/sx: dull abd. pain, N/V, anorexia, increased abd. girth, pulmonary emboli

Diagnostic tests Liver scan CT MRI MRA (magnetic resonance angiography) Hepatic angiography ERCP

Diagnostic Tests cont. Laparoscopic liver biopsy – to minimize tumor spread Serum alpha fetoprotein – help distinguish cancer from metastasis

Collaborative management Prevention * focused on identifying and treatment of chronic viral hepatitis * treatment of of chronic alcohol ingestion * surveillance of at risk patients: with cirrhosis

Collaborative management Treatment * surgical intervention- offers best prognosis * lobectomy (surgical excision) * radiofrequency ablation – used for both resectable tumors and palliative _ uses electrical energy to destroy tumors

Collaborative management cont. Treatment * cryoablation - used for unresectable tumors with no s/sx of metastasis - liquid nitrogen/argon flows thru cryoprobes directly into the liver and freezes it

Collaborative management cont. Treatment * percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI) - to treat non-metastasized but unresectable liver cancers - ethanol or acetic acid is injected into site via an ultrasound guided catheter

Collaborative management cont. Treatment * chemotherapy - used when all other procedures fail - chemo used: e.g., 5Fu, Leucovorin - targeted therapy: Sorafenib * chemoembolization - embolic agent is administered via catheter

Collaborative management: liver transplantation Option in end-stage liver disease Leading indications : liver disease RT chronic viral hepatitis Requires rigorous presurgery screening Contraindications: pulmonary Hpn, morbid obesity, obstructed splanchnic blood flow

Liver transplantation cont. Performed using either deceased or live donor livers. Split liver transplant - uses one liver for two patients, not as successful as whole liver transplant Postop complications - rejection & infection Cyclosporine – drug given to overcome rejection