2. Risk factors 4 th most common cancer in the world Cirrhosis – primary risk factor Other risk factors: hepatitis C and B Metastatic – more common than primary

3. Etiology & Pathophysiology Why is the Liver a common site of cancer metastasis from other parts of the body?

4. Clinical manifestations Pain – a continuous dull ache in the RUQ, epigastrium, or back Weight loss Loss of strength Anorexia, nausea and vomiting Anemia

5. Clinical Manifestations As condition worsens will exhibit: Hepatomegaly and irregularly shaped Jaundice Ascites, increase in abdominal girth Pulmonary emboli

6. Diagnostic Tests Laparoscopic liver biopsy – to minimize tumor spread. Complications – bleeding. Lie on Rt. Side –pressure on site. Serum alpha fetoprotein – protein produced by the liver and elevations detect some liver disorders and cancers in adults.

7. Goals of Care Prevention Prevention Focused on identifying and treatment of chronic viral hepatitis Treatment of chronic alcohol ingestion Surveillance of at risk patients: with cirrhosis

8. Treatment and Nursing Care Radiation Therapy Radiation Therapy Chemotherapy Chemotherapy Chemoembolization Chemotherapy by constant infusion to the liver via the hepatic artery Produces anoxic necrosis Percutaneous Ethanol Injection (PEI) or Percutaneous acetic acid injection (PAI)

9. Treatment and Nursing Care Surgical intervention Lobectomy Lobectomy – removal of lobe of liver to excise liver tumor Radiofrequency ablation Radiofrequency ablation – used for both resectable tumors and palliative - needle devices that contain multiple curved, retractable electrodes. The electrodes are kept inside the needle until its tip is positioned within a tumor. Electrical energy Creates heat

10. Treatment Cryoablation: - used for unresectable tumors with no s/s of metastasis - liquid nitrogen/argon flows thru cryoprobes directly into the liver and freezes it