Transcript Liver Cancer

Liver Cancer
ACC
RNSG 1247
Risk factors
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4th 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
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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
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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
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Liver scan
CT
MRI
MRA (magnetic resonance angiography)
Hepatic angiography
ERCP
Diagnostic Tests cont.
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Laparoscopic liver biopsy – to minimize
tumor spread
Serum alpha fetoprotein – help
distinguish cancer from metastasis
Collaborative management
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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
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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.
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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.
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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.
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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
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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.
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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