Liver cancer: Nursing

Liver cancer is a malignant tumor that can originate in the liver or, more frequently, spread to the liver from another organ.Now, let’s go over some anatomy and physiology, The liver is a large, solid organ located in the right upper quadrant of the abdomen, which has several functions, including the production of bile, cholesterol, and certain blood proteins like albumin and clotting factors, as well as helping with glucose and fat metabolism, drug metabolism, and detoxification to eliminate harmful substances like alcohol.

To be able to carry out these functions, the liver needs to have a rich blood supply, and there are two main sources. One source is the hepatic portal vein, which carries deoxygenated venous blood from the intestines and spleen into the liver to be filtered and detoxified before entering the systemic venous system.

On the other hand, the hepatic artery supplies the liver with oxygenated arterial blood from the systemic arterial system.So, liver cancer can arise due to chronic tissue damage from a variety of factors.

Modifiable risk factors include prolonged exposure to harmful substances like alcohol, high fat or carbohydrate diet, as well as obesity and smoking.

On the other hand, non-modifiable risk factors include having a chronic liver disease, such as cirrhosis or chronic hepatitis B or C infection; genetic disorders like hemochromatosis or alpha-1 antitrypsin deficiency; as well as family history, older age, and being assigned male at birth.

Now, liver cancer can be either primary or secondary. Primary liver cancer occurs when the malignant tumor originates in the liver, the most common type being hepatocellular carcinoma.

On the other hand, secondary liver cancer occurs when a malignant tumor originates in another organ, and then manages to metastasize or spread through blood and ultimately settle in the liver.

And because of the liver’s rich blood supply, the majority of liver cancer cases are actually secondary, most often coming from primary colorectal, breast, or lung cancers.Okay, so the clinical manifestations of liver cancer may vary based on the size and location of the tumor.

Initially, clients are typically asymptomatic. As the disease progresses over time, clients may develop hepatomegaly, and can experience symptoms like weight loss, fatigue, early satiety, abdominal pain, nausea, and vomiting.

If the tumor obstructs the outflow of bile from the liver, clients may also develop obstructive jaundice. If the hepatic portal vein is blocked, pressure builds in the portal system, leading to portal hypertension; this can result in splenomegaly, or spleen enlargement, as well as ascites, or abdominal swelling as fluid is pushed into the peritoneal cavity.

In addition, the cancer may impair the liver’s ability to produce clotting factors, resulting in coagulopathy or impaired coagulation, so clients can present with easy bruising or bleeding.The diagnosis of liver cancer starts with the client’s history and physical assessment, followed by additional diagnostic tests.

Laboratory test results are generally non-specific, and may show elevated blood levels of amylase and lipase, as well as tumor markers like alpha-fetoprotein or AFP for short, as well as carbohydrate antigen or CA 19-9, and carcinoembryonic antigen or CEA.

Imaging tests like abdominal ultrasound, CT scan, and MRI can be used to stage the tumor by defining the location, and look for lymph node involvement or metastasis.

Once a suspicious lesion is found on imaging, a biopsy is performed to confirm the diagnosis. Treatment for liver cancer depends on its aggressiveness and extension.

Unfortunately, most clients with liver cancer have a poor prognosis, since it’s often pretty advanced at the time of diagnosis.

For small, localized tumors, the treatment of choice is surgical resection with partial hepatectomy, where the affected part of the liver is removed.

On the other hand, larger but still localized tumors can be treated with liver transplantation.There are nonsurgical treatment options for clients with localized tumors who can’t undergo surgery.

These include tumor thermal ablation, such as radiofrequency ablation, microwave ablation, or cryoablation; as well as transarterial chemoembolization or radioembolization; percutaneous injection therapy; or external beam radiation therapy.

These clients can also be treated with chemotherapy, or with targeted therapies like sorafenib.Finally, clients with metastatic cancer can be treated with a combination of chemotherapy or targeted therapy and palliative care, in order to decrease their symptoms and improve their quality of life.Okay, let’s look at the nursing care you’ll provide for a client with liver cancer.

Your priority nursing goals include symptom management, monitoring for complications, and providing comfort and emotional support to promote quality of life.

Begin by assessing your client’s vital signs, as well as for symptoms of portal hypertension like bleeding, peripheral edema, and ascites.

Then measure your client’s abdominal girth, monitor their fluid balance, and administer diuretics and other treatments, as ordered.

Be sure to provide comfort measures, monitor your client closely for bleeding, and notify the healthcare provider immediately if your client develops problems like epistaxis or hematemesis.Now, your client may receive transarterial chemoembolization, where a chemotherapeutic agent is infused directly to the tumor, followed by embolization or closing off of the blood vessels supplying the tumor, resulting in tumor necrosis.

After the procedure, be sure to keep the affected limb straight for the prescribed amount of time with manual compression.

Closely monitor your client’s femoral access site, and immediately report signs of bleeding or hematoma formation, to the healthcare provider.

Also monitor for signs of postembolization syndrome caused by the tumor’s response to ischemia, and report to the healthcare provider if your client develops a low-grade fever, abdominal pain, nausea, and vomiting; be prepared to administer the prescribed analgesics, antiemetics, and IV fluids.

If you are caring for a client after a partial hepatectomy, implement routine post-operative interventions, and monitor them closely for complications related to the procedure.

If your client is prescribed chemotherapy, administer the medication, and assess them for side effects like nausea, vomiting, and neutropenia.

Also administer the prescribed antiemetics, provide comfort measures, and institute neutropenic precautions, as needed. For clients also receiving radiation therapy, assess them for localized skin reactions, and report to the healthcare provider if you notice worsening skin integrity.Okay, let’s move on to client and family teaching.

First, provide information about the disease process, and review the plan of care and potential side effects of treatments.

Then, emphasize the importance of good oral hygiene; and encourage them to stay well hydrated and to eat small, frequent meals or snacks to optimize nutrition.

Also advise your client to include physical activity in their daily routine, as tolerated, and remind them that getting enough sleep can help reduce stress.

Lastly, teach your client to safely self-administer any prescribed medications. Instruct your client to contact their healthcare provider right away if they experience any abnormal bleeding, including nosebleeds, bloody or black stools, or bloody or pink urine, or other signs their condition is worsening like fever, new or worse pain in their belly, or confusion.Finally, provide your client with additional resources, including home health services, physical therapy, psychosocial services, palliative care, and hospice care as needed; and encourage them to follow up regularly for monitoring of their condition.

Alright, as a quick recap… Liver cancer is a malignant tumor that can originate in the liver or, more frequently, spread to the liver from another organ.

It can arise due to chronic tissue damage from modifiable risk factors, including prolonged exposure to harmful substances like alcohol and smoking, or non-modifiable risk factors like having a chronic liver disease, such as cirrhosis or chronic hepatitis B or C infection.

Clients can be asymptomatic initially, but as the disease progresses over time, they may develop hepatomegaly, jaundice, complications of portal hypertension, and coagulopathy.

Treatment for liver cancer depends on its aggressiveness and extension; and can include a partial hepatectomy, transarterial chemoembolization, as well as chemotherapy, radiation therapy, or liver transplantation.

Nursing goals include symptom management, monitoring for complications, and providing comfort and emotional support to promote quality of life.

Client teaching includes instructions for self-care at home, safe medication self-administration, and when to contact their healthcare provider.

and providing comfort and emotional support to promote quality of life. Client teaching, includes instructions for self-care at home, safe medication, self-administration and went to contact their health-care