MANAGEMENT OF PATIENT

WITH CANCER OF LIVER

PRESENTED BY-
Ms FARAH NAAZ
M.Sc NURSING I YEAR
COLLEGE OF NURSING,KGMU
LIVER CANCER

PRIMARY LIVER TUMORS-

Few cancers originate in the liver
These are usually associated with chronic liver disease,
hepatitis B and C infections and cirrhosis
Hepatocellular carcinoma (HCC) is the most common type
of primary liver cancer.
LIVER METASTASES
 Metastases from other primary sites are found in liver.
 Malignant tumors are likely to reach liver by the way of
portal system or lymphatic channels or by direct extension
from an abdominal tumor.
MEDICAL MANAGEMENT
 Although surgical resection of the liver tumor is possible in
some patients, the underlying cirrhosis, so prevalent in
cancer of the liver, increases the risks associated with
surgery.

 Although these therapies may prolong survival and

improve quality of life by reducing pain and discomfort,
their major effect is palliative.
Radiation Therapy

 Limited use of external beam radiation by the

radiosensitivity of normal hepatocytes and the risk of
destruction of normal parenchyma.
 More effective methods are available for delivering
radiation to tumors of the liver.

 IV or intra-arterial injection of antibodies tagged with

radioactive isotopes that specifically attack tumor-
associated antigens.

 Percutaneous placement –intensity source for interstitial

radiation therapy.
CHEMOTHERAPY
 Advanced cases of liver cancer show poor prognosis with
chemotherapy.
 For patients with stable hepatic function (Child class A),
new anti-cancer drugs such as sorafenib (Nexavar), have
been developed and approved for use.

 Systemic chemotherapy may be used to treat metastatic

liver lesions.

 Transarterial chemoembolization produces anoxic necrosis

with high concentrations of trapped chemotherapeutic
agents. This therapy has begun to show promising results.
TACE – transcatheter arterial chemo - embolization
 An implantable pump has been used to deliver a
high concentration of chemotherapy to the liver
through the hepatic artery.

 This method provides a reliable, controlled, and

continuous infusion of medication that can be
carried out in the patient’s home.

 This method has shown moderate response rate

PERCUTANEOUS BILIARY DRAINAGE

 Percutaneous biliary or transhepatic drainage is used to

bypass biliary ducts obstructed by liver, pancreatic, or bile
duct tumors.

 Used in patients with inoperable tumors or are considered

poor surgical risks.

 Under fluoroscopy, a catheter is inserted through the

abdominal wall and past the obstruction into the
duodenum.
 Such procedures are used to reestablish biliary drainage,
relieve pressure and pain from the buildup of bile behind the
obstruction, and decrease pruritus and jaundice.

 Patient is made more comfortable and quality of life and

survival are improved.

 For several days after its insertion, the catheter is opened to

external drainage.
 The bile is observed closely for amount, color, and presence of
blood and debris. Complications include sepsis, leakage of bile,
hemorrhage, and reobstruction of the biliary system by debris in
the catheter or from encroaching tumor.

 The patient is observed for fever and chills, bile drainage around
the catheter, changes in vital signs, and evidence of biliary
obstruction, including increased pain or pressure, pruritus, and
recurrence of jaundice.
Laser hyperthermia

 Used to treat hepatic metastases.

 Heat is directed to tumors through several methods to
cause necrosis of the tumor cells while sparing normal
tissue.
 In radiofrequency thermal ablation, a needle electrode
is inserted into the liver tumor under imaging
guidance.
 Radiofrequency energy passes through to the
noninsulated needle tip, causing heat and tumor cell
death from coagulation necrosis.
Immunotherapy

 lymphocytes with antitumor reactivity are administered to

the patient with hepatic cancer.

 Regression of the tumor has been demonstrated in patients

with metastatic cancer in whom standard treatment has
failed.
Transcatheter arterial embolization

 It interrupts the arterial blood flow to small tumors by

injecting small particulate embolic or chemotherapeutic
agents into the artery supplying the tumor.

 Ischemia and necrosis of the tumor occur as a result.

 For multiple small lesions, ultrasound-guided injection of

alcohol promotes dehydration of tumor cells and tumor
necrosis
SURGICAL MANAGEMENT
 Surgical Resection is the treatment of choice when HCC is
confined to one lobe of the liver and the function of the
remaining liver is considered adequate for postoperative
recovery.
 In preparation for surgery, the patient’s nutritional, fluid,
and general physical status is assessed. Support,
explanation, and encouragement are provided to help the
patient prepare psychologically for the surgery. Extensive
diagnostic studies may be performed.
LOBECTOMY

 Removal of a lobe of the liver is the most common surgical

procedure for excising a liver tumor.

 For a right liver lobectomy or an extended right lobectomy

(including the medial left lobe), a thoracoabdominal incision is
used.

 An extensive abdominal incision is made for a left lobectomy.

LOCAL ABLATION

 Ablation of HCC is accomplished for patients who are not

candidates for resection or chemotherapy.

 Chemicals such as ethanol or physical means –

radiofrequency ablation or microwave coagulation are used.

 These techniques may be performed under ultrasound or CT

guidance laparoscopically or percutaneously.
 A tumor of up to 5 cm in size can be destroyed in one
session.

 Most common complications- local pain. Bleeding. Serious

complications are rare
LIVER TRANSPLANTATION

 Removing the liver and replacing it with a healthy donor

organ.
 Recurrence of the primary liver malignancy after transplantation
is decreased with improvement in survival rates.

 The patient with small tumors may have a good prognosis after
transplantation, but recurrence is common with tumors greater
than 8 cm in diameter.

 Recurrence and metastasis may be enhanced by

immunosuppressive therapy that is used to prevent rejection.
NURSING MANAGEMENT
 For patients anticipating surgery, support, education and
encouragement are provided.

 Monitor potential problems such as vascular complications,

respiratory and liver dysfunction after surgery.

 Infusions of blood and IV fluids because of blood loss.

 constant , close monitoring and care for first 2-3 days.

 Patients receiving chemotherapy or radiation therapy can

be discharged to receive these at home

 The patient can also go home with a biliary drainage

system or hepatic artery catheter in place.
 health education to the patient and family about care of the
biliary catheter and effects and side-effects of hepatic
artery chemotherapy.
Home and community based care

Educating patients about self-care

 Educate the patient to recognize and report the potential
complications and side-effects of chemotherapy regimen.

 Importance of follow-up visits to assess the response to

chemotherapy and radiation therapy.

 Managing chemotherapy infusion and assessing the

infusion and insertion site in an outpatient.
 Encourage the patient to resume activities soon while cautioning
falls and protecting the infusion pump or site from damage.

 Education on catheter care- cleaning, drying and assessment.

 Irrigation of the catheter with sterile normal saline or water.

 Instruct not to aspirate or draw back on syringe during irrigation

 Notify the signs of complications or any problem.

 Education regarding implantable ports- the port with one-

way valve is never aspirated for blood return before the
infusion is initiated.

 Assess the port site between infusions and report any signs
of infusion or inflammation.
Continuing care
 Because of the poor prognosis, home care nurse assist the
family and patient to cope with symptoms.

 The home care nurse assesses patient’s physical and

psychological status , pain , nutritional status , symptoms
and complications of treatment or progression of disease.
 During home visits, the nurse assesses chemotherapy
pump, infusion site and biliary drainage system, if
indicated.

 collaborate with other members of health care team,

patient and family to mage weakness, pruritus, inadequate
dietary intake, jaundice and other symptoms.
 Home care nurse also assists the patient and family in
making decisions about hospice care and assist with
initiation of referrals.

 The patient is encouraged to discuss preferences for end-

of-life care with family members and health care providers.
REFERENCES

Bare G Brenda, Smeltzer C Suzanne, “Textbook Of Medical-Surgical Nursing”, 10th

edition (2004), published by Lippincott Williams and Wilkins.

Black M Joyce, Hawks Hokanson Jane, “ Textbook Of Medical Surgical Nursing”,

7th edition (2005), published by Elsevier.

Chintamani, “Lewis’ Medical Surgical Nursing”, 1st edition (2011), published by

Elsevier.

Hinkle H. Jenice, Cheever H.kerry, “textbook of medical-surgical nursing’ , 13th

edition (2016), published by wolters kluver.
Assignment

Nursing care plan for ‘patient with liver

cancer’
THANK YOU