Liver Cancer Overview and Pathophysiology

Liver Cancer

• 3rd leading cause of cancer death worldwide and in the Philippines
• 4th in incidence in the Philippines

Etiology and Pathophysiology

• Primary Liver Cancers:
  • Hepatocellular Carcinoma (HCC)
• Liver Metastasis:
  • More common than primary liver cancer
  • 2.5 times more frequent than primary liver cancers
  • Originates from gastrointestinal tract (GIT), breast, and lung
  • Ideal location for malignant cells

Causes of Primary Liver Cancers

• Cirrhosis
• Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV)
• Exposure to chemical toxins (e.g., arsenic, vinyl chloride)
• Cigarette smoking (particularly when combined with alcoholism)
• Aflatoxin (or other toxic molds)

Clinical Manifestations (Early)

• Early liver cancer: Symptoms are absent or subtle
• Hepatomegaly
• Splenomegaly
• Fatigue
• Peripheral edema, ascites

Clinical Manifestations (Late)

• Fever/chills
• Jaundice
• Anorexia
• Weight loss
• Palpable mass
• Right upper quadrant (RUQ) pain

Diagnostics

• Ultrasound
• Serum AFP (alpha-fetoprotein) /TAAT
• CT Scan
• MRI
• Biopsy
• Colonoscopy
• CEA (carcinoembryonic antigen)

Medical Management - Prevention

• Treat chronic HBV and HCV infections
• Treat chronic alcohol use
• Screen at-risk patients (those with cirrhosis and NAFLD)

Medical Management - Treatment

• Cure:
  • Liver resection (partial hepatectomy)
  • Liver transplantation (for early-stage liver cancer with impaired function)
• Nonsurgical therapies:
  • Percutaneous ablation
  • Laparoscopic ablation
  • Microwave ablation
  • Radiofrequency ablation
  • Transarterial chemoembolization (TACE)
  • Chemotherapy and immune-based therapy
    • Monoclonal antibodies
    • Tyrosine kinase inhibitors
    • Immune checkpoint inhibitors

Medical Management - Staging

• Treatment/prognosis correlated with staging
• TNM (tumor, node, metastasis) commonly used to stage
  • Staging is vital for determining the appropriate treatment. Stage 0 to Stage IV
  • Specific TNM classifications and 5-year survival rates given

Colorectal Cancer

• 3rd in cases worldwide and in the Philippines
• 2nd cause of cancer death worldwide
• 4th cause of cancer death in the Philippines

Risk Factors for Colorectal Cancer

• Risk is higher in men
• Risk increases with age
• Alcohol (>=4 drinks per week)
• Cigarette smoking
• Family history of CRC in first-degree relatives
• History of familial adenomatous polyposis (FAP)
• History of hereditary nonpolyposis colorectal cancer
• Obesity
• Personal history of colon cancer, inflammatory bowel disease (IBD), or diabetes
• Red meat (>=7 servings/week)

Pathophysiology

• CRC typically begins as a polyp
• Polyps usually evolve into adenomas over 10 to 20 years.
• As tumors grow, they can invade and penetrate the walls.
• Cancer cells can spread to lymph nodes and the vascular system.

Clinical Manifestations - Presentation

• Colorectal cancer develops slowly
• Symptoms are often absent until the disease is advanced
• Nonspecific in early disease, potentially including Fatigue, Weight loss, Abdominal pain, tenderness, and change in bowel habits
• Possible later-stage manifestations including abdominal pain, tenderness, change in bowel habits, maybe a palpable abdominal mass, hepatomegaly, ascites, bleeding (more common on the right), hematochezia (usually left), right-sided diarrhea, bowel obstruction, bleeding perforation, peritonitis, and fistula formation

Diagnostics

• Screening tests (45 to 75):
  • Flexible sigmoidoscopy (every 5 years)
  • Colonoscopy (every 10 years)
  • Double contrast barium enema (every 5 years)
  • CT colonography (virtual colonoscopy) (every 5 years)
• Other tests:
  • Colonoscopies
  • CEA (carcinoembryonic antigen)
  • Biopsy of polyps

Medical Management - Surgical Therapy

• Goals: Complete resection of the tumor, thorough exploration to assess spread, removal of all draining lymph nodes, restoration of bowel function
• Stages:
  • Stage 1 and 2: Resection
  • High-risk stage 2: Chemotherapy after surgery
  • Stage 3: Surgery and chemotherapy
  • Stage 1, 2, and 3 generally have good prognoses (higher survival rates)

Medical Management - Other Treatments

• Neo-adjuvant therapy
• Palliative therapy
• Adjuvant therapy (recommended for stage 3 tumors)
• Targeted therapies (angiogenesis inhibitors, multikinase inhibitors)
• Radiation therapy (adjuvant to surgery & chemo; palliative for metastasis)

Nursing Management - Diagnoses

• Altered bowel elimination
• Anxiety
• Difficulty coping

Nursing Management - Implementation

• Follow screening guidelines
• Routine postoperative care
• Sterile dressing changes & drain care, pt/caregiver teaching on ostomy
• Psychological support

This quiz covers essential information on liver cancer, including its incidence, etiology, and clinical manifestations. Learn about primary liver cancers such as Hepatocellular Carcinoma (HCC) and factors contributing to liver metastasis. Understand the early and late signs and symptoms associated with liver cancer.