Liver Cancer Overview

Liver Cancer Overview

• Primary liver cancer originates within the liver, with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (bile duct cancer) being the most common types.
• In 2018, about 42,220 liver cancer cases and 30,200 deaths occurred in the U.S. Globally, it ranks as the 5th most common cancer and 2nd leading cause of cancer death.
• Cirrhosis, especially from HCV, is a significant risk factor for HCC in the U.S. NAFLD is also a contributing factor. Approximately 2% of cirrhosis patients annually develop liver cancer.
• Liver cancer lesions can be singular or multiple, nodular or diffuse, potentially infiltrating surrounding organs (gallbladder, peritoneum, diaphragm). Lung metastasis is common.
• Metastatic liver cancer is more prevalent than primary liver cancer, due to the liver's high blood flow and capillary network, which facilitates the spread of cancerous cells from other parts of the body via the portal circulation.

Clinical Manifestations and Diagnosis

• Early-stage liver cancer often presents with subtle or absent symptoms, often masking the malignancy behind underlying cirrhosis symptoms.
• Symptoms may include hepatomegaly, splenomegaly, fatigue, peripheral edema, ascites, or other portal hypertension complications.
• In later stages, fever, chills, jaundice, anorexia, weight loss, palpable mass, and right upper quadrant (RUQ) pain are common symptoms.
• Diagnostic tools such as ultrasound, CT, and MRI are used. Advanced MRI technology allows accurate diagnosis and staging without biopsy, though biopsy may be needed for inconclusive results or tissue guidance. Biopsy risks include bleeding and potential tumor seeding.
• Serum alpha-fetoprotein (AFP) levels, combined with ultrasound imaging, effectively detect early-stage HCC.

Interprofessional and Nursing Care

• Prevention strategies include managing chronic HBV and HCV infections and treating chronic alcohol use.

• Screening for high-risk patients (cirrhosis) involves a combination of serum AFP and imaging (CT, MRI, ultrasound).

• Treatment approaches depend on cancer stage, tumour characteristics (number, size, location, vessel involvement), patient age/health, and liver disease severity.

• Liver resection (partial hepatectomy) offers a potential cure in suitable cases, but only about 15% of patients meet the prerequisite healthy liver tissue threshold.

• Cirrhosis and portal hypertension may complicate post-surgery liver recovery and lead to liver failure. Many patients are diagnosed at advanced stages, limiting surgical options.

• For early-stage HCC with impaired liver function, liver transplantation can offer a favorable prognosis.

• Nonsurgical therapies incorporate percutaneous ablation (using needles, heat, or chemical agents to destroy tumors), chemoembolization (blocking blood supply to a tumor by introducing chemotherapy drugs), and radioembolization (delivering radioactive materials to the tumor area).

• Systemic therapies (chemotherapy, monoclonal antibodies, tyrosine kinase inhibitors, immune checkpoint inhibitors) prolong survival by slowing tumor growth. Nursing care focuses on patient comfort management. Cirrhosis-related issues are also likely present.

Prognosis and Treatment Considerations

• While liver cancer prognosis is generally poor, early screening & surveillance efforts in chronic hepatitis and cirrhosis patients show improvement in outcomes.
• The rapid progression of liver cancer often compounds with failing liver function and complications from the cancer.
• Without treatment, death can occur within 6–12 months, often due to hepatic encephalopathy or massive GI bleeding.