Primary and Metastatic Liver Cancer

Primary Liver Cancer

• Primary liver cancer originates within the liver itself.
• Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (bile duct cancer) are the most common types.
• In 2018, about 42,220 cases and 30,200 deaths from liver cancer occurred in the US.
• Globally, this cancer is the 5th most common and 2nd most frequent cause of cancer death.
• Cirrhosis, frequently caused by HCV (Hepatitis C virus) in the US, is a major risk factor for HCC, followed by NAFLD.
• About 2% of patients with cirrhosis develop liver cancer annually.
• Lesions can be singular or multiple, nodular, or diffuse.
• Some tumors can spread to other organs, such as the gallbladder, peritoneum, or diaphragm.
• Commonly metastasizes to the lung

Metastatic Liver Cancer

• More common than primary liver cancer.
• Liver's high blood flow and capillary network make it a common metastasis site.
• Cancer cells travel to the liver through the portal circulation.

Clinical Manifestations and Diagnosis

• Early signs of primary liver cancer are often subtle or absent and are commonly associated with the underlying liver disease.
• Symptoms might include hepatomegaly, splenomegaly, fatigue, edema, ascites, resulting from portal hypertension.
• Later stages can cause fever, chills, jaundice, loss of appetite, weight loss, palpable masses, and RUQ pain.
• Diagnostic methods include ultrasound, CT scans, and MRI.
• Recent MRI advancements enable accurate diagnosis and staging without biopsy in many cases.
• Biopsy may be needed for inconclusive imaging or for treatment guidance but carries risks of bleeding and potential tumor spread.
• Serum α-fetoprotein (AFP) levels combined with ultrasound improve early HCC detection rates.

Interprofessional and Nursing Care

• Preventing liver cancer involves managing chronic HBV and HCV infections and treating alcohol use disorders.
• Screening for high-risk patients (e.g., those with cirrhosis) often combines AFP levels with CT, MRI, or ultrasound imaging.
• Treatment options vary based on cancer stage, tumor characteristics, patient health, and underlying liver disease.
• Partial hepatectomy (liver resection) offers the greatest chance of cure, but only feasible in about 15% of patients due to cirrhosis and portal hypertension.
• Liver transplantation is potentially effective for early-stage cancer with impaired liver function.

Nonsurgical Liver Cancer Therapies

• Percutaneous ablation destroys tumors via needle insertion to inject substances (ethanol, acetic acid) or alter probe temperatures (radiofrequency, microwave, cryotherapy). This can be done percutaneously, laparoscopically, or by open incision.
• Tumor embolization (TACE or TARE) targets tumor blood supply. TACE uses chemotherapy drugs, while TARE uses radioactive beads. TARE procedure results may take up to three months.
• Systemic therapies, like chemotherapy and immunotherapies (like monoclonal antibodies, tyrosine kinase inhibitors, and immune checkpoint inhibitors), can slow tumor progression and extend survival.

Prognosis and Patient Care Considerations

• While overall liver cancer prognosis is generally poor, it is improving via early screening and surveillance, particularly in patients with chronic hepatitis and cirrhosis.
• The cancer progresses rapidly with complications and declining liver function.
• Without treatment, death can occur within a few months from hepatic encephalopathy or severe GI bleeding.
• Nursing care prioritizes patient comfort given the advanced nature and liver problems.