Primary and Metastatic Liver Cancer

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Questions and Answers

What is the most common cause of hepatocellular carcinoma (HCC) in the United States?

Non-alcoholic fatty liver disease (NAFLD)

Chronic hepatitis B virus (HBV) infection

Alcohol abuse

Chronic hepatitis C virus (HCV) infection (correct)

What percentage of patients with cirrhosis develop liver cancer each year?

2% (correct)

10%

Which of the following is NOT a common clinical manifestation of late-stage liver cancer?

Anorexia

Jaundice

Hepatomegaly (correct)

Palpable mass

What is the most common site of metastatic liver cancer?

Lung (C) Signup and view all the answers

Which of the following imaging techniques is used to diagnose and stage liver cancer?

Ultrasound (A) Signup and view all the answers

What is the main reason why the liver is a common site for metastatic cancer?

Its high rate of blood flow and extensive capillary network (D) Signup and view all the answers

What serum marker is used in combination with ultrasound for the detection of early-stage HCC?

α-fetoprotein (AFP) (C) Signup and view all the answers

Which of the following is NOT a prevention strategy for liver cancer?

Vaccination against HPV (C) Signup and view all the answers

What is the primary reason liver resection is not an option for the majority of patients?

Insufficient healthy liver tissue (D) Signup and view all the answers

Which treatment offers the best chances for curing early-stage liver cancer?

Liver resection (A) Signup and view all the answers

What is one of the complications associated with percutaneous ablation?

Skin burn (D) Signup and view all the answers

What does TACE primarily do to treat liver tumors?

Shuts off the blood supply (A) Signup and view all the answers

What is a characteristic of liver cancer prognosis?

Generally poor but improving due to early screening (C) Signup and view all the answers

Which intervention is commonly used for patients with multinodular HCC?

Chemoembolization (B) Signup and view all the answers

Which factors are considered when determining treatment for liver cancer?

Extent of underlying liver disease (C) Signup and view all the answers

What may be a common outcome if liver cancer goes untreated?

Death within 6 to 12 months (C) Signup and view all the answers

What is a significant limitation of percutaneous ablation?

Limited by tumor size, number, and location (C) Signup and view all the answers

What is one way systemic therapies for liver cancer can affect tumor progression?

They can slow tumor progression and prolong life (C) Signup and view all the answers

Study Notes

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.

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Description

Explore the distinctions between primary liver cancer, such as hepatocellular carcinoma and intrahepatic cholangiocarcinoma, and metastatic liver cancer. This quiz covers key statistics, risk factors, and the clinical implications of liver tumors. Test your understanding of liver cancer and its impact on health.