Liver and Colorectal Cancer PDF

# 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 - Causes - Cirrhosis - Chronic HBV, HCV - Exposure to chemi...

# 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 - Causes - Cirrhosis - Chronic HBV, HCV - Exposure to chemical toxin - Arsenic, vinyl chloride - Risk Factors - Cigarette Smoking - Especially when combined with alcoholism - Aflatoxin (or other toxic molds) ### Liver Metastasis - More common than Primary Liver cancer - 2.5 more frequent than primary liver cancers from GIT, Breast, Lung - Ideal place for malignant cells - High rate of blood flow - Extensive capillary network ## Clinical Manifestations ### Early liver cancer - Absent or subtle - Hepatomegaly - Splenomegaly - Fatigue - Peripheral edema, ascites ### Late Stages - Fever/chills - Jaundice - Anorexia - Weight loss - Palpable mass - RUQ pain ## Diagnostics - Diagnostics and screening tests - Ultrasound - Serum AFP - CT Scan - MRI - Biopsy ## Medical Management ### Prevention - Treatment of Chronic HBV and HCV infections - Treatment of chronic alcohol use - Screening for at-risk patients - Those with cirrhosis - Those with NAFLD ### Treatment #### Cure - Liver resection (Partial Hepatectomy) #### For early stage liver cancer, impaired function - Liver transplantation #### Nonsurgical Therapies - Percutaneous ablation - Cupellation - Burning - Microwave radiofrequency - Ethanol - Acetic acid - Transarterial chemo embolization - TACE - TARE - Radioembolization - Chemotherapy and Immune based therapy - Monoclonal antibodies - Tyrokinase inhibitors, and - Immune checkpoint inhibitors ### Prognosis - Usually poor - Improves with early screening and surveillance # Nursing Management ## Diagnoses - Pain, acute or chronic - Imbalance nutrition - Risk for fluid volume excess - Anxiety ## Nursing Implementation - For those waiting surgery: support, education, and encouragement - Educate to recognize and report the potential complications and side effects of the chemotherapy. - Assess adequacy of pain relief, nutritional status. - Assist in decision bout hospice care and end of life care. # Colorectal Cancer - Compiled by: Shadrach John Joash S. Valdez, RN, LPT - 3rd in cases Worldwide and in the Philippines - 2nd cause of cancer death in the world - 4th cause of cancer death in the Philippines ## Risk factors - Risk is higher in men - Risk increases with age - Alcohol (>= 4 drinks per week) - Cigarette smoking - Family history of CRC in first degree relative - History of familial adenomatous polyposis (FAP) - History of hereditary nonpolyposis colorectal cancer - Obesity - Personal history of CRC, IBD or diabetes - Red meat (>=7 servings/week) ## Etiology and Pathophysiology - CRC usually starts as polyps. - Grows over 10 to 20 years - Most of these polyps are adenomas. - As tumor grows, the cancer invades and penetrate walls. - Eventually gains access to the lymph nodes and vascular system. ## Clinical Manifestations - CRC develops slowly. - Symptoms often do not appear until disease is advanced. ### Nonspecific in early disease - Fatigue - Weight loss - Abdominal pain, tenderness - Change in bowel habits ### Late stages - Maybe able palpable abdominal mass - Hepatomegaly, ascites. - Bleeding, more common on the right. - Often unrecognized, maybe anemia. - Hematochezia usually left. - Right sided: diarrhea - Complications - Bowel obstruction - Bleeding perforation, peritonitis, and fistula formation ## Diagnostics ### Screening tests - Flexible sigmoidoscopy (every 5 years) - Colonoscopy (every 10 years) - Double contrast barium enema (every 5 years) - CT colonography (virtual colonoscopy) (every 5 years) ### Diagnostic tests - Colonoscopy - CEA carcinoembryonic antigen ## Medical Management ### Staging - Treatment and prognosis correlated with staging - TNM is commonly used to stage | Staegea | TNMb | 5-YearSurvival Rate (%) | |---|---|---| | 0 | Tis, N0, M0 | >96 | | 1 | T1, N0, M0 | 92 | | | T2, N0, M0 | 87 | | | T3, N0, M0 | 70-80 | | II | Any T, N1-2, M0 | 53-84 | | IV | Any T, any N, M1 | 12 | ### Surgical Therapy - Goals - Complete resection of the tumor - Thorough exploration of the abdomen to determine of the cancer has spread - Removing all lymph node that drain the area where the cancer is located - Restoring bowel continuity to promote bowel function - Stage 1 and 2 - Resection - High risk risk stage 2 - Chemotherapy after surgery - Stage 3 - Surgery and Chemotherapy ### Chemotherapy and targeted therapy - Neo adjuvant therapy - Palliative therapy - Adjuvant therapy - Recommended for stage 3 tumors - Targeted therapies - Angiogenesis inhibitors - Multikinase inhibitors ### Radiation therapy - Adjuvant to surgery and chemotherapy - Palliative for metastasis. - Reduce tumor size - provide symptomatic relief # Nursing Management ## Diagnoses - Altered bowel elimination - Anxiety - Difficulty coping ## Implementation - Follow screening guidelines. - Routine post op care - Sterile dressing changes, care of drains, and patient and caregiver teaching about ostomy. - Provide psychologic support.