Cancer of the Liver

  1. General information
    1. Primary cancer of the liver is extremely rare, but it is a common site for metastasis because of liver's large blood supply and portal drainage. Primary cancers of the colon, rectum, stomach, pancreas, esophagus, breast, lung, and melanomas frequently metastasize to the liver.
    2. Enlargement, hemorrhage, and necrosis are common occurrences; primary liver tumors often metastasize to the lung.
    3. Higher incidence in men.
    4. Prognosis poor; disease well advanced before clinical signs evident.
  2. Medical management
    1. Chemotherapy and radiotherapy (palliative) to decrease tumor size and pain
    2. Resection of liver segment or lobe if tumor is localized
  3. Assessment findings
    1. Weakness, anorexia, nausea and vomiting, weight loss, slight increase in temperature
    2. Right upper quadrant discomfort/ tenderness, hepatomegaly, blood-tinged ascites, friction rub over liver, peripheral edema, jaundice
    3. Diagnostic tests: same as cirrhosis of the liver (see Cirrhosis of the Liver) plus
      1. Blood sugar decreased
      2. Alpha fetoprotein increased
      3. Abdominal x-ray, liver scan, liver biopsy all positive
  4. Nursing interventions: same as for cirrhosis of the liver plus
    1. Provide emotional support for client/significant others regarding poor prognosis.
    2. Provide care of the client receiving radiation therapy or chemotherapy.
    3. Provide care of client with abdominal surgery plus
      1. Preoperative
        1. Perform bowel prep to decrease ammonium intoxication.
        2. Administer vitamin K to decrease risk of bleeding.
      2. Postoperative
        1. Administer 10% glucose for first 48 hours to avoid rapid blood sugar drop.
        2. Monitor for hyper/hypoglycemia.
        3. Assess for bleeding (hemorrhage is most threatening complication).
        4. Assess for signs of hepatic encephalopathy.

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