Hepatocellular Carcinoma
HEPATOCELLULAR CARCINOMA
Primary malignancy of the liver
Third leading cause of cancer deaths worldwide, with over
500,000 people affected
Incidence of hepatocellular carcinoma is highest in Asia and
Africa where the endemic high prevalence of Hepatitis B
and Hepatitis C strongly predisposes to the development of
chronic liver disease
Most common form of liver cancer in adults
HEPATOCELLULAR CARCINOMA
Hepatocellular cancer (HCC) can have different growth
patterns:
Some begin as a single tumor that grows larger. Only late in
the disease does it spread to other parts of the liver
A second type seems to start as many small cancer nodules
throughout the liver, not just a single tumor. This is seen
most often in people with cirrhosis (chronic liver damage)
STAGING:
Hepatocellular
Carcinoma
Diagnostics: Hepatocellular Carcinoma
1. CT Scan
2. MRI
3. Ultrasound
4. Serum tumor marker Alpha-fetoprotein (AFP)
*Patients without hepatitis who have AFP levels above 400 mcg/dl and
abnormal radiologic findings are likely to have HCC, whereas the AFP levels
suggestive of HCC in patients positive for hepatitis B surface antigen is over
4000 mcg/dl
5. Tissue Biopsy is not often recommended because of the potential of
tumor seeding and bleeding
STAGING of Hepatocellular Carcinoma:
The staging system is based on the results of the
physical exam, imaging tests (ultrasound, CT or
MRI scan, etc.) and other tests.
• Stage I: T1, N0, M0: There is a single tumor (any size)
that has not grown into any blood vessels. The cancer
has not spread to nearby lymph nodes or distant sites.
• Stage II: T2, N0, M0: Either there is a single tumor (any
size) that has grown into blood vessels, OR there are
several tumors, and all are 5 cm (2 inches) or less. The
cancer has not spread to nearby lymph nodes or distant
sites.
• Stage IIIA: T3a, N0, M0: There is more than one
tumor, and at least one is larger than 5 cm (2 inches)
across. The cancer has not spread to nearby lymph
nodes or distant sites.
• Stage IIIB: T3b, N0, M0: At least one tumor is growing
into a branch of a major vein of the liver (portal vein or
hepatic vein). The cancer has not spread to nearby
lymph nodes or distant sites.
• Stage IIIC: T4, N0, M0: A tumor is growing into a
nearby organ (other than the gallbladder), OR a tumor
has grown into the outer covering of the liver. The
cancer has not spread to nearby lymph nodes or
distant sites.
• Stage IV: Any T, N1, M0: Tumors in the liver can be any
size or number and they may have grown into blood
vessels or nearby organs. The cancer has spread to
nearby lymph nodes. The cancer has not spread to distant
sites.
Hepatocellular
Carcinoma
PATHOPHYSIO
Hepatocellular
Carcinoma
DRUGS/Chemotherapy
CHEMOTHERAPY
5-fluorouracil
5-FU belongs to the category of chemotherapy called
antimetabolites. Antimetabolites are very similar to normal
substances within the cell. They attack cells at very specific phases
in the cycle.
Nursing Consideration:
To help treat/prevent mouth sores, use a soft toothbrush, and rinse
three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1
teaspoon of salt mixed with 8 ounces of water.
Doxorubicin (Adriamycin)
slows or stops the growth of cancer cells
Nursing considerations:
You should not use this medication if you are allergic to doxorubicin
or similar medications
Avoid being near people who are sick or have infections.
Avoid activities that may increase your risk of bleeding injury.
Cisplatin
Produces interstrand and intrastrand cross linkage in DNA of
rapidly dividing cells, thus preventing DNA, RNA, and protein
synthesis
Nursing considerations:
Monitor urine output and specific gravity for 4 consecutive hours
before treatment and for 24 h after therapy.
Check BP, mental status, pupils, and fundi every hour during
therapy
Nursing Diagnosis: Hepatocellular Carcinoma
1. Ineffective breathing pattern related to a decrease in lung expansion
(emphasis ascites and diaphragm).
2. Pain (acute / chronic) related to a buildup of fluid in the abdominal cavity
(ascites).
3. Imbalanced Nutrition: less than body requirements related to inadequate
nutritional intake, abdominal distention, and anorexia.
4. Anxiety related to enlargement of the abdomen.
5. Activity intolerance related to fatigue, lethargy and malaise.
SIGNS AND SYMPTOMS
Weight loss (without trying) An enlarged spleen, felt as a mass
under the ribs on the left side
Loss of appetite
Pain in the abdomen or near the
Feeling very full after a small meal right shoulder blade
Nausea or vomiting Swelling or fluid build-up in the
abdomen
An enlarged liver, felt as a mass
under the ribs on the right side Itching
Yellowing of the skin and eyes
(jaundice)
Treatment
your treatment options may include:
• Surgery (partial hepatectomy or liver transplant)
• Tumor ablation
• Tumor embolization
• Radiation therapy
• Targeted therapy
• Chemotherapy
Liver cancer surgery
Liver cancer surgery At this time, surgery, either with resection
(removal of the tumor) or a liver transplant, offers the only reasonable
chance to cure liver cancer. If all known cancer in the liver is
successfully removed, you will have the best outlook.
Partial hepatectomy Surgery to remove part of the liver is called partial
hepatectomy. This operation is only attempted if the person is healthy
enough for surgery and all of the tumor can be removed while leaving
enough healthy liver behind. Unfortunately, most liver cancers cannot
be completely removed. Often the cancer is in too many different parts
of the liver, is too large, or has spread beyond the liver.
Imaging tests, such as CT or MRI with angiography are done first to
see if the cancer can be removed completely. Still, sometimes during
surgery the cancer is found to be too large or spread too far to be
removed, and the surgery has to be cancelled.
Liver Transplant
a liver transplant may be the best option for some people with small liver cancers.
At this time, liver transplants can be an option for those with tumors that cannot
be removed with surgery, either because of the location of the tumors or because
the liver is too diseased for the patient to withstand removing part of it. In general,
it is used to treat patients with small tumors (either 1 tumor smaller than 5 cm
across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood
vessels. It can also rarely be an option for patients with resectable cancers (cancers
that can be removed completely).
Tumor Ablation
Tumor ablation for liver cancer Ablation refers to treatments that destroy liver tumors
without removing them. These techniques are often used in patients with no more than a
few small tumors but for whom surgery is not a good option (often because of poor health
or reduced liver function).
Ablation is best used for tumors no larger than about 3 cm across. For slightly larger tumors
(3 to 5 cm across), it may be used along with embolization (see next section). Because
ablation often destroys some of the normal tissue around the tumor, it might not be a good
choice for treating tumors near major blood vessels, the diaphragm, or major bile ducts.
Embolization Therapy
Embolization is a procedure that injects substances to try
to block or reduce the blood flow to cancer cells in the
liver.
Radiation Therapy
Radiation therapy for liver cancer Radiation therapy uses
high-energy rays to kill cancer cells. There are different
kinds of radiation therapy.
Targeted Therapy
Sorafenib
Sorafenib (Nexavar ) is a targeted drug that works in 2 ways. It helps
block tumors from
forming new blood vessels, which they need to grow. It also targets
some of the proteins on cancer cells that normally help them grow. This
drug has been shown to slow the growth of advanced liver cancer and
to help some patients live longer (by an average of about 3 months).
Sorafenib is taken twice daily as a pill. The most common side effects
of this drug include fatigue, rash, loss of appetite, diarrhea, high blood
pressure, and redness, pain, swelling, or blisters on the palms of the
hands or soles of the feet.
