Hepatic Tumors

Overview of Hepatic Tumors

  • Types of Tumors:

    • Cancerous: 1. Primary (originate in liver, uncommon), 2. Metastatic (from other body sites).

    • Benign: e.g., Hepatic Adenomas (more common in women on oral contraceptives).

Types of Cancerous Hepatic Tumors

  • Primary Cancerous Tumors:

    • Hepatocellular Carcinoma (HCC) (rare, primary).

    • Cholangiocarcinoma (bile duct lining).

    • Mixed Tumors (epithelial and mesenchymal cells).

    • Angiosarcoma (blood vessels).

    • Hepatoblastoma (children, can cause early puberty).

Risk Factors for Cancerous Hepatic Tumors

  • Key Factors:

    • Viral Infections (Hepatitis B & C).

    • Chronic Alcohol Use.

    • Cirrhosis (alcoholic & non-alcoholic).

    • Exposure to Toxins, Anabolic Steroids.

    • Age (over 60), Sex (men double risk), Race (Asians highest risk).

    • Lifestyle (smoking) & Genetic Factors.

Metastatic Hepatic Tumors

  • Can originate from cancers in the colon, breast, lung, kidney, pancreas, stomach, etc.

Symptoms and Signs of Cancerous Hepatic Tumors

  • Early Stages: Often asymptomatic.

  • Possible Symptoms:

    • Pain (right upper abdomen, referred to shoulder/back/epigastric area).

    • Fever (without infection).

    • Jaundice (with bile duct obstruction).

    • Indigestion, loss of appetite, weight loss, nausea.

    • Abdominal/Leg swelling (edema).

    • Generalized Weakness, Enlarged Liver (Hepatomegaly).

Biopsy Considerations

  • Post-Biopsy Care: Patient should lie on affected side; monitor vital signs (pulse, BP, RR for bleeding/shock), check insertion site, manage pain.

Staging and Diagnosis

  • Diagnosis: Abdominal Ultrasound, Blood Counts, Clotting Tests (PT, PTT).

  • Staging System: AJCC TNM Classification (TT: Tumor size/spread, NN: Lymph Node involvement, MM: Metastasis).

    • T Stages: T0 (no tumor), T1 (single without vessel invasion), T2 (single with vessel invasion or multiple <5 cm), T3 (multiple >5 cm or major vessel invasion), T4 (invading neighboring organs).

    • N Stages: N0 (no regional spread), N1 (regional spread).

    • M Stages: MX (unasessable), M0 (no distant spread), M1 (distant spread).

Treatment Options for Liver Cancer
Surgical Treatment

  • Limited candidates due to tumor location/recurrence risk.

  • Options: Lobectomy, Liver Transplantation (stringent criteria), Cryosurgery, Ethanol/Microwave Coagulation.

Non-Surgical Treatment

  • Chemotherapy: Adriamycin, 5-FU, cisplatin (single or combination).

    • Chemoembolization (direct to tumor via hepatic artery).

    • Percutaneous Biliary Drainage (external).

  • Radiation Therapy: Mostly supportive/palliative, sometimes post-surgery.

  • Thermal Ablation: For coagulation necrosis.

  • Cirrhosis increases surgical risk and complicates non-surgical choices.

Post-Operative Monitoring and Management

  • Immediate Monitoring: Assess for hypoglycemia, hypovolemia, hypothermia, bile leakage, infections.

  • Management: Blood transfusions, IV therapy, hypothermia treatment.

Patient Education and Follow-Up Care

  • Key Aspects: Dietary recommendations, drainage system management, chemotherapy/radiation follow-up, psychosocial support, infection monitoring, port management, reassurance, scheduled follow-up appointments.