1. LIVER CANCER
• Liver cancer, also known as hepatic cancer and primary hepatic cancer, is cancer that
starts in the liver.
• Cancer which has spread from elsewhere to the liver, known as liver metastasis, is more
common than that which starts in the liver.
Causes and risk factors of liver cancer
• Anabolic steroids - used by athletes and weight lifters. These male hormones, if used
regularly and for long enough, can raise the risk of developing liver cancer, as well as some
other cancers.
• Aflatoxins - a substance made by a fungus and may be found in moldy wheat, groundnuts,
corn, nuts, soybeans and peanuts. For liver cancer risk to increase there needs to be long-
term exposure. This is more of a problem in less wealthy countries.
• Cirrhosis - when liver cells are damaged and replaced with scar tissue. People with
cirrhosis of the liver have a higher risk of developing liver cancer.
• Diabetes - patients with diabetes, especially if they also have hepatitis, or regularly
consume a lot of alcohol, are more likely to develop liver cancer.
• Family history - people whose mother, father, brother, or sister had liver cancer are at a
higher risk of developing it themselves, compared to others.
• Obesity - obesity raises the risk of developing many cancers, including liver cancer.
• Liver disease and inherited liver disease - people with hepatitis B or C have a
significantly higher risk of developing liver cancer, compared to other healthy individuals.
According to the American Cancer Society, hepatitis C is the most common cause of liver
cancer in the USA. The Society mentions that some inherited liver diseases also increase
the risk of liver cancer.
• Low immunity - people with weakened immune systems, such as those with HIV/AIDS
have a risk of liver cancer that is five times greater than other healthy individuals.
• Gender - a higher percentage of males get liver cancer compared to females. Some
experts believe this is not due to gender, but to lifestyle characteristics. On average, males
tend to smoke and abuse alcohol more than females.
• Smoking - individuals with hepatitis B or C have a higher risk of liver cancer if they
smoke.
Stages of cancer
Liver cancer is categorized into four stages:
• Stage 1 - the tumor is just in/on the liver and no where else
• Stage 2 - either there are several small tumors with little increase in size, but all within
the liver, or one tumor that has reached a blood vessel
• Stage 3 - either there are various large tumors, or there is just one that has reached the
main blood vessel(s). Cancer may have also reached the gallbladder
• Stage 4 - metastasis. The liver cancer has spread to other parts of the body.
Symptoms
Most people don't have signs and symptoms in the early stages of primary liver cancer.
When signs and symptoms do appear, they may include:
• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting

2. • General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools
Diagnosis of liver cancer
• HCC screening (Hepatic Cancer Cell screening) - high risk individuals for HCC should
have regular screenings for liver cancer. Liver cancer, if not diagnosed early is much more
difficult to remove. The only way to know whether you have liver cancer early on is through
screening, because symptoms are either slight or non-existent.
High risk people include those with hepatitis C and B, patients with alcohol-related
cirrhosis and other alcohol abusers.
• Blood test - AFP (alpha fetoprotein), a type of protein, is produced by liver tumors and
can be detected in a blood test
• Imaging scans - either an MRI or CT scan
• Biopsy - a small sample of tumor tissue is removed and analyzed. The analysis can reveal
whether the tumor is cancerous (malignant) or non-cancerous (benign).
Treatment
• Surgery - In the early stages, when the tumor is small and occupies just a small part of
the liver, it can be surgically removed (surgical resection).
Even if part of the liver is removed during this procedure, the patient's health should not be
significantly undermined.
• Liver transplant - candidates for a liver transplant cannot have a tumor larger than 2
inches (5cm), according to the NHS. If the tumor is larger, the risk of the cancer coming
back is too high, says the NHS.
• Ablative therapy - substances are injected directly into the tumor, such as alcohol. Lasers
and radio waves can also be used
• Radiation therapy (radiotherapy) - radiation is directed at the tumor(s), killing a
significant number of them. Patients may experience nausea, vomiting and fatigue.
• Chemotherapy - medications are injected into the liver to kill cancer cells
(chemoembolization). In chemoembolization the blood supply to the tumor is blocked
surgically or mechanically and anticancer drugs (chemotherapy) are administered directly
into the tumor
• Targeted drug therapy - Targeted drugs work by interfering with specific abnormalities
within a tumor.
They have been shown to slow or stop advanced hepatocellular carcinoma from progressing
for a few months longer than with no treatment.
More studies are needed to understand how targeted therapies, such as the drug sorafenib
(Nexavar), may be used to control advanced liver cancer.

3. Alternative medicines
Ask doctor about alternative treatments that may help you cope with pain, such as:
• Acupressure
• Acupuncture
• Deep breathing
• Listening to music (music therapy)
• Massage
Prevention
• Alcohol: long-term, regular high alcohol intake significantly increases the risk of cirrhosis
of the liver, which in turn makes the likelihood of developing liver cancer much greater. It
stands to reason, therefore, that moderating one's alcohol intake (or giving up completely)
can significantly reduce the risk of developing liver cancer.
• Hepatitis B: The following individuals should seriously consider receiving the hepatitis
vaccine: drug addicts who share needles, individuals who engage in unprotected sex with
partners who may be at risk of having hepatitis B, nurses, doctors, dentists and other
individuals whose occupations raise their risk of becoming infected.
• Hepatitis C: Although there is no sure way of protecting oneself from hepatitis C, using
a condom during sex may help reduce the risk of infection.
• Body piercings and tattoos: make sure the establishment is reputable and new or very
well sterilized needles are being used. If you have any doubt about the place, go somewhere
else.
• Use caution with chemicals: Follow instructions on chemicals you use at home or at
work.
Nursing management
• Give analgesics as ordered and encourage the patient to identify care measures that
promote comfort.
• Provide patient with a special diet that restricts sodium, fluids, and protein and that
prohibits alcohol.
• To increase venous return and prevent edema, elevate the patient’s legs whenever
possible.
• Provide meticulous skin care.
• Turn the patient frequently and keep his skin clean to prevent pressure ulcers.
• Prepare the patient for surgery, if indicated.
• Provide comprehensive care and emotional assistance.
• Monitor the patient for fluid retention and ascites.
• Keep the patient’s fever down.
• Monitor respiratory function.
• Explain the treatments to the patient and his family, including adverse reactions the patient
may experience.