CNA511 Oncology Nursing: Liver Cancer Case Study Analysis

This report presents a comprehensive case study on liver cancer, detailing the signs, symptoms, causes, and various treatment options. The case study focuses on a 42-year-old male patient, Mr. R, with a family history of liver cancer, smoking, alcohol consumption, and pre-existing conditions such as asthma, diabetes, and hypertension. The report includes a review of the patient's history, physical assessment, and diagnostic results, including biochemical laboratory findings, cancer marker tests, and imaging reports such as abdominal sonography, hepatic angiography, and magnetic resonance elastography. The report also covers staging of liver cancer and nursing interventions. The references include research papers and medical journals on liver cancer, diagnosis, and treatment.

LIVER CANCER

LIVER CANCER: Signs and Symptoms
Liver cancer is the second leading cause of death from cancer across the globe and
is 6th most common cancer. It is observed more in males particularly from the
age group of 40 to 65 years.
The common signs and symptoms are as follows:
 Sudden weight loss
 Abdominal pain and swelling
 Enlarged liver
 Vomiting and nausea
 Loss of appetite

Causes of Liver Cancer
 The chronic infection such as Hepatitis B virus and Hepatitis C virus
 Cirrhosis which is a progressive irreversible damage of tissues in the
liver
 Inherited liver diseases such as Wilson’s disease
 Diabetes
 Excessive intake of alcohol
 Exposure to alfatoxins that are produced by molds grown on crops

Preventing Liver cancer

Treatment of liver cancer
The different treatment options for liver cancer are as follows:
• Surgery : Partial hepatectomy, Liver transplantation,
Cryosurgery and Laser therapy
• Chemotherapy: Heaptic arterial chemotherapy, Hepatc arterial
infusion pump and chemobilisation
• Radiation therapy – Use of radiation to destroy cancerous cells
• Targeted therapy – Use of pharmacologic agents that targets
tissues, cells, genes, proteins that fosters cancer cell growth.
• Immuno-therapy – Boosting the immune system to address the
cancer and fight against the effects of cancer.

PATIENT CASE STUDY
• Mr. R was referred to hospital from his GP for diagnosis of liver cancer
based on patient history and social history.
• The patient family history says, both of his grandparents died due to liver
cancers and grandmother has a second diagnosis of colorectal cancer.
• Patient has a 20 years history of smoking and alcohol.
• Patient medical history says he has asthma , diabetes and hypertension.
• Recently patient complained of upper abdominal pain, loss of appetite,
nausea and vomiting.
• He was diagnosed with liver cancer six months ago.
• Physical assessment of patient reported – yellowish of skin, increased fluid
in the abdomen, general weakness and fatigue, enlarged liver and spleen.
Other symptoms includes - weight loss, abdominal swelling and chalky
coloured stools.

CASE STUDY BIOCHEMICAL, IMAGING AND
OTHER DIAGNOSTIC RESULTS
• Biochemical laboratory findings reports -haemoglobin was 122 g/L and haematocrit
was 32.2%, leucocytes and platelets were elevated up to 18 x 109/L and 1000 x
109/L respectively, total bilirubin 2.8 μmol/L, albumin 33 g/L and AST/ALT 56/68 U/L
• Cancer marker tests - Tumour markers like alpha-fetoprotein (α-FP), serum
carcinoembryonic antigen (CEA) and CA 19-9 increased up to 558 ng/ml, 5.8 ng/ml,
and 45 U/ml respectably.
• Abdominal sonography report - abdominal ultrasound demonstrated a 7.2 cm mass
in the left medial segment of the liver, Increased mass was observed in the right
poster inferior segment, intrahepatic bile ducts of left lobe expanded.
• Hepatic angiography report states - Hypervascularity of the tumour periphery, dot-
like lesions around the left lobe.
• Autopsy report shows - hepatocellular carcinoma and cholangiocarcinoma.
• Magnetic resonance elastography (MRE) report shows stiffness of the liver
indicating liver cirrhosis.

PREFERRED DIAGNOSTIC IMAGING STUDIES
• Ultrasonography- The imaging study can help in assessment of liver
and further planning for surgery. The sensitivity is 60% warranting
other techniques to be used for assistance.
• Computed tomography – Triple phase computer tomography that
can investigate arterial [phase, portal venous phase, late washout
phase can help in accurate diagnosis of hepatocellular carcinoma. It
has a specificity and sensitivity of 93% and 68% percent
respectively.
• Magnetic Resonance Elastography– Can help in facilitating
characterisation of cancerous areas without radiation and
iodonisation contrast. Increased specificity and reduced time. It has
the highest sensitivity and specificity of 81% and 85% respectively.

LIVER BIOPSY PICTORIAL PRESENTATION

STAGING OF LIVER CANCER

NURSING INTERVENTION- LIVER CANCER
• Nursing intervention depends on in which
stage the cancer is currently present

REFERENCES
• Muriel, P. (2017). The liver: General aspects and epidemiology. In Liver
Pathophysiology (pp. 3-22). Academic Press.
• Kudo, M. (2015). Surveillance, diagnosis, treatment, and outcome of liver cancer in
Japan. Liver Cancer, 4(1), 39-50.
• Bruix, J., Reig, M., & Sherman, M. (2016). Evidence-based diagnosis, staging, and
treatment of patients with hepatocellular carcinoma. Gastroenterology, 150(4), 835-
853.
• Pepin, K. M., Ehman, R. L., & McGee, K. P. (2015). Magnetic resonance elastography
(MRE) in cancer: technique, analysis, and applications. Progress in nuclear magnetic
resonance spectroscopy, 90, 32-48.
• Oliveira, I. S., Kilcoyne, A., Everett, J. M., Mino-Kenudson, M., Harisinghani, M. G., &
Ganesan, K. (2017). Cholangiocarcinoma: classification, diagnosis, staging, imaging
features, and management. Abdominal radiology, 42(6), 1637-1649.
• Tapper, E. B., & Lok, A. S. F. (2017). Use of liver imaging and biopsy in clinical
practice. New England Journal of Medicine, 377(8), 756-768.