A primary cancer that arises in the liver, as oppose to cancer that spreads to the liver from other parts

of the body, known as liver metastases. Worldwide, it is fifth of the most common cancer, with highest incidence found in areas of China and Sub-Saharan Africa

HCC commonly develops in the presence of chronic liver cell injury, which produces inflammation, leading to hepatocyte regeneration and fibrosis. Repeated cycles of cell death and regeneration ultimately lead to cirrhosis, which is found in 60% to 80% of patients with HCC.

Chronic infections with Hep B virus and Hep C virus are the most important cause of liver damage worldwide. Long-term exposure to toxic chemicals is associated with HCC. Less common risk factors include certain genetic metabolic diseases, such as hereditary hemochromatosis, hereditary tyrosinemia, and antitrypsin deficiency. Aflatoxin B1 has the highest potency among the aflatoxins as a toxin and carcinogen. Chronic alcohol use is an important cause of cirrhosis

Abdominal pain Hepatomegaly Increasing abdominal girth secondary to ascites Anorexia Weight loss Hepatic arterial bruits Jaundice

Splenomegaly Fever Weakness and nonspecific symptoms Paraneoplastic syndromes (hypoglycemia, erythrocytosis, hypercalcemia, hyperthyroidism, hypercholesterolemia, carcinoid syndrome)

Center on the prevention of chronic liver damage and cirrhosis. Universal vaccinations of newborns against HBV in endemic areas may dramatically reduce incidence. Interferon - E is an approved treatment to reduce both liver damage and the onset of cirrhosis in chronic HBV, as well as prevent the development of HCC.

Refrigerated storage and transportation of food grains should reduce the rate of ingestion of aflatoxins. Continued efforts to reduce chronic alcohol abuse is also important. Screening high-risk individuals with annual ultrasounds and obtaining an Efetoprotein tumor marker every 4 months has helped to identify HCC at early stages.

High risk patients with elevated AFP levels and patients seen with clinical features of HCC should undergo a high-speed helical CT scanning, allowing threedimensional reconstitution and vascular imaging w/o invasive angiography. (Magnetic Resonance Imaging (MRI) is more sensitive)

Transcutaneous ultrasonography can be used to identify liver lesions, guide percutaneous biopsy, and provide treatment by direction injection or ablation techniques. Intraoperative ultrasound can determine the number and extent of lesions, as well as the association of intrahepatic arteries and veins. Laparoscopic ultrasound probes can exclude the presence of extra hepatic disease on perotonial surfaces.

Common sites for distant metastases from HCC, which usually develop late in the disease course, are the lung, bone, and the adrenal glands. Recurrent or progressively enlarging liver lesions are serious conditions , since they greatly affect the liver function. Death usually occurs due to liver failure, fatal bleeding, tumor rupture, or esophageal varices.

Surgery Chemotherapy Radiation Therapy

PREVENTIVE MANAGEMENT Note if client works in high risk occupation. Assess for exposure to contaminated food or poor sanitation practices by food service workers. Determine presence of condition noting whether problem is acute or chronic.

Stress importance of responsible drinking or avoiding alcohol, when indicated. Identify signs/symptoms that warrant prompt notification of health care provider. Encourage client with liver dysfunction to avoid fatty foods. Discuss safe use/concerns about clients medication regimen, certain cardiovascular drugs, antidepressants.

Refer to specialist/liver treatment center, as indicated. Discuss the need for vaccination, as indicated. Discuss the appropriateness of prophylaxis immunizations. Refer to community resources, drug/alcohol treatment program, as indicated.

Acute pain related to side effects of therapeutic agents as evidenced by verbal report of pain. Imbalanced nutrition less than body requirements related to interference of metabolism of nutrients and amino acids as evidenced by weight loss.