LIVER CANCER

liver
 Anatomy and physiology

Anatomy
- The liver is in the upper abdomen near the stomach, intestines,
gallbladder, and pancreas. The liver has four lobes. Two lobes are on the
front and two small lobes (not shown) are on the back of the liver.
Intrahepatic bile ducts are a network of small tubes that carry bile inside
the liver. normal size of liver for
adult
1.5 kg or 1500g and 15 cm 6
in thick according to
Brunner and Suddarth.
 Anatomy and physiology

Physiology
- Because all the blood in the body must pass through it, the liver is
unusually accessible to cancer cells traveling in the bloodstream. The liver
can be affected by primary liver cancer, which arises in the liver, or by
cancer which forms in other parts of the body and then spreads to the
liver. normal size of liver for
adult
1.5 kg or 1500g and 15 cm 6
in thick according to
Brunner and Suddarth.
FUNCTIONS OF LIVER

Process of nutrients Regulate blood

composition
Destroys old RBC’s

Produces Bile

Detoxes
blood Produces protein
cholesterole

Breakdown alcohol Control metabolic

and medications process
Liver Cancer

Liver cancer is cancer that begins in the cells of your liver and also known as
hepatic cancer. Your liver is a Football-sized organ that sits in the upper right
portion of your abdomen, beneath your diaphragm and above your stomach
in this condition liver stop functioning properly due to the presence of growth
of the cancerous cells in the liver
TYPES OF LIVER CANCER

PRIMARY LIVER CANCER

-Originates in the liver where abnormal cells begin dividing and
multiply rapidly
Hepatocellular carcinoma
- Hepatocellular carcinoma (HCC)
is the most common type of primary liver
cancer. Hepatocellular carcinoma occurs
most often in people with chronic liver
diseases, such as cirrhosis caused
by hepatitis B or hepatitis C infection.
TYPES OF LIVER CANCER

PRIMARY LIVER CANCER

-Originates in the liver where abnormal cells begin dividing and
multiply rapidly
Cholangiocarcinoma
- Also known as bile duct cancer,
cholangiocarcinoma occurs in the small, tube-
like bile ducts within the liver that carry bile to the
gallbladder.
Cholangiocarcinomas account for 10 percent to 20
percent of all liver cancers,
and about 8,000 patients are diagnosed with bile
duct cancer each year in the
United States, according to the ACS.
TYPES OF LIVER CANCER

PRIMARY LIVER CANCER

-Originates in the liver where abnormal cells begin dividing and
multiply rapidly
Angiosarcoma of the liver
- Angiosarcoma of the liver accounts for about
1 percent of all liver cancers.
Angiosarcomas begin in the blood vessels of
the liver and grow quickly.
They are typically diagnosed at an advanced
stage. About one in a million people are
estimated to be diagnosed with angiosarcoma
each year in the United States,
according to the National Cancer Institute
(NCI).
 TYPES OF LIVER CANCER

SECONDARY LIVER CANCER

-Result of cancer from nearby or different internal organs from other
sites that spread to the liver.
Risk factors

Factors that increase the risk of primary liver cancer include:

1. Chronic infection with HBV or HCV.
2. Cirrhosis.
3. Certain inherited liver diseases.
4. Diabetes.
5. Nonalcoholic fatty liver disease.
6. Exposure to aflatoxins.
7. Excessive alcohol consumption.
4 Stages of Liver Cancer

STAGE 1
-The tumor is just in/on the liver and no where else
STAGE 2
-There are several small tumors with little increase of size , but
all within the liver, or one tumor that has reached a blood
vessel.
STAGE 3
-large tumor that reached the main blood vessels. Cancer may
have also reached the gallbladder.
4 Stages of Liver Cancer

STAGE 4
the liver cancer has spread to other parts of the body also
called as Metastasis.
CLINICAL FEATURES

Most people dont 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
● General weakness and fatigue
● Abdominal swelling
● Yellow discoloration of your skin and the whites of your eyes (jaundice)
● White, chalky stools
 SCREENING

High risk individuals include those with hepatitis Cand B, patients with
alcohol-related cirrhosis and other alcohol abusers, they should have
regular screening.

PHYSICAL EXAMINATION
check the abdomen for lumps,swelling, ascites
sign for jaundice- yellowing of the skin and sclera.
LFT: Liver function test blood test that measured different
substances that made by your liver to know if your liver is still
functioning. ALPHA-FETOPROTEIN
 SCREENING

IMAGING SCANS
ULTRASOUND
CT SCAN: to measure the tumor’s size.
MRI: to identify the extent of the liver
PET scan: liver scans
BIOPSY: A small sample of tissue is removed and analyzed,
that can reveal whether the tumor is cancerous (malignant) or
non-cancerous(benign).
MOLECULAR TESTING: to identify specific genes, proteins , to
plan for targeted therapy.
 TREATMENT

PERCUTANEOUS BILIARY DRAINAGE

It is used to bypass biliary ducts obstructed by the liver,
pancreatic, bile ducts in patients with inoperable tumors or those
who are poor surgical risks.
COMPLICATION: sepsis, leakage of bile, hemorrhage, and re
obstruction of biliary system.
OBSERVE PATIENT FOR:
Fever and chills
bile drainage around the catheter
changes in Vs
EVIDENCE OF BILIARY OBSTRUCTION : increased pain or pressure,
pruritus and recurrence of jaundice.
 TREATMENT

PERCUTANEOUS BILIARY DRAINAGE

It is used to bypass biliary ducts obstructed by the liver,
pancreatic, bile ducts in patients with inoperable tumors or those
who are poor surgical risks.
COMPLICATION: sepsis, leakage of bile, hemorrhage, and re
obstruction of biliary system.
OBSERVE PATIENT FOR:
Fever and chills
bile drainage around the catheter
changes in Vs
EVIDENCE OF BILIARY OBSTRUCTION : increased pain or pressure,
pruritus and recurrence of jaundice.
PERCUTANEOUS BILIARY DRAINAGE
 TREATMENT

CHEMOEMBOLIZATION : Is a palliative treatment for patient

that has liver cancer, this could be a liver cancer that
started there or a cancer that moved from other parts of the
body to the liver (metastasized).
embolization of tumor vessels with chemotherapy
an implant pump to deliver high- concentration
chemotherapy , to the liver through the hepatic artery
in chemoembolization the blood supply to the tumor is
blocked surgically or mechanically and anticancer drugs
are administered directly into the tumor.
CHEMOEMBOLIZATION
drug therapy

targeted drugs work by interfering with specific

abnormalities within a tumor
to slow or stop advanced hepatocellular carcinoma from
progressing for few months longer than with no
treatment e.g Sorafenib- is used to treat late-stage
kidney cancer (advanced renal cell carcinoma), liver
cancer (hepatocellular carcinoma) that cannot be
treated by surgery, and differentiated thyroid cancer
that has come back or spread to other parts of your
body. Sorafenib is an antineoplastic (cancer) agent.
 RADIOTHERAPY

Radiotherapy IV or intra-arterial injection of antibodies

tagged with radioactive isotopes that specifically attack
tumors associated with antigens percutaneous placement of
a high-intensity source for inter- stitial radiation therapy
patient may experience nausea, vomiting, fatigue.
embolization ischema and necrosis of the tumor occur
for multiple small lesions , ultrasound-guided injection of
alcohol promotes dehydration og tumor cells anf tumor
necrosis
SURGICAL MANAGEMENT

1. HEPATECTOMY : liver resection is a surgical operation to

remove part or all of your liver.
it can only done if the cancer is in 1 part of the liver. the
remaining section of the liver take over the functioning
of the entire liver.
CONTRAINDICATION:
advanced cirrhosis, small tumor.
SIDE EFFECTS
pain, weakness, fatigue, and temporary liver failue.
SURGICAL MANAGEMENT

1. HEPATECTOMY
NURSE RESPONSIBILITIES
watch for sign of bleeding, infections or liver failure.
SURGICAL MANAGEMENT

2. LIVER TRANSPLANT
This procedure is possible only suitable donor is found.
however liver transplant has significant risk of serious
complication , including from infection or the body’s
rejection of the donor liver.
sign of body rejection
puffiness in the face ( facial edema)
increased of blood pressure
Palliative care

Palliative care plans vary widely among people with liver cancer due to the
complicated nature of the disease and the high likelihood of coexisting
conditions.
It may involve one or more of the following services:
management or relief of symptoms from liver cancer, including pain, fatigue,
ascites, weight loss, nausea, anxiety, depression, shortness of breath, and skin
problems
advance care planning that focuses on your definition of “quality of life”
completing advance directives
psychosocial support, such as referrals to support groups or art therapy
programs
spiritual or religious activities
support and advice for treatment decision-making, stress management for you
and your family, and other concerns
care coordination between your various health care specialists
NURSING INTERVENTION

monitor vital sign

restricts sodium, fluids and proteins
prohibits alcohol
to increased venous return and prevent edema, elevate the
patients legs whenever possible.
turn the patients frequently and keep his skin clean to prevent
pressure
monitor patients for fluid retention and ascites
monitor respiratory function
provide comprehensive care and emotional assistance.
 pass bagong buhay
PREVENTION Shot mo par!
par
ALCOHOL
long- term, regular high alcohol intake
significantly increases the risk of cirrhosis
, which in turn makes likelihood of developing liver cancer

HEPATITIS B, C
advise to take hepatitis vaccine
drug addicts who share needles are at risk
practice safe sex to prevent hep- B infection
REFERENCES
https://www.healthline.com/health/treating-hcc/palliative-care#Starting-palliative-care
https://www.cancer.gov/types/liver/what-is-liver-
cancer/treatment#:~:text=Treatment%20of%20locally%20advanced%20or%20metastatic%20live
r%20cancer,-
Treatment%20of%20locally&text=embolization%20therapy%20using%20transarterial%20emboliz
ation,%2C%20cabozantinib%2C%20bevacizumab%2C%20or%20ramucirumab
https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664
https://my.clevelandclinic.org/health/diseases/9418-liver-cancer
https://www.cancer.org/cancer/types/liver-cancer/treating/by-stage.html

THANKYOU

ALOOT, ALYSA
ALOOT, ANGELI
ALIPIT, MC. GREGOR.
PANCREATIC
CANCER
MEDICAL SURGICAL REPORTING
GROUP 1
 Table Of Contents

Predisposing Factors
01 Introduction &
Sign/ Symptoms
02 & Complications

Diagnosis & Treatment/

03 Nutrition
 01
Introduction
& Signs and
Symptoms
DIGESTIVE
SYSTEM
What is “PANCREATIC CANCER?”
1. It occurs when cells in your pancreas develop genetic mutations. These
mutations cause the cells to grow uncontrollably and to continue living after
normal cells would die. These accumulating cells can form a TUMOR.

2. It is often has a poor prognosis, even when diagnosed early. Most likely it
spreads rapidly and is seldom detected in its early stages, which is a major
reason why it is a leading cause of cancer death.

3. The signs and symptoms of pancreatic cancer may not appear until pancreatic
cancer is quite advanced and surgical removal isn’t possible.
 Who gets it?

Most pancreatic cancer is diagnosed AFTER AGE 65.

Smoking, Diabetes, Chronic Pancreatitis or Inflammation of
the Pancreas, Family History of pancreatic cancer, and certain
genetic syndromes are all known as risk factors. Carrying
extra weight that is unhealthy for your body may also be a
contributing factor.
ANATOMY &
PHYSIOLOGY
 Types of Pancreatic
Cancer
1. Cancer that forms in the pancreas ducts
(Adenocarcinoma)

2. Cancer that forms in the hormone -

producing cells
 Neuroendocrine
Adenocarcinoma Tumor
Cells that line the ducts of the Cancer that forms in the
pancreas to help produce Hormone- Producing cells of the
digestive juices. pancreas.
Signs & Symptoms
1. Upper Abdominal pain that may radiate to your
back.
2. Yellowing of skin and eyes (Jaundice)
3. Loss of Appetite
4. Weight Loss
5. Depression
6. Bowel Obstruction
7. Nausea and Vomiting
8. Weakness
 02
Predisposing
Factors &
Complications
Causes and risk factors
Pancreatic cancer is a disease caused by damage to DNA (Inheritance or Carcinogens)

Modifiable Non-modifiable

Smoking Increased age

Alcohol consumption Chronic pancreatitis
Obesity Genetic syndromes - MEN, VHL
Occupational exposures Immunosuppression
Prolonged use of corticosteroids or FAmily history
Antibiotics
Stages of pancreatic cancer
STAGE 0 - Also known as “Carcinoma in City”. Characterized by abnormal
cells in the lining of the pancreas.
STAGE 1 - The tumor is in the pancreas

STAGE 2 - The tumor has spread to nearby tissues, organs or lymph nodes.

STAGE 3 - The cancer has spread to major blood vessels near the pancreas.

STAGE 4 - Cancer has spread to distant areas in the body such as the liver, lungs or
abdominal cavity
Complications
Weight loss

∟ Nausea and vomiting caused by cancer treatments or a tumor pressing on stomach may make it
difficult to eat

Pain

∟ Growing tumor may press on nerves in abdomen, causing pain that can become severe

Bowel obstruction

∟ Pancreatic cancer that grows and presses on the first part of the small intestine (duodenum), can block
the flow of digested food from the stomach into intestines

Jaundice

∟ Pancreatic cancer that blocks the liver’s bile duct can cause jaundice
03
Diagnosis &
Interventions
/Nutritions
 DIAGNOSTIC PROCEDURES:
1. Ultrasound
- Sound waves can be used to form images of the abdomen that identify the presence of
tumor. Ultrasound is performed by placing a probe on the surface of the abdomen while
looking at the image on the screen. This procedure is non-invasive and painless.
2. CT Scan
- Generate 2D images of the body that can show whether cancer has invaded other tissues or
organs
3. MRI
- Technology that uses magnetic fields and radio waves to create detailed images of the
pancreas. It is designed to be highly sensitive, this technology can identify small
abnormalities.
4. ERCP
- A thin Flexible Tube (Endoscope) is passed down the throat, through the stomach and into
the upper small intestine and dye is injected into the pancreas
5. PTC
- A procedure that has a thin needle that is inserted into the liver to deliver dye to the bile
ducts.
 MRI
MRI

PTC

ERCP
 DIAGNOSTIC PROCEDURES:
a. Biopsy
- A small tissue collected by fine- needle aspiration (FNA) is examined under a microscope by
a pathologist
b. Endoscopic Ultrasound
- It is an ultrasound probe that is passed through an endoscope into the stomach. Sound waves
are directed toward the pancreas and a computer translates them into images.
c. Blood Sample
- Liver Function Tests will reveal elevations that correspond to jaundice, The first sign of
pancreatic cancer.
- Tumor Markers are found in the blood.
- Increased CA 19-9 and Carcinoembryonic antigen (CEA) helps identify pancreatic cancer.
- Total Bilirubin of 2-3 mg/dL indicates jaundice.
d. Review the stage
- After diagnosis, doctors will identify the spread of the cancer using staging. Pancreatic
cancers range in stages from 0 (carcinoma in situ) through stages I (1) to IV (4), along with
TNM staging, which identifies the extent of the (T) tumor, spread to lymph (.N) nodes, and
(M) metastasis to other organs or bones.
ULTRASOUND PANCREATIC CANCER
 NURSING INTERVENTIONS
1. Assist with surgical interventions.
- The primary type of treatment for pancreatic cancer is surgery.
- However, Chemotherapy and Radiation Therapy play a significant role in patients with
unresectable disease and as adjuvant or neoadjuvant treatment.
- Whipple procedure (pancreaticoduodenectomy) benefits most patients with tumors in the
pancreas head or the junction between the small intestines and the pancreas. The distal
pancreatic duct and biliary system are surgically drained during the procedure due to shared
blood supply. It usually involves removing the pancreatic head, duodenum, gallbladder, and
stomach antrum.
- Distal pancreatectomy is indicated for malignancies found in the body or tail of the pancreas.
The spleen may be removed as well. Total pancreatectomy is the least performed surgical
procedure. The entire pancreas, gallbladder, part of the stomach, small intestine, and spleen
are removed.

2. Educate on the different cancer treatment modalities.Treatment options for patients with pancreatic
cancer depend on the type, stage, and other aspects of cancer:
- Neoadjuvant treatment (chemotherapy and/or radiation) prior to surgery is preferred
for locally advanced unresectable pancreatic cancer.
 NURSING INTERVENTIONS
- Adjuvant therapy includes treating patients with resected pancreatic cancer with FOLFIRINOX
(FOL = Leucovorin Calcium (Folinic Acid); F = Fluorouracil; IRIN = Irinotecan Hydrochloride;
OX = Oxaliplatin) chemotherapy regimen.

3. Control the tumor growth.

Radiation treatment can be coupled with chemotherapy (chemoradiation). Typically, chemotherapy treats
cancer that has not metastasized (spread) to other organs from the pancreas. Chemotherapy may control tumor
growth, ease symptoms, and extend survival in patients with advanced pancreatic cancer and metastasis.

4. Consider radiation therapy.

Traditional radiation therapy employs X-rays to treat cancer, but a more recent radiation treatment uses
protons. Proton therapy can treat pancreatic cancer and have fewer adverse effects than conventional radiation
therapy.

5. Relieve the pain.

It is essential to utilize narcotic analgesics promptly and in appropriate dosages. Tricyclic antidepressants or
antiemetics can enhance the analgesic effects of narcotic analgesics.
 NUTRITION
1. Monitor the weight regularly.

- Patients with pancreatic carcinoma frequently exhibit weight loss due to anorexia (loss of
appetite), as do most patients with advanced malignancy.

2. Determine the presence of malnutrition.

- Assess if malnutrition is present and identify the possible cause.

.3. Administer pancreatic enzymes as prescribed.

- Pancreatic enzyme supplements may help patients with diarrhea caused by malabsorption
who are also losing weight.

4. Avoid alcohol and fats.

- Patients with pancreatic cancer should refrain from drinking alcohol and eating fatty, fried
meals since they are hard to digest and can cause diarrhea, gas, and bloating.
 NUTRITION
5. Choose foods that are easy to digest.

- The pancreas is essential in digesting food but may not work as well due to cancer or
treatments.
Q&A
TIME
STOMACH CANCER
ABARENIO, ALLIANA B.
ABELLA, AIRA D.
ACOSTA, CHESKA P.
AGUSTIN, JASMINE GWEN M.
 ANATOMY

• The stomach J-shaped. The stomach has 5

parts: CARDIA, FUNDUS, BODY(corpus),
ANTRUM, an PYLORUS.
STOMACH CANCER

• Stomach cancer is characterized by a growth of cancerous cells

within the cancer
➢ Gastric lining of thetostomach.
refers malignant Also called
lesions found gastric cancer, this
in the stomach.
➢ It of
type is more common
cancer in men than
is difficult women. because most people
to diagnose
➢ The most common cause is infection by the bacteria HELICOBACTER
typically don't show symptoms in the earlier stages.
pylori.
➢ Most cases of the stomach cancers are gastric carcinomas
➢ Gastric cancer refers to malignant lesions found in the stomach.
➢ It is more common in men than women.
➢ The most common cause is infection by the bacteria HELICOBACTER pylori.
➢ Most cases of the stomach cancers are gastric carcinomas.
➢ Gastric cancer refers to the malignant neoplasms found in the stomach,
usually adenocarcinoma.
 STOMACH CANCER

INCIDENCE
➢The incidence of gastric or stomach cancer continues to
decrease in the United States, it still accounts for more than
11,000 deaths annually.
➢The typical patient with gastric cancer is between 40 to 70 years
of age, but gastric cancer can occur in people younger than 40
years of age.
➢Stomach cancer is twice as common in men as in women more
common in whites in the United States.
➢It is estimated that 21,500 new cases of gastric cancer would be
diagnosed in 2003 with 13,00 deaths attributed to gastric cancer.
FUNCTIONS OF STOMACH
SIGNS AND SYMPTOMS

▪ INDIGESTION
▪ HEARTBURN
▪ ABDOMINAL PAIN
▪ LOSS OF APPETITE
▪ NAUSEA/ VOMITING
▪ WEIGHT LOSS
▪ FATIGUE
▪ FEELING FULL AFTER
SMALL AMOUNT OF FOOD
SIGNS AND SYPTOMS: TROISIER’S SIGN
RISK FACTORS
 DIAGNOSTIC FINDINGS
• Esophagogastroduodenoscopy • Barium x-ray
• Endoscopy
• CT
• CBC
 COMPLICATIONS

▪ Ascites
▪ Hepatomegaly
 TREATMENT

• Surgery Gastrectomy
• Chemotherapy (used before surgery are
5-FU (fluorouracil), often given along with
leucovorin (folinic acid), Capecitabine
(Xelode), Carboplatin, Cisplatin, etc. After
surgery are ECF (epirubicin, cisplatin, and
5-FU).
• Targeted therapy
➢ Trastuzumab (a recombinant humanized
anti-HER-2 monoclonal antibody)
prescribed in combination with
fluorouracil or capecitabine and cisplatin
has shown an improvement in survival of
patients with advanced gastric cancer
who are HER-2 positive
• Radiation therapy.
REFERENCES

Medical surgical book. Volume 2

https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438
https://www.cancer.gov/types/stomach/causes-risk-factors
https://www.slideshare.net/AbhayRajpoot3/stomach-cancer-229711607?fbclid=IwAR2wO8yC1_-
wRM1Jmf4Zh1Bc3wlly2M8-_fqDZekLbBrt4vdwrnWW7lSKxg
https://www.google.com/search?q=functions+of+stomach&tbm=isch&chips=q:functions+of+stomach,
online_chips:diagram:b_vPmEh6O2c%3D&rlz=1C1CHZN_enPH989PH989&hl=en&sa=X&ved=2ahUKE
wju74zTyYaDAxW6VmwGHT7GA7MQ4lYoAXoECAEQNg&biw=1519&bih=707#imgrc=-
7_jfIN_Lb23AM&imgdii=qbjjUYNYgWNJ0M
https://www.google.com/search?q=functions+of+stomach&tbm=isch&chips=q:functions+of+stomach,
online_chips:diagram:b_vPmEh6O2c%3D&rlz=1C1CHZN_enPH989PH989&hl=en&sa=X&ved=2ahUKE
wju74zTyYaDAxW6VmwGHT7GA7MQ4lYoAXoECAEQNg&biw=1519&bih=707#imgrc=-
7_jfIN_Lb23AM&imgdii=qbjjUYNYgWNJ0M