Hepatic tumors may be malignant or benign. Benign liver tumors were uncommon until oral contraceptives were in widespread use. Now benign liver tumors such as hepatic adenomas occur most frequently in women who are in their reproductive years and taking oral contraceptives. Few cancers originate in the liver. Primary liver tumors usually are associated with chronic liver disease, hepatitis B and C, and cirrhosis. Hepatocellular carcinoma (HCC), the most common type of primary liver tumor, usually cannot be resected because of rapid growth and metastasis elsewhere. Other types include cholangiocellular carcinoma and combined hepatocellular and cholangiocellular carcinoma. If found early, resection may be possible; however, early detection is unlikely.

Cirrhosis, chronic infection with hepatitis B and C, and exposure to certain chemical toxins have been implicated as causes of HCC. Cigarette smoking, especially when combined with alcohol use, has also been identified as a risk factor. Other substances that have been implicated include aflatoxins and other similar toxic molds that can contaminate food such as ground nuts and grains and may act as co-carcinogens with hepatitis B. Metastases from other primary sites, particularly the digestive system, breast, and lung, are found in the liver 2.5 times more frequently than tumors due to primary liver cancers.

• Early manifestations include pain (dull ache in upper right quadrant, epigastrium, or back), weight loss, loss of strength, anorexia, and anemia.
• Liver enlargement and irregular surface may be noted on palpation.
• Jaundice is present only if larger bile ducts are occluded.
• Ascites develop if such nodules obstruct the portal veins or if tumor tissue is seeded in the peritoneal cavity.

Diagnosis is made on the basis of clinical signs and symptoms, history and physical examination, and results of laboratory and x-ray studies, PET scans, liver scans, CT scans, ultrasound, MRI, arteriography, laparoscopy, or biopsy. Leukocytosis, erythrocytosis, hypercalcemia, hypoglycemia, and hypocholesterolemia can also be seen on laboratory assessment. Elevated levels of serum alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) may be found.

Nursing Management: Postoperative

See “Nursing Management” under Cancer for additional information.

• Provide close monitoring and care for the first 2 or 3 days.
• Assess for problems related to cardiopulmonary involvement, vascular complications, and respiratory and liver dysfunction.
• Monitor metabolic abnormalities (glucose, protein, and lipids).
• Instruct patient and family about care of the biliary catheter and the potential complications and side effects of hepatic artery chemotherapy.
• Educate patient about the importance of follow-up visits to permit frequent checks on the response of patient and tumor to chemotherapy, condition of the implanted pump site, and any toxic effects.
• Refer patient for home care.
• Encourage patient to resume routine activities as soon as possible, while cautioning about activities that may damage the pump or site.
• Provide reassurance and instruction to patient and family to reduce fear that the percutaneous biliary drainage catheter will fall out.
• Provide verbal and written instructions as well as demonstration of biliary catheter care to patient and family; instruct in techniques to keep catheter site clean and dry, to assess the catheter and its insertion site, and to irrigate the catheter to prevent debris and promote patency.
• Collaborate with the health care team, patient, and family to identify and implement pain management strategies and approaches to management of other problems: weakness, pruritus, inadequate dietary intake, jaundice, and symptoms associated with metastasis.
• Assist patient and family in making decisions about hospice care and initiate referrals. Encourage patient to discuss end-of-life care preferences with family and health care providers.

For more information, see Chapter 49 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.