Liver Health

The liver is a triangular-shaped organ tucked under the ribcage on the right side of the body.  In an average adult, the liver is about the size of a football and weighs about three pounds.  The liver is responsible for filtering out toxins from the blood, aiding with digestion and metabolism, and producing many important substances, including blood-clotting proteins.

Treatment for children’s cancer can sometimes damage the liver.  It is important to know about how the liver functions in order to keep the liver as healthy as possible.

Signs and Symptoms of Liver Damage

Many people with liver damage have no symptoms at all. Some people may develop jaundice (yellowish eyes and skin), dark urine, pale (clay-colored) stools, severe itching, easy bruising or bleeding, chronic fatigue, nausea, loss of appetite or other symptoms.  The liver sometimes enlarges (hepatomegaly), and as liver damage increases, the liver may become hard (fibrosis) and scarred (cirrhosis).  Eventually, there can be accumulation of fluid in the abdomen (ascites), swelling of the spleen (splenomegaly), or bleeding into the esophagus or stomach. Very rarely, liver cancer may develop.

Treatments for Children’s Cancer Which Can Cause Liver Problems

People who had radiation to the following areas may be at risk for liver problems:

  • Total Body Irradiation (TBI)
  • Radiation to the whole abdomen
  • Radiation to the liver, especially at doses of 20 Gy (2000 cGy/rads) or higher

The following chemotherapy drugs also have the potential to cause liver damage, although the most likely time for this to happen is during treatment or shortly after treatment ends.  It is very uncommon for these medicines to cause liver problems years after treatment:

  • Methotrexate
  • Mercaptopurine
  • Dactinomycin

Other risk factors include:

  • Medical conditions that involve the liver, such as a liver tumor or surgical removal of a large portion of the liver
  • Pre-existing liver problems
  • Excessive alcohol use
  • Chronic liver infection (hepatitis) - see related Health Link: “Hepatitis after Childhood Cancer”
  • History of multiple transfusions - see related Health Link: “Hepatitis after Childhood Cancer”
  • Chronic graft-versus-host disease (as a result of bone marrow or stem cell transplant)

Tests Performed to Monitor Liver Function

There are three main types of blood tests used to monitor the liver:

  • Liver enzyme tests monitor levels of specialized proteins that are normally present inside liver cells.  If liver cells are damaged, these proteins can leak out, causing high blood levels of liver enzymes.  The most common liver enzyme tests are:
  • Alanine aminotransferase (ALT), sometimes also called SGPT
  • Aspartate aminotransferase (AST), sometimes also called SGOT
  • Liver function tests are indicators of how well the liver is working.  Common liver function tests include:
  • Bilirubin—a waste product formed during the breakdown of red blood cells
  • Albumin—a major blood protein that is produced by the liver
  • Prothrombin Time (PT)—a measure of blood clotting

Follow-Up Care for those at Risk

A blood test to evaluate the liver (including ALT, AST, and bilirubin) should be done when survivors enter long-term follow-up care (usually about 5 years from diagnosis or 2 years following completion of therapy).  The liver should also be checked for enlargement by a healthcare professional during yearly physical examinations.  If problems are identified, additional tests and a referral to a liver specialist may be recommended.  People at risk for hepatitis may need further testing.

Keeping the Liver Healthy

  • If patients do not have immunity to hepatitis A and B, they should be immunized against these common infections to protect the liver (there is currently no vaccine to protect against hepatitis C).  A blood test can determine if a person has immunity to hepatitis A and B.
  • Drink alcohol in moderation.
  • Drink plenty of water.
  • Eat a well-balanced, high-fiber diet.  Cut down on fatty, salty, smoked and cured foods.
  • Do not take more than the recommended doses of medications.
  • Avoid taking unnecessary medications.
  • Do not mix drugs and alcohol.
  • Do not use illegal street drugs.
  • Check with a healthcare provider before starting any new over-the-counter medications or herbs and supplements to be sure that they do not have harmful effects on the liver.
  • If sexually active, use barrier protection (such as latex condoms) during intimate sexual contact to prevent infection by viruses that can damage the liver.
  • Avoid exposure to chemicals (solvents, aerosol cleaners, insecticides, paint thinners, and other toxins) that can be harmful to the liver.  When using these substances, wear a mask and gloves and work in a well-ventilated area.