LIVER PROBLEMS

Liver problems

The liver is an organ in the right upper abdomen, just beneath the rib cage. The liver has multiple functions and one of the main ones is to filter toxic substances and remove them from the bloodstream. The liver also produces bile and proteins that help in the digestion of food. Bile produced by the liver is temporarily stored in the gallbladder and then it is released into the gut in order to help digestion.

Sometimes problems can occur with the liver. Liver problems include:

  • Liver fibrosis or cirrhosis, where the liver tissue becomes scarred.
  • Liver failure, where the liver function is decreased or stops working.
  • Biliary tract damage, which may interfere with the release of bile from the gallbladder.
  • Iron overload, where the liver does not clear enough iron from the bloodstream. This causes too much iron to build up in the body (iron overload).

Most survivors do not develop liver problems. There are a number of things anyone can do that may lower your risk of liver problems, such as avoiding or limiting alcohol use.

Am I at higher risk of liver problems?

Anyone, including people who have never had cancer treatment, may develop liver problems. However, we know that there are some medical conditions and cancer treatments that may increase the risk of having liver problems later in life. The problems that can occur depend on the type of cancer treatment received.

The following medical conditions can cause liver problems:

  • A chronic (long-term) viral infection of the liver, also called viral hepatitis.
  • Chronic graft-versus-host-disease (GvHD), which can occur after stem cell transplantation.
  • Sinusoidal obstruction syndrome (veno-occlusive disease), where smaller blood vessels in the liver are blocked.

If you had the following treatments, this may increase the risk of liver problems:

  • Radiotherapy to the liver or an area that includes the liver
  • Stem cell transplantation
  • Certain chemotherapy drugs (methotrexate, mercaptopurine, thioguanine, dactinomycin and busulfan). Any dose of these chemotherapy drugs can cause liver problems.
  • Multiple red blood cell transfusions as a risk factor for iron overload
  • Surgery to the liver

You can find out if you had any of these medical conditions or treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you experience liver problems, it does not always mean that this is caused by your cancer treatment. Liver problems may have other causes, such as drinking (too much) alcohol, certain infections, dyslipidemia and being overweight. For more information on dyslipidemia and being overweight and obese, please read: Dyslipidemia, overweight and obesity.

What are the symptoms and signs of liver problems?

There are symptoms and signs that can tell you if you might have liver problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

These symptoms and signs may suggest that you have liver problems:

  • Yellow coloured eyes and/or skin. This is also known as jaundice (icterus).
  • Dark orange, amber or brown coloured urine and/or pale stool
  • Nausea, vomiting or abdominal pain
  • Itchy skin
  • Feeling (very) tired all the time
  • Bruising easily

If you recognise any of these symptoms or signs in yourself, please contact a general practitioner or follow-up care specialist.

I am at higher risk of liver problems. What tests should I have and when?

If you are at higher risk of liver problems, it is advised to:

  • Have a physical examination once at entry into long-term follow-up (LTFU).
  • Have a blood test to measure liver proteins (enzymes) in the blood once at entry into LTFU.

If you have received 10 or more red blood cell transfusions, it is also advised to have a blood test which measures ferritin (another protein produced by the liver) once at entry into LTFU.

If your blood tests are abnormal, it may be necessary to confirm the diagnosis by repeating the blood test. Sometimes additional tests, such as an ultrasound of the liver, are needed.

What happens if I have liver problems?

If you have liver problems, your general practitioner or follow-up care specialist will probably refer you to a specialist. Depending on the symptoms and/or signs you experience, you may be referred to a:

  • Hepatologist (physician specialised in the liver)
  • Gastroenterologist (physician specialised in the digestive system)

The specialist may discuss different treatment options with you.

In addition, when having liver problems, it is advised to avoid drinking alcohol and taking over the counter medication that may further damage your liver function (eg. Paracetamol, Ibuprofen). Prescribed medication can also be harmful for the liver, but before you stop taking any prescribed medication, always discuss this with your general practitioner or follow-up care specialist first.

What else can I do?

Knowing you have an increased risk of liver problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

To lower your risk of liver problems, adopting or maintaining a healthy lifestyle and a healthy weight is extremely important. In particular, it is important to avoid or limit alcohol use. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

Vaccination against hepatitis A and B may reduce the risk of developing liver problems. A vaccination against hepatitis B will also protect you from an infection with hepatitis D. There are currently no vaccines available against hepatitis C and E. If you would like to get vaccinated, please discuss this with your general practitioner or follow-up care specialist.

It is important that you are aware of the possibility of developing liver problems and that you know the symptoms and signs. If you have any further questions or the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about liver problems online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

On this website, you can also find more information related to this topic:

Please note

This PLAIN summary is based on the IGHG* guideline about “Hepatic toxicity” [1].

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

*International Guideline Harmonization Group for Late Effects of Childhood Cancer

[1] Bardi, E. et al. (2021) Late hepatic toxicity surveillance for survivors of childhood, adolescent and young adult cancer: Recommendations from the international late effects of childhood cancer guideline harmonization group. Available at: https://www.cancertreatmentreviews.com/article/S0305-7372(21)00144-4/fulltext