Some of the functions of the PLAIN summaries work best on the desktop version. We are currently working on optimizing the mobile version.
Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
LIVER PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
This PLAIN summary is based on the IGHG* guideline about “Hepatic toxicity” [1].
PLAIN version 2.1: 27/05/2024
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.
The liver
Created with BioRender.com
Hover over the numbers in the figure for more information.
Survivors
Liver fibrosis or cirrhosis
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 and Overweight and obesity.
Graft versus host disease
Stem cell transplantation is a type of cancer treatment that involves taking stem cells from the blood of a donor (‘graft’) and putting them in your body (‘host’). Sometimes these stem cells can attack your own cells because they falsely recognize them as foreign and attack them. This is called GvHD.
GvHD can have serious health implications when you are experiencing it but it can also put you at higher risk of some late effects.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Hepatitis
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
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.
Symptoms and signs
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 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 long-term follow-up (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.
Long-term follow-up (LTFU)
In LTFU, you will be monitored and tested for potential late effects according to your Survivorship Care Plan. If you don’t have one, contact your LTFU specialist or GP. For more information about the survivorship care plan click here.
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.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
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:
- British Liver Trust: Here you can find more information about liver problems and about support for those affected by it in the UK
- World Health organisation (WHO): Here you can find more information about the different types of hepatitis viruses
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.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
*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