Liver
Introduction
Treatment for childhood cancer is commonly associated with acute and often reversible hepatotoxicity.
Long-term hepatic effects following chemotherapy alone are uncommon, but there is little follow-up on long-term liver health in survivors of adult or childhood cancer.
Acute or subacute hepato-biliary injury is seen after:
- Radiation therapy (RT)
- Chemotherapy
- Hematopoietic stem cell transplantation (HSCT)
- Graft-versus-host-disease (GVHD)
- Supportive care measures:
- Transfusion-acquired hepatitis
- Transfusion associated iron overload
- Cholestatic disease from total parenteral nutrition (TPN)
Acute liver injury related to cancer therapy has varying pathophysiology including:
- Cholestasis
- Hepatocellular necrosis
- ductal injury
- steatosis
- veno-occlusion
Histological findings include periportal and concentric fibrosis and injury to sinusoidal endothelial cells
Chronic or delayed liver injury following childhood cancer is from hepatic fibrosis secondary to :
- inflammation from chronic viral hepatitis
- drug-induced injury
- fatty infiltration
Chronic GVHD involving the liver after HSCT is associated with:
- Hepatocellular necroinflammatory changes
- Paucity of interlobular bile ducts
- Intrahepatic cholestasis
Progressive fibrosis increases the risk of cirrhosis, portal hypertension, and hepatocellular carcinoma.
Normal liver anatomy and function:
The liver is an essential organ which has many important functions:
- Detoxification of drugs
- Synthesis of:
- Enzymes
- Production of biochemicals necessary for digestion
- Albumin
- Coagulation proteins
- Urea
- Steroids
- Cholesterol and primary bile acids Conjugation of bilirubin
- Enzymes
- Storage of fat soluble vitamins
- Hepatocytes responsible for gluconeogenesis and glycolysis
Liver function tests measure a number of liver enzymes. Elevated enzymes are associated with liver inflammation.
Links:
Liver anatomy and function at Wikipedia
The liver at University of Maryland Medical Center
Liver function tests at Wikipedia
