Liver Problems Caused by Cancer Treatment

What does my liver do?

Your liver is an organ and gland in your abdomen (belly), on the right side of your body under your ribcage. It is spongy and wedge-shaped. Your liver does many things, like:

• Cleaning your blood.
• Making bile (a fluid that helps break down food).
• Making proteins that help your blood clot.
• Producing hormones your body needs.

Can cancer treatment affect my liver?

Yes, some cancer treatments can affect how your liver works and cause liver toxicity or hepatotoxicity. This is damage to the liver caused by exposure to harmful substances. It is important to tell your care team if you have a history of liver problems since some treatments can make these problems worse. Steps will be taken to help protect your liver. Blood work, like liver function tests (LFT’s) can be done to check how well your liver is working.

Which cancer treatments can affect my liver?

Cancer treatments that may affect your liver are:

• Chemotherapy and Immunotherapy: Some chemotherapy and immunotherapy medications are systemic. This means they enter your bloodstream and go throughout your whole body. Your liver processes and filters these medications. Some chemotherapies and immunotherapies are known to cause liver problems, so you may get extra fluids, medications, or other treatments to prevent or lessen this damage.
• Targeted Therapy: Targeted therapies use drugs to target genes and proteins that control how cancer cells grow, divide, and spread. Some targeted therapies can cause damage to your liver.
• Radiation Therapy: Radiation therapy to your liver or areas near your liver, like your abdomen (belly) can damage your liver and how it works. Your care team will try to limit the damage to your liver by making the radiation area as small and accurate as possible. The effect of radiation on your liver depends on:
  • The dose of radiation.
  • How often you receive it.
  • Any liver problems you might already have.
• Radiopharmaceutical Therapy (RPT): RPT is a treatment that uses a small amount of radioactive medicine given by vein (IV) or by mouth to treat cancer. It is a targeted type of treatment that attacks cancer cells, while mostly leaving healthy cells unharmed. Some of the RPT medications have a risk of liver damage.
• Stem Cell Transplant: The chemotherapy medications and radiation given before a stem cell transplant can cause liver problems. Liver damage can be caused by the transplant itself or by complications of the transplant.

What are the symptoms of liver problems?

Symptoms of liver problems can be:

• Jaundice or yellowing of the skin or eyes.
• Urine looking dark or brown.
• Pale stool.
• Pain in your abdomen (belly).
• Bruising easily.
• A buildup of fluid in your belly (ascites).
• Swelling in the legs.
• Itching.
• Feeling very tired.
• Not feeling hungry.
• Bruising or bleeding easily.
• Feeling generally unwell (malaise).
• Nausea or loss of appetite.

 Tell your provider if you have any of these symptoms.

How are liver problems treated?

Your provider may monitor you for liver toxicity using blood tests called liver function tests. If your liver function test shows your liver is damaged, your healthcare provider may need to change your treatment plan.

What can I do to lessen or prevent liver problems?

Before starting treatment for cancer, ask about things you should do at home to protect your liver, like drinking enough fluids or following a certain diet. You can also do things to help keep your liver healthy like:

• Not drinking alcohol.
• Not smoking.
• Avoid other chemicals that can harm the liver (solvents, paint thinners, aerosol cleaners, and insecticides).

When should I call my provider?

Call your provider if you have any of the symptoms of liver problems listed above. Talk with your care team about your risk of liver problems from your specific cancer treatment and ask them any questions you may have.