Liver problems

What are liver problems?

The liver is located in the upper right part of the abdomen, just under the ribcage, and has several functions. One of the most important is to filter and remove toxins from the blood. The liver also produces bile and proteins that help digest food. Bile is first stored in the gallbladder and then released into the intestines.

Sometimes liver problems occur, such as:

• Liver fibrosis or cirrhosis: the liver tissue is damaged

• Liver failure: the liver functions less well or stops working

• Bile duct damage: bile does not reach the intestines

• Iron overload: the liver removes too little iron from the blood

Do I have an increased risk of liver problems?

Anyone, including people who have never had cancer, can develop liver problems. However, certain conditions and cancer treatments can increase the risk.

The following conditions may increase the risk of liver problems:

• Chronic viral infection of the liver (viral hepatitis)

• Chronic graft-versus-host disease after allogeneic stem cell transplantation (from a donor)

• Veno-occlusive disease: small blood vessels in the liver are blocked

The following treatments may increase the risk of liver problems:

• Radiotherapy to the liver or to an area including the liver

• Stem cell transplantation

• Chemotherapy: any dose of methotrexate, mercaptopurine, thioguanine, dactinomycin, and busulfan

• Multiple red blood cell transfusions

• Liver surgery

You can check your treatment summary to see whether you have had any of these conditions or treatments. If you do not have a summary, you can contact the LATER clinic or the hospital where you were treated. Liver problems do not always result from treatment; other causes include alcohol use, certain infections, dyslipidemia, or overweight and obesity.

What are the symptoms and signs of liver problems?

Certain symptoms and signs may indicate liver problems. Even if you do not currently have these symptoms, it is important to recognize them in case they occur in the future.

The following symptoms and signs may indicate liver problems:

• Yellowing of the eyes or skin (jaundice)

• Dark orange, amber, or brown urine

• Pale stools

• Nausea, vomiting, abdominal pain

• Itching

• Persistent (extreme) fatigue

• Easy bruising

If you recognize any of these symptoms or signs, contact your general practitioner or LATER doctor.

I have an increased risk of liver problems. What tests are needed and when?

If you have an increased risk of liver problems, it is recommended at your first LATER visit to:

• Have a physical examination

• Have your blood tested for liver proteins

• If you have received ten or more red blood cell transfusions, have your blood tested for ferritin, another liver protein

If abnormalities are found, additional tests may be required, such as an ultrasound of the liver.

What happens if I have liver problems?

If you have liver problems, your general practitioner or LATER doctor will likely refer you to a specialist. Depending on your symptoms and signs, this may be:

• Hepatologist (doctor specialized in the liver)

• Gastroenterologist (doctor specialized in the digestive system)

The specialist will discuss treatment options with you. You will likely be advised to stop drinking alcohol and avoid over-the-counter medications that affect the liver, such as paracetamol or ibuprofen. Always consult your doctor before stopping prescribed medications.

What else can I do?

Living with (an increased risk of) liver problems can be difficult. Talking with friends and family can help. Contact with others in a similar situation can also be helpful, for example through a patient organization such as VOX, part of the Dutch Childhood Cancer Organization.

Take good care of yourself. You can reduce the risk of liver problems by living a healthy lifestyle. It is especially important to avoid alcohol or drink as little as possible. Take care of your mental health as well. Small changes can already have a positive impact on your physical and mental well-being. Vaccination against hepatitis A and B can reduce the risk of liver problems. Hepatitis B vaccination also protects against hepatitis D. There are currently no vaccines for hepatitis C and E. Ask your general practitioner or LATER doctor if you want to be vaccinated.

It is important to know that you have an increased risk of liver problems and to recognize the symptoms and signs. If you have questions or concerns after reading this information, contact your general practitioner or LATER doctor.

Where can I find more information?

This LATER website also provides information on:

• Dyslipidemia

• Healthy lifestyle

• Mental health

• Overweight and obesity

The PanCare Plain Language Summaries provide links to reliable information in English. You can search online for information about liver problems, but be aware that it may not always be up-to-date or accurate.

Disclaimer

This information is based on the plain language summary of the guideline, prepared by the PanCare Plain Information Group, and has been adapted where necessary to the Dutch LATER guideline. Do not rely solely on this information if you have symptoms or concerns, but consult your general practitioner, LATER doctor, or specialist.