Liver problems are common among cancer patients. Should particular care be taken when treating these patients? What problems can occur in terms of treatment? We talked about this topic with Dr. Pietro Invernizzi.
What are the most important issues in the treatment of an oncological patient who also suffers from liver problems?
Some distinctions need to be made. First, in most patients diagnosed with liver cancer, this disease is related to an advanced liver disease. In these patients, it is necessary to pay great attention to residual liver function, both in planning medical therapy and in planning any surgical resection surgery. However, when the liver disease is not related to the tumor, this should be taken into account for medical therapy, although most chemotherapeutics have more important side effects on the kidney than on the liver.
Are there other particular cases to be considered?
There is another hepatological problem that the oncologist specialist must always keep in mind and that is the risk of a reactivation of an infection with the B virus (hepatitis B), even when the infection seems to be no longer present in the patient, in patients who start chemotherapy, especially if it contains immunosuppressants. In these patients, the immunosuppression induced during chemotherapy allows the virus to replicate without immune control. This huge amount of virus in the liver to the suspension of chemotherapy and reconstitution of immune defenses causes a violent hepatic suffering, sometimes even fatal. To prevent this from happening, it is important to “screen” all patients who need to start chemotherapy and work with the hepatologist to initiate preventive antiviral therapy. The same problem obviously also applies to non-cancer patients who are immunosuppressed.