Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Liver Health after Cancer Treatment
Treatment for childhood cancer can sometimes damage the liver. It is important to know about how the liver functions
so that you can keep your liver as healthy as possible.
What is the liver?
The liver is a triangular-shaped organ tucked under the rib cage on the right side of the body. In an average adult, theliver is about the size of a football and weighs about three pounds. The liver is responsible for filtering out toxins fromthe blood, aiding with digestion and metabolism, and producing many important substances, including blood-clotting
proteins.
What are the signs and symptoms of liver damage?
Many people with liver damage have no symptoms at all. Some people may develop jaundice (yellowish eyes and skin),dark urine, pale (clay-colored) stools, severe itching, easy bruising or bleeding, chronic fatigue, nausea, loss of appetite,or other symptoms. The liver sometimes enlarges (hepatomegaly), and as liver damage increases, the liver may
become hard (fibrosis) and scarred (cirrhosis). Eventually, there can be accumulation of fluid in the abdomen (ascites),swelling of the spleen (splenomegaly), or bleeding into the esophagus or stomach. Very rarely, liver cancer may develop.
Who is at risk?
People who had radiation to the abdomen or received certain chemotherapy medicines (methotrexate, mercaptopurine,and/or thioguanine) may be at risk for liver problems. Liver problems related to medications typically occur duringcancer therapy and are unlikely to occur long after the end of treatment.
Other risk factors include:• Medical conditions that involve the liver, such as a liver tumor or surgical removal of a large portion of the liver• Development of sinusoidal obstruction syndrome (SOS, previously known as veno-occlusive disease [VOD]) duringtreatment• Pre-existing liver problems• Excessive alcohol use• Chronic liver infection (hepatitis)—see related Health Link: Hepatitis after Childhood Cancer• History of multiple transfusions•

Chronic graft-versus-host disease (as a result of bone marrow, cord blood, or stem cell transplant)

What tests are done to monitor the liver?
The following blood tests are used to monitor the liver.
• Liver enzyme tests monitor levels of specialized proteins that are normally present inside liver cells. If liver cells
are damaged, these proteins can leak out, causing high blood levels of liver enzymes. The most common liver
enzyme tests are:– Alanine aminotransferase (ALT), sometimes also called SGPT– Aspartate aminotransferase (AST), sometimes also called SGOT
• Liver function tests are indicators of how well the liver is working. Common liver function tests include:– Bilirubin (a waste product formed during the breakdown of red blood cells)– Albumin (a major blood protein that is produced by the liver)– Prothrombin Time (PT), a measure of blood clotting
Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Liver Health | Version 6.0 | October 2023 | Page 1 of 3

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer•

Tests for liver infection, including specific tests for viral hepatitis A, B, and C•

Test to check for iron overload (ferritin) related to multiple transfusions

What follow up is needed for those at risk?
A blood test to evaluate the liver (including ALT, AST, and bilirubin) should be done when the survivor enters into
long-term follow-up. Those who have undergone a bone marrow, cord blood, or stem cell transplant should also havea blood test to check for iron overload (ferritin). The liver should also be checked for enlargement by a healthcare
professional during yearly physical examinations. If problems are identified, additional tests and a referral to a liver
specialist may be recommended. People at risk for hepatitis may need further testing (see related Health Link:
Hepatitis after Cancer Treatment).
What can I do to keep my liver healthy?
• If you do not have immunity to hepatitis A and B, get immunized against these common infections in orderto protect your liver (there is currently no vaccine to protect against hepatitis C). You can find out if you have
immunity to hepatitis A and B by having a blood test (Hepatitis A IgG antibody and Hepatitis B surface antibody).
• If you drink alcohol, do so in moderation.
• Drink plenty of water.
• Eat a well-balanced, high-fiber diet. Cut down on fatty, salty, smoked and cured foods.
• Do not take more than the recommended doses of medications.
• Avoid taking unnecessary medications.
• Do not mix drugs and alcohol.
• Do not use illicit drugs.
• Check with your healthcare provider before starting any new over-the-counter medications or herbs andsupplements to be sure that they do not have harmful effects on the liver.
• If you are sexually active, use barrier protection (such as latex condoms) during intimate sexual contact toprevent infection by viruses that can damage the liver.
• Avoid exposure to chemicals (solvents, aerosol cleaners, insecticides, paint thinners, and other toxins) that canbe harmful to the liver. If you must use these substances, wear a mask and gloves and work in a well-ventilatedarea.
Written by Wendy Landier, PhD, CPNP, Children’s Hospital of Alabama, Birmingham, AL.
Reviewed by Daniel Smith, DNP, FNP; Kayla L. Foster, MD, MPH; and Melissa Acquazzino, MD, MS.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’sOncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Liver Health | Version 6.0 | October 2023 | Page 2 of 3

Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
Children’s Oncology Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.
No endorsement of any specific tests, products, or procedures is made by Informational Content, the Children’s Oncology Group, or affiliated party or member of the Children’s Oncology Group.
No Claim to Accuracy or Completeness: While the Children’s Oncology Group has made every attempt to assure that the Informational Content is accurate and complete as of the date of publication, nowarranty or representation, express or implied, is made as to the accuracy, reliability, completeness, relevance, or timeliness of such Informational Content.
No Liability on Part of Children’s Oncology Group and Related Parties/Agreement to Indemnify and Hold Harmless the Children’s Oncology Group and Related Parties: No liability is assumed
by the Children’s Oncology Group or any affiliated party or member thereof for damage resulting from the use, review, or access of the Informational Content. You agree to the following terms ofindemnification: (i) “Indemnified Parties” include authors and contributors to the Informational Content, all officers, directors, representatives, employees, agents, and members of the Children’s Oncology
Group and affiliated organizations; (ii) by using, reviewing, or accessing the Informational Content, you agree, at your own expense, to indemnify, defend and hold harmless Indemnified Parties from any
and all losses, liabilities, or damages (including attorneys’ fees and costs) resulting from any and all claims, causes of action, suits, proceedings, or demands related to or arising out of use, review oraccess of the Informational Content.
Proprietary Rights: The Informational Content is subject to protection under the copyright law and other intellectual property law in the United States and worldwide. The Children’s Oncology Groupretains excursive copyright and other right, title, and interest to the Informational Content and claims all intellectual property rights available under law. You hereby agree to help the Children’s Oncology
Group secure all copyright and intellectual property rights for the benefit of the Children’s Oncology Group by taking additional action at a later time, action which could include signing consents and legal
documents and limiting dissemination or reproduction of Informational Content.

Copyright 2023 © Children’s Oncology Group. All rights reserved worldwide.

Liver Health | Version 6.0 | October 2023 | Page 3 of 3