Liver Health after Childhood Cancer

Certain treatments for childhood cancer can damage the liver. Here’s what you need to know to assess your risk and help keep your liver healthy.

Am I at Risk?

Survivors who had high doses of radiation to the liver or abdomen are at risk for liver problems.

Certain chemotherapy drugs (such as methotrexate, mercaptopurine, thioguanine) also can cause liver damage, but this tends to occur during treatment or shortly after treatment ends.

Other factors that raise risk for liver problems include:

• health conditions that involve the liver, such as a liver tumor or surgical removal of a large part of the liver
• liver problems that occurred before cancer treatment
• drinking too much alcohol
• chronic liver infection; see related Health Link: “Hepatitis after Childhood Cancer”
• multiple transfusions
• chronic graft-versus-host disease after a bone marrow, cord blood, or stem cell transplant

What Are the Symptoms of Liver Problems?

Many people with liver damage have no symptoms. Others have these symptoms:

• yellowish eyes and skin (jaundice)
• dark urine
• pale stools
• severe itching
• easy bruising or bleeding
• chronic fatigue
• nausea
• loss of appetite

Symptoms of more severe liver damage include fluid in the abdomen, swelling of the spleen, or bleeding into the esophagus or stomach. Very rarely, liver cancer can occur.

Should I Be Checked for Liver Problems?

Survivors at risk for liver problems should have a blood test to evaluate the health of their liver when they enter into long-term follow-up care. Also, your doctor should check the size of your liver every year. If any liver problems are suspected, including hepatitis (see related Health Link: “Hepatitis after Childhood Cancer”), you may need to receive additional tests or be referred to a liver specialist.

What Can I Do to Keep My Liver Healthy?

To help prevent liver problems, talk with your doctor about getting vaccinated against hepatitis A and B. Also, keep a healthy lifestyle by following these tips:

• If you drink alcohol, do so in moderation.
• Drink plenty of water.
• Eat a well-balanced, high-fiber diet. Cut back on fatty, salty, smoked, and cured food.
• Take your medicine only as prescribed.
• Don’t mix drugs and alcohol.
• Avoid illegal drugs.
• If you are sexually active, use condoms during intimate sexual contact to prevent infection by viruses that can damage the liver (such as hepatitis C).
• Avoid exposure to chemicals that can be harmful to the liver, such as paint thinner and aerosol cleaners. If you must use them, wear a mask and gloves and work in an area that is ventilated well.
• Check with your doctor before starting any new over-the-counter medicine, herb, or supplement.