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The liver is a triangular-shaped organ tucked under the ribcage on the right side of the body. In an average adult, the liver is about the size of a football and weighs about three pounds. The liver is responsible for filtering out toxins from the blood, aiding with digestion and metabolism, and producing many important substances, including blood-clotting proteins.
Treatment for children's cancer can sometimes damage the liver. It is important to know about how the liver functions in order to keep the liver as healthy as possible.
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.
People who had radiation to the following areas may be at risk for liver problems:
The following chemotherapy drugs also have the potential to cause liver damage, although the most likely time for this to happen is during treatment or shortly after treatment ends. It is very uncommon for these medicines to cause liver problems years after treatment:
Other risk factors include:
There are three main types of blood tests used to monitor the liver:
A blood test to evaluate the liver (including ALT, AST, and bilirubin) should be done when survivors enter long-term follow-up care (usually about 5 years from diagnosis or 2 years following completion of therapy). 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.