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Liver Late Effects

Some treatments for childhood cancer may damage the liver.

How the liver functions

The liver is a triangular-shaped organ located under the rib cage on the right side of the body. It:

  • Helps clear wastes from the blood
  • Makes bile to help digest food
  • Produces blood-clotting proteins
  • Stores energy to fuel the body
A graphic of a liver, showing the triangular shape and the yellow falciform ligament on top.

Risk factors for liver late effects

Cancer treatments

  • Radiation to the abdomen
  • Chemotherapy with methotrexate, mercaptopurine, and thioguanine. It is very rare for these drugs to lead to liver problems years after treatment. If liver damage occurs, it will most likely happen during or shortly after treatment.

Other risk factors

  • Medical problems involving the liver, including liver tumor or surgical removal of a significant portion of the liver
  • Pre-existing liver problems
  • Excessive alcohol drinking
  • Chronic hepatitis (liver infection)
  • Multiple blood transfusions
  • Chronic graft-versus-host disease

Signs and symptoms of liver damage

Many people with liver damage have no symptoms at all.

But some people may have:

  • Jaundice (yellow eyes/skin)
  • Dark urine
  • Pale (clay-colored) stools
  • Severe itching
  • Easy bruising or bleeding
  • Chronic fatigue
  • Nausea
  • Loss of appetite

The liver sometimes swells. As liver damage increases, it may become hard (fibrosis) and scarred (cirrhosis).

Fluid may build up in the abdomen. The spleen may enlarge. Bleeding could occur into the esophagus or stomach. In very rare cases, liver cancer may develop.

What survivors can do

Reviewed: December 2019