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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

  1. Ask your oncologist about your risks of developing late effects.

    Inform your primary health care provider about your risks. Share a copy of your Survivorship Care Plan, which includes details about your cancer treatment and information about health problems that may occur because of your treatment.

    Have a yearly physical examination. Your provider may check for liver enlargement and order tests to monitor liver health. If problems are identified, the provider may refer you to a liver specialist for evaluation and further testing.

  2. Survivors may have tests for liver function when they enter long-term follow-up care through their pediatric cancer center.

    Blood tests to monitor the liver include:

    • Liver enzyme tests – These tests monitor levels of proteins 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 called SGPT
      • Aspartate aminotransferase (AST), sometimes also called SGOT
    • Liver function tests – These tests show 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 blood protein produced by the liver
      • Prothrombin Time (PT), a measure of blood clotting
    • Tests for liver infection – Specific tests for viral hepatitis A, B, and C

    Those who have had a hematopoietic cell transplant (also called a bone marrow transplant or stem cell transplant) should have a test to check for iron overload.

  3. Survivors can take steps to keep their liver healthy:

    • If you do not have immunity to hepatitis A and B, get immunized. A blood test for Hepatitis A and B antibodies will indicate immunity.
    • If you drink alcohol, consume it in moderation.
    • Do not mix drugs and alcohol.
    • Do not use illegal drugs.
    • Eat a well-balanced diet high in fiber and low in fatty, smoked, and cured foods.
    • Drink plenty of water.
    • Maintain a healthy body weight.
    • Take recommended doses of medications.
    • Avoid taking unnecessary medications.
    • Check with a health care provider before taking new over-the-counter medications, herbs or supplements.
    • If you are sexually active, use barrier protection (such as latex condoms) during intimate sexual contact.
    • Avoid exposure to solvents, aerosol cleaners, insecticides, paint thinners, and other toxins. If you must use these substances, wear a mask and work in a well ventilated area.


Reviewed: December 2019