Hepatotoxicity Associated with Cancer Therapy

Spectrum of hepatotoxic reactions:

(1) hepatocellular injury, including fulminant hepatic failure

(2) cholestasis

(3) hepatic sinusoidal obstruction syndrome (veno-occlusive disease)

(4) fibrosis which may progress to cirrhosis

(5) steatosis

Risk factors:

(1) high risk chemotherapeutic regimen

(2) high dose irradiation of the liver

(3) mixed chemotherapy and radiation to the liver

(4) pre-existing liver disease

(4a) chronic hepatitis (HBV)

(4b) nonalcoholic fatty liver disease

(4c) other

Differential diagnosis:

(1) pre-existing or concurrent liver disease

(2) metastatic cancer