Late effects: Liver health

What are the signs and symptoms of liver damage?

Many people with liver damage have no symptoms at all.

Some people may develop jaundice (yellowish eyes and skin), dark urine, pale 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 oesophagus or stomach. Very rarely, liver cancer may develop.

Who is at risk?

People who have had radiation to the following areas may be at risk for liver problems:

• Upper abdomen or whole abdomen
• Liver

Some 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:

• Methotrexate
• Mercaptopurine
• Thioguanine

Other risk factors include:

• Pre-existing liver problems
• Family history of liver problems (such as haemochromatosis)
• Excessive alcohol use
• Chronic liver infection (hepatitis B or hepatitis C)
• History of multiple blood transfusions
• Chronic graft-versus-host disease

What tests are done to monitor the liver?

The following blood tests are used to monitor the liver.

• Liver enzyme tests monitor levels of specialized proteins that are 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)
  • Aspartate aminotransferase (AST)
• Liver function tests are indicators of 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 protein that is produced by the liver)
  • Prothrombin Time (PT), a measure of blood clotting
• Tests for liver infection including specific tests for viral hepatitis A, B, and C
• Tests to check for iron overload (ferritin) related to multiple blood transfusions

What follow up is needed for those at risk?

Blood tests to evaluate the liver should be done throughout long-term follow-up. The liver should also be checked for enlargement by a doctor during yearly physical examinations. If problems are identified, additional tests and a referral to a liver specialist may be recommended. 

What can I do to keep my liver healthy?

You can do the following to keep your liver healthy:

• If you do not have immunity to hepatitis A and B, get immunized against these common infections in order to protect your liver (there is currently no vaccine to protect against hepatitis C). You can find out if you have immunity to hepatitis A and B by having a blood test.
• If you drink alcohol, do so in moderation
• Drink plenty of water
• Eat a well-balanced, high-fibre diet. Cut down on fatty, salty, smoked and cured foods
• If you have liver problems, always alert your doctor or pharmacist before taking any new medicines
• Do not take more than the recommended doses of medications
• Avoid taking unnecessary medications
• Do not mix drugs and alcohol
• Do not use illegal street drugs
• Check with your doctor before starting any new over-the-counter medications or herbs and supplements to be sure that they do not have harmful effects on the liver
• Use barrier protection (such as condoms) during intimate sexual contact to prevent infection by viruses that can damage the liver
• Avoid exposure to chemicals (solvents, aerosol cleaners, insecticides, paint thinners, and other toxins) that can be harmful to the liver