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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Liver


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
155.0 - Malignant Neoplasm of Liver and Intrahepatic Bile Ducts; Liver, Primary: Carcinoma: Liver, Specified as Primary; Hepatocellular; Liver Cell; Hepatoblastoma
155.1 - Malignant Neoplasm of Liver and Intrahepatic Bile Ducts; Intrahepatic Bile Ducts; Canaliculi Biliferi; Interlobular: Bile Ducts, Biliary Canals; Intrahepatic: Biliary Passages, Canaliculi, Gall Duct
197.7 - Secondary Malignant Neoplasm of Respiratory and Digestive Systems; Liver, Specified as Secondary
230.8 - Carcinoma in Situ of Liver and Biliary System, Ampulla of Vater, Common Bile Duct, Cystic Duct, Gallbladder, Hepatic Duct, Sphincter of Oddi

Related Terms

  • Cancer of the Liver
  • Cholangiocarcinoma
  • Cholangiosarcoma
  • HCC
  • Hepatocarcinoma
  • Hepatocellular Carcinoma
  • Liver Cancer
  • Liver Cell Cancer
  • Liver Cell Carcinoma

Overview

Liver cancer is the growth of a deadly (malignant) tumor in the liver. The largest organ in the body, the liver is located in the upper right part of the abdominal cavity. It has many functions such as neutralizing poisons; metabolizing nutrients; producing blood-clotting proteins, some hormones, and bile; and storing vitamins in the body. The two common types of tumors that develop directly from liver cells (primary tumors) are cancer from hepatocytes (hepatocellular carcinoma, or HCC) and cancer from epithelial cells in the bile ducts of the liver (cholangiosarcoma). Most cancer found in the liver has spread from a primary cancer that developed elsewhere in the body (metastatic cancer).

The most common cause of liver cancer worldwide is infection with hepatitis B or hepatitis C. In some parts of the world, toxins (aflatoxins) generated by fungi (aspergillus flavus and aspergillus parasiticus) found on nuts and meal stored under hot, humid conditions are a common cause of liver cancer. This type of cancer is also associated with chronic degenerative disease of the liver (cirrhosis), especially from alcohol abuse.

Other, less common causes of liver cancer include glycogen storage disease, anabolic steroids, accumulation of copper in the liver due to a genetic disorder (Wilson's disease), and a hereditary metabolic disease that results in excessive iron deposition in the liver (hemochromatosis).

Incidence and Prevalence: Estimates from the American Cancer Society show that there will be 18,920 new cases of primary liver cancer and intrahepatic bile duct cancer diagnosed in the US in 2004, with twice as many cases in men as in women. About 14,270 people (9,450 men and 4,820 women) will die of liver cancer in the US in 2004. In contrast to many other cancers, the incidence and mortality rates for liver cancer are increasing. Liver cancer is the most common cancer in some countries and is many times more common in developing countries in Africa and East Asia than in the US.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Men older than 50 who have both hepatitis B and C are especially at high-risk in developing liver cancer. Minor risk factors for liver cancer may include use of oral contraceptives or steroids and cigarette smoking.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of upper abdominal pain, often on the right side; weight loss; and loss of appetite (anorexia). A history of hepatitis and cirrhosis from alcohol or other causes could be significant.

Physical exam: There may be a yellow discoloration (jaundice) of the skin, the whites (sclera) of the eyes, and the mucous membranes. Examination of the abdomen using the hands or fingers (palpation) may reveal an enlarged, tender liver; a lump (mass) on the liver; and swelling as a result of fluid (ascites).

Tests: Levels of blood cholesterol, liver enzymes in the bloodstream (alkaline phosphatase, or ALP, and serum gamma glutamyl transpeptidase, or GGTP), serum bilirubin, and urine bilirubin are often elevated. A complete blood count (CBC) may show an abnormally low number of red blood cells (anemia). A biological marker called alpha-fetoprotein (AFP) is elevated in 50% to 70% of Americans with liver cancer but may also be elevated in other types of tumors. Screening tests for hepatitis B and C viruses may also be done. A definitive diagnosis of primary liver cancer is done with a CT of the abdomen and sampling of the liver tissue using CT-guided liver biopsy.

Visualization of the liver following injection of radiopaque dye (arteriography) and an MRI may be used to determine if the individual would benefit from surgery. Looking at the abdominal organs through a fiberoptic device inserted through a small cut in the abdominal wall (laparoscopy) may also help determine whether surgery is necessary.

Source: Medical Disability Advisor



Treatment

The only treatment that may cure liver cancer is either surgery to remove the diseased portion of the liver (liver resection) or replacement of the liver (liver transplantation). The types of liver resection are based on the portion of the organ to be removed (i.e., right or left hepatectomy, right or left lobectomy, extended left hepatectomy). Whenever possible, resection is the treatment of choice for liver cancer. Only 9% to 27% of individuals, however, are eligible for this treatment due to the size of the lesion or the degree to which it has spread (metastasized).

Nonsurgical treatments designed to relieve discomfort (palliative) should be considered, including chemotherapy, radiation therapy, treatment using antibodies or biological response modifiers (monoclonal antibodies), injection of alcohol directly into the liver to kill diseased tissue (direct intralesional treatment), or partial elimination of blood flow to the diseased tissue. Chemotherapy may be used in conjunction with surgery to minimize the possibility of further spread of the disease. Radiation therapy may be applied from an external source (external beam irradiation) or internally by injecting radiolabeled antibodies that seek out the tumor (internal irradiation with radioimmunoglobulin).

Source: Medical Disability Advisor



Prognosis

Because the symptoms of liver cancer often do not appear until the disease is advanced, less than 30% of patients having explorative surgery are eligible for complete surgical removal of their tumors. The overall 5-year relative survival rate from liver cancer is about 7% ("Detailed Guide").

Liver cancer is rapidly fatal in more advanced cases. AFP levels may help determine the outcome, as survival is significantly longer when this biological marker of liver cancer is absent. Other factors associated with a more favorable outcome include better health, ability to perform daily activities when the diagnosis is first made, and normal levels of liver enzymes.

Source: Medical Disability Advisor



Differential Diagnosis

  • Hemangioma
  • Liver cysts or nodules
  • Secondary tumor in the liver from other organs (metastatic cancer)

Source: Medical Disability Advisor



Specialists

  • Gastroenterologist
  • General Surgeon
  • Oncologist
  • Radiology Oncologist

Source: Medical Disability Advisor



Rehabilitation

Several types of rehabilitation benefit individuals recovering from liver cancer. Supportive rehabilitation allows individuals to gain some control over the ordinary activities of life and helps them cope emotionally. It may include group vocational rehabilitation to help the individual return to work or begin training for a new career if the individual cannot physically return to the previous workplace and career. Palliative rehabilitation addresses the pain an individual experiences, allows some level of physical comfort, and provides emotional support and assistance in day-to-day functioning.

Physical rehabilitation allows individuals to regain strength and stamina that were lost due to the disease process and during treatment. Strengthening starts at a low level and progresses only as tolerated, especially if strengthening is attempted during the course of treatment. If surgery is required, breathing exercises after surgery may be useful to prevent postoperative pulmonary complications. Certain exercises may also be performed to reduce postoperative pain and speed recovery, including progressive relaxation and deep breathing techniques.

Early in physical rehabilitation of this disease, the therapist should perform range of motion exercises to help return mobility to joints and stretch key muscles that will enable the individual to return to the activities of daily living. Active range of motion is the next progression and involves the individual performing all of the motion independently, with or without resistance from an outside force. When resistance is tolerated, the physical therapist may instruct the individual regarding isotonic exercise.

The frequency and duration of the rehabilitation program vary among individuals with liver cancer. The intensity and progression of the exercises introduced in physical therapy depend on the prognosis, on whether or not surgery was performed, on whether or not the individual is receiving any current cancer treatment, on the extent of the disease, and on the individual's overall health.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of liver cancer are related to the stage of the disease. The condition has a tendency to invade the blood vessels and lymph glands of the liver, producing circulatory problems within the organ. The individual may also have bleeding (hemorrhage) problems because the damaged liver may not adequately produce the proteins normally required for blood clotting. The liver is located close to several vital organs, including the lungs and spleen. Liver tumors may metastasize into these organs directly or indirectly via the lymphatic or vascular systems and lead to widespread cancer throughout the body.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the length of disability include the type and stage of the disease at initial presentation, the presence of concurrent infection and overall health, the type of treatment pursued, the response to treatment, any underlying complications, and the requirements of the job.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may require more sedentary work for a period of time due to weakness and fatigue following surgery. Heavy physical labor is restricted for 5 to 6 weeks following liver resection or transplantation and possibly longer if postoperative chemotherapy treatment is necessary. If chemotherapy is used in conjunction with surgery, the individual may need extended recovery time from this treatment. Individuals who receive palliative treatment only will generally not return to work even in a limited capacity.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual complain of upper abdominal pain, often on the right side; weight loss; and loss of appetite (anorexia)?
  • Does individual have a history of hepatitis and cirrhosis from alcohol or other causes?
  • Is yellow discoloration (jaundice) present in the skin, whites (sclera) of the eyes, and mucous membranes?
  • Did examination of the abdomen using the hands or fingers (palpation) reveal an enlarged, tender liver; a lump (mass) on the liver; and swelling as a result of fluid (ascites)?
  • Did tests show elevated levels of blood cholesterol, liver enzymes in the bloodstream (alkaline phosphatase, or ALP, and serum gamma glutamyl transpeptidase, or GGTP), serum bilirubin, and urine bilirubin?
  • Were other conditions with similar symptoms, including benign tumors or cysts, hemangioma, nodules, or secondary tumors ruled out?
  • Was diagnosis of liver cancer confirmed?

Regarding treatment:

  • If resection is not an option, is individual a candidate for liver transplantation?
  • Is individual on local or national transplant lists?
  • Would individual benefit from either chemotherapy to minimize further spread of the disease or radiation therapy (external or internal)?
  • Were nonsurgical treatments designed to relieve discomfort considered, such as chemotherapy, radiation therapy, treatment using antibodies or biological response modifiers, direct intralesional treatment, or partial elimination of blood flow to the diseased tissue?
  • If symptoms are not relieved through current therapy, what other options are available?
  • Is rehabilitation appropriate to increase functional tolerances?

Regarding prognosis:

  • At what stage was cancer detected?
  • Was surgery performed?
  • Has individual experienced any complications such as hemorrhage or other circulatory problems that may affect recovery?
  • Does individual have underlying conditions (prior liver disease, malnutrition, exposure to environmental toxins or alcohol resulting in cirrhosis, or increased vulnerability to bleeding disorders due to lack of blood clotting factors) that may affect recovery?
  • What is the prognosis?
  • Does individual have a functional support system in place?
  • Would individual benefit from psychological counseling or enrollment in a support group?

Source: Medical Disability Advisor



References

Cited

"Detailed Guide: Liver Cancer." American Cancer Society. 30 Sep. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_liver_cancer_25.asp?sitearea=>.

Source: Medical Disability Advisor