The prognosis of malignant tumor depends on whether it can be detected early and treated actively. However, early stage of liver cancer is easy to be misdiagnosed because of its insidious onset and lack of obvious symptoms; once symptoms such as upper abdominal fullness, obvious enlargement of liver volume, pain in liver area and wasting occur, most of them are already in advanced stage and the best time for treatment is lost.
Some symptoms and signs of hepatocellular carcinoma are easily confused with other diseases because of their lack of specificity. Sometimes, there are also some rare “syndromes with cancer”, which may lead to misdiagnosis and adverse consequences if they are not well understood, and may also lead to doctor-patient disputes. Therefore, we should be alert to the following misdiagnosis situations and try to recognize the true nature of liver cancer in time.
1.Fever
Liver cancer is prone to cancer fever, which is often intermittent fever without chills or chills and lasts for a long time. Occasionally, it can be seen as continuous high fever without obvious toxemia symptoms. This kind of cancer fever is sensitive to antipyretic drugs such as anti-inflammatory pain, naproxen and corticosteroids to reduce fever, but the fever starts again after stopping the drugs. The principle of cancer fever may be due to pyrogen or tumor necrosis factor produced by cancer tissue itself or infiltrated leukocytes. However, conversely, the diagnosis must also exclude infection.
2.Cirrhosis of liver
Primary liver cancer often occurs on the basis of liver cirrhosis. According to statistics, at least 80% of liver cancers are accompanied by cirrhosis, and cirrhosis eventually leads to liver cancer in about 15% to 75% of cases. Therefore, patients with cirrhosis, especially those infected with hepatitis B and C viruses, should be highly alert to the occurrence of liver cancer and should undergo regular related examinations. In addition, when hospitals admit patients with cirrhosis complicated by upper gastrointestinal bleeding, doctors often focus on hemostatic measures and prevention of liver coma, but ignore the possible existence of liver cancer (especially diffuse liver cancer), resulting in misdiagnosis or omission.
3.Acute abdomen
About 10% of patients with hepatocellular carcinoma die due to rupture and bleeding of the cancer mass, which can be due to external force or spontaneous rupture. If it is confined to the subhepatic envelope, severe right upper abdominal pain will appear. If it ruptures into the abdominal cavity, acute abdominal symptoms will appear. In addition, middle and late stage hepatocellular carcinoma is prone to spontaneous peritonitis, which is also very easy to be misdiagnosed.
4.Diarrhea
Some patients with liver cancer have diarrhea as the main gastrointestinal symptom, which is easily misdiagnosed as chronic enteritis or malabsorption syndrome. Diarrhea can also be the first symptom of liver cancer. According to some statistics, among 3254 liver cancer patients, 5.8% of them have diarrhea as the first symptom.
5.Spontaneous hypoglycemia
This is the most common syndrome associated with cancer in liver cancer patients, with an incidence rate of 10%-30%, which is easily misdiagnosed when liver cancer is not detected. Its occurrence may be mainly related to the ectopic insulin production by liver cancer cells. This syndrome can lead to coma, shock and death in severe cases.
6. Erythrocytosis
It may be related to the production of erythropoietin by hepatocellular carcinoma cells, which is often misdiagnosed as hematological disease.
7.Bone pain
It is caused by bone metastasis of liver cancer, which can be single or multiple, often involving vertebrae, ribs, long bones of limbs, etc. It is worth noting that bone pain can be the first symptom of primary liver cancer patients, which is often misdiagnosed as other bone and joint diseases. The incidence of bone pain in hepatocellular carcinoma is 3%-12%, but the incidence of bone metastasis can reach 20% in autopsy.
8.Benign intrahepatic occupying lesions
The main reason for misdiagnosis is that the ultrasound operator misjudged the intrahepatic sonogram, and sometimes CT can also misdiagnose. For example, a patient who was considered to have fatty liver after ultrasound and CT enhancement scan was diagnosed with advanced hepatocellular carcinoma 10 months later.
Three main culprits of liver cancer
According to incomplete statistics, about 37% of liver disease patients mistook “stomach disease” for “stomach disease” at the early stage of the disease and missed the treatment. Due to the atypical symptoms at the early stage of liver disease, such as loss of appetite, nausea, abdominal distension and upper abdominal discomfort, liver disease is easily confused with stomach disease.
Hepatitis B virus is the biggest hidden danger to induce liver cancer, and about 80% of liver cancer patients in China are transformed from hepatitis B patients or hepatitis B virus carriers. Hepatitis B virus triggers liver cancer because the human body is infected with the virus, which is actively replicating in the body and causing damage to the liver, resulting in chronic hepatitis, which in turn leads to liver cirrhosis and then liver cancer. This process is relatively long, taking more than ten years.
Secondly, biliary system diseases, such as hepatobiliary stones and hepatic schistosomiasis, can induce liver cancer. Although the etiology and pathogenesis of liver and biliary diseases are different, they affect each other at some levels and both may eventually lead to liver insufficiency or even chronic liver failure.
In addition, recent international studies now show that fatty liver can also lead to liver cancer, and the incidence is on the rise. Severe steatohepatitis can also lead to cirrhosis, which can eventually develop into liver cancer as well.