Early diagnosis of primary liver cancer (PLC, hereafter referred to as hepatocellular carcinoma) is crucial. Since the 1970s to 1980s, the early diagnosis of hepatocellular carcinoma has been greatly facilitated by the gradual popularization and widespread use of serum alpha-fetoprotein (AFP), real-time ultrasound imaging and CT. Since the early diagnosis rate has significantly increased, the surgical resection rate has increased and the prognosis has also been significantly improved. The diagnosis of liver cancer, especially the early diagnosis, is the key to clinical treatment and prognosis.
In terms of early diagnosis, full attention should be paid to the background of liver disease of patients. In China, 95% of patients with liver cancer have background of hepatitis B virus (HBV) infection, 10% have background of hepatitis C virus (HCV) infection, and some patients have overlapping HBV and HCV infection.
Special attention should be paid to the following risk groups: middle-aged and elderly men with high HBV load, HCV-infected patients, patients with overlapping HBV and HCV infection, alcoholics, patients with combined diabetes mellitus, and patients with family history of liver cancer. After the age of 35-40, these patients should be screened regularly every 6 months (including serum AFP test and liver ultrasound); when there is an elevated AFP or “occupying lesion” in the liver area, they should enter the diagnostic process immediately and be closely observed to make early diagnosis.
Laboratory diagnosis methods of liver cancer
At present, the qualitative diagnosis of hepatocellular carcinoma in China is still based on the detection of serum AFP, which should be highly regarded.
1. in China, more than 60% of liver cancer cases have serum AFP>400μg/L.
2. there are no other tumor markers with specificity comparable to AFP.
3.AFP detection is less dependent on imaging equipment and new technology.
Diagnostic imaging methods of liver cancer
In recent years, the progress of medical imaging examination methods is obvious, which provides a reliable basis for the clinical “four determinations” (localization, characterization, quantification and regularity) of liver cancer and the formulation of treatment plans.
Ultrasound examination
Ultrasound examination is non-invasive and has no adverse effects on human tissues. It is simple, intuitive, accurate, inexpensive, convenient, non-invasive and widely used in the screening and post-treatment follow-up of liver cancer.
Real-time ultrasonography has important clinical value for the differential diagnosis of small hepatocellular carcinoma, and is often used for early detection and diagnosis of hepatocellular carcinoma, and is a good reference for the differential diagnosis of hepatocellular carcinoma from hepatic cysts and hepatic hemangioma. However, ultrasound examination is susceptible to the experience, technique and meticulousness of the examiner.
Multilayer spiral CT
The resolution of CT is much higher than ultrasound, and the image is clear and stable, so it can reflect the characteristics of liver cancer comprehensively and objectively.
CT has the following advantages: CT enhanced scan can clearly show the size, number, shape, location, boundary, richness of blood supply and relationship with intrahepatic ducts of hepatocellular carcinoma; it has important diagnostic value for whether there are cancer clots in portal vein, hepatic vein and inferior vena cava, whether there are metastases in hilar and abdominal lymph nodes, and whether hepatocellular carcinoma invades adjacent tissues and organs; it can also show the shape of liver, size of spleen and whether there is ascites. Therefore, CT has become an important routine tool for liver cancer diagnosis. In particular, CT dynamic enhancement scan can significantly increase the detection rate of small hepatocellular carcinoma; CT scan after 3-4 weeks of hepatic artery iodine embolization can also effectively detect small hepatocellular carcinoma lesions.
Magnetic resonance imaging (MRI)
MRI has features such as high tissue resolution and multi-parameter and multi-directional imaging, and it has no radiation effect, so MRI is another efficient and non-invasive diagnostic method for liver cancer examination after CT.
The application of liver-specific MRI contrast agent can improve the detection rate of small hepatocellular carcinoma and help to differentiate hepatocellular carcinoma from focal hyperplastic nodules and hepatic adenoma, etc. In addition, MRI has higher clinical value than CT for the follow-up of the efficacy of hepatic artery chemoembolization (TACE) in patients with hepatocellular carcinoma. MRI has unique features and can be an important supplement to CT.
Positron Emission Computed Tomography (PET-CT)
PET-CT is a functional molecular imaging system that integrates PET and CT into one, which can reflect the biochemical and metabolic information of liver occupancy by PET functional imaging, and can perform precise anatomical localization of lesions by CT morphological imaging, and simultaneous whole-body scanning can understand the overall condition and evaluate metastasis to achieve the purpose of early detection of lesions, as well as to understand the size and It is also possible to understand the size and metabolic changes before and after tumor treatment.
Selective Hepatic Arteriography
Selective hepatic arteriogram is an invasive test, while chemotherapy and iodine embolization are also therapeutic, and can clearly show small liver lesions and their blood supply.