I. Liver Cancer Symptoms
Early symptoms of liver cancer are relatively insidious and there is usually no symptom in early stage. When patients show obvious symptoms of late stage liver cancer, the condition is often more serious. The incidence of typical symptoms of hepatocellular carcinoma is basically the same at home and abroad, and the first symptom is pain in the liver area, followed by upper abdominal mass. The first symptom is pain in the liver area, followed by upper abdominal mass. Right shoulder pain, etc. Some patients also present with some complications of cirrhosis, such as black stool, vomiting blood. Jaundice, etc. A few patients are hospitalized due to the symptoms caused by metastases, and most of these symptoms are not specific. The following is an introduction of some common symptoms of liver cancer.
1. Pain in liver area. The majority of patients with mid- to late-stage liver cancer have pain in the liver area as the first symptom, and the incidence rate is over 50%. Pain in the liver area is usually located in the right rib area or under the saber process, and the nature of pain is intermittent or continuous hidden pain. The pain is intermittent or persistent, dull or stabbing, and the patient may feel discomfort in the right upper abdomen for a period of time before the pain. The pain may be mild and severe or may resolve on its own for a short period of time. The pain is mainly caused by the rapid enlargement of the tumor, which compresses the peritoneum and causes pulling pain.
In a few patients, severe pain in the liver area occurs spontaneously or suddenly after hepatic puncture, mostly due to the rupture and bleeding of cancer nodules located on the surface of the liver. If there is also a decrease in blood pressure and shock, and there is bloody fluid in the abdominal cavity, it means that the rupture and bleeding of cancer nodules are serious. In this case, emergency resuscitation is needed. If there is no accompanying symptom as mentioned above and the pain is more limited, it indicates that the bleeding is located in the subhepatic peritoneum. If the tumor is located in the left lobe, it often causes pain in the middle and upper abdomen; if the tumor is located in the right lobe, the pain is in the right quarter rib area; if the tumor involves the transverse septum, the pain radiates to the right shoulder or right back, which is easily mistaken for shoulder arthritis; if the tumor is located in the posterior part of the right lobe, it sometimes causes lumbago; if the tumor is located deep in the liver parenchyma, the pain is rarely felt.
2. Gastrointestinal symptoms. Decreased appetite, epigastric fullness after meals. Ambiguous gas, indigestion and nausea are common digestive tract symptoms of liver cancer, among which loss of appetite and abdominal distension are the most common. Diarrhea is also a common GI symptom of hepatocellular carcinoma, which has been reported both at home and abroad, with a high incidence and easily mistaken for chronic enteritis. Portal hypertension and intestinal dysfunction caused by portal vein or hepatic vein thrombosis can lead to abdominal distension and increased stool frequency, and abdominal distension can also be caused by ascites. Gastrointestinal dysfunction can also lead to indigestion, ambiguous gas, nausea and other symptoms.
3. Fever. A considerable number of liver cancer patients will have sweating and fever. Most of the fever is low to moderate, but a few patients may have high fever, above 39℃, which is usually not accompanied by chills. The fever in liver cancer is mostly cancer fever, which is caused by the release of pyrogen into blood circulation after tumor tissue necrosis. It is not easy to distinguish it from cancer fever of liver cancer, but it can be determined only after combining with blood picture and observing the effectiveness of antibacterial treatment.
4.Loss of weight and weakness. Patients with hepatocellular carcinoma often feel more weak than patients with other tumors, which is similar to patients with chronic hepatitis. The causes of weakness are unknown. It may be due to digestive disorders, lack of energy due to impaired nutrient absorption, or liver cell damage and decreased liver function, which may cause metabolic disorders, inactivation of certain toxins in time, or release of toxic substances due to liver cancer tissue necrosis. Wasting is also a common symptom of liver cancer patients, which is due to impaired liver function. It is caused by impaired liver function and decreased digestion and absorption function. With the development of disease, the degree of wasting can be aggravated, and in serious cases, cachexia can appear.
5. Bleeding tendency. Patients with hepatocellular carcinoma often have bleeding tendency such as gum bleeding and subcutaneous bruises, which is mainly due to impaired liver function and abnormal coagulation function. Gastrointestinal bleeding is more common and is mainly due to varices in the esophagogastric fundus due to portal hypertension. In fact, gastrointestinal bleeding is also the most common cause of death in patients with hepatocellular carcinoma.
6. Lower limb edema. Patients with hepatocellular carcinoma with ascites often have lower limb edema, which occurs in the ankle in mild cases and may spread to the whole lower limb in severe cases. In clinical practice, we have seen some patients with highly edematous lower extremities, and the water can ooze out from the skin of thighs. The main cause of lower limb edema is obstruction of venous return by ascites compression of lower limb veins or cancer thrombus. Mild edema can also be caused by low plasma albumin.
7.Rupture of cancer nodules in acute abdomen. It usually causes pain in the liver area and obvious pressure pain in the liver area during physical examination, which is a symptom of liver peritoneal irritation. After rupture of cancer nodules, some patients show acute abdominal pain with peritoneal irritation symptoms, which can be easily misdiagnosed as acute peritonitis. The abdominal pain caused by rupture of cancer nodules is usually accompanied by blood pressure drop or even shock, which is different from general acute peritonitis.
Diagnosis of hepatocellular carcinoma
(I) Pathological diagnosis
1.Hepatic histological examination confirms primary liver cancer.
2. Histological examination of extrahepatic tissues confirms that it is hepatocellular carcinoma.
(II) Clinical diagnosis
1.If there is no other evidence of hepatocellular carcinoma, positive AFP convective method or radiolucent method >400μgml for more than four weeks, and pregnancy, active liver disease, germinal gland embryogenic tumor and metastatic hepatocellular carcinoma can be excluded.
2. Those who have clear intrahepatic substantial occupying lesions on imaging, can exclude hepatic hemangioma and metastatic hepatocellular carcinoma, and have one of the following conditions
①AFP＞200mg/mI.
②Typical imaging manifestation of primary hepatocellular carcinoma.
②No jaundice but significantly increased AKP or r-GT.
④Distantly defined metastatic lesions or bloody ascites, or cancer cells found in ascites.
⑤ Clearly positive hepatitis B markers for cirrhosis.
(C) Qualitative diagnosis
Qualitative diagnosis of primary liver cancer requires comprehensive analysis of patient’s symptoms, signs and various auxiliary examination data.
1.Symptoms and signs as before.
2. Auxiliary tests.
① AFP test: positive by convective electrophoresis or >400mgml by radioimmunoassay; for four weeks, and exclude pregnancy, active liver disease and germinal gland embryonic-derived tumor.
② Other markers: alkaline phosphatase (A1(P) is elevated in about 20% of patients with hepatocellular carcinoma. r-glutamyl transpeptidase (r-GT) is elevated in 70% of patients with hepatocellular carcinoma. 5— nucleoglycerate diphosphatase isoenzyme V (5- NPDase-v), about 80% of patients this enzyme appears to be more positive in patients with metastatic liver cancer. α-antitrypsin (α-AT) is increased in about 90% of patients with hepatocellular carcinoma. Ferritinase, 905 patients with hepatocellular carcinoma had increased levels. Carcinoembryonic antigen (CEA) was increased in 70% of patients with hepatocellular carcinoma. Abnormal prothrombin >300mgml.
③Liver function and hepatitis B antigen antibody system examination, abnormal liver function and positive hepatitis B markers suggest a liver disease basis of primary liver cancer.
④Various imaging examinations, suggesting intrahepatic occupying lesions. ⑤ Laparoscopy and liver puncture examination: laparoscopy can directly show the liver surface; liver puncture biopsy.
⑧Other examinations: lymph node biopsy, ascites to find cancer cells, etc.
(iv) Localization diagnosis
1.B-ultrasound examination to obtain the sectional shadow picture of liver and adjacent organs, which can detect microscopic liver cancer below 2—3cm.
2.Radionuclide liver imaging, the size of the lesion is above 2c2n to present positive results.
3.CT and MRI: It is beneficial to the diagnosis of liver cancer. When the diameter of liver cancer is less than 2cm or the density is close to normal liver parenchyma, CT is difficult to show. When liver cancer is diffuse, it is not easy to be detected by CT; it is difficult to distinguish primary or secondary liver cancer. MRI has the advantage of ding, which can show the metastatic lesions of liver cancer more clearly and can be scanned in different directions.
4.Selective hepatic arteriography and digital subtraction angiography, selective hepatic arteriography (DSA) is a sensitive examination method, which can show hepatocellular carcinoma within 1cm in diameter.