The clinical manifestations of hepatocellular carcinoma after metastasis vary depending on the site of metastasis.
The main routes of liver cancer metastasis are bloodstream metastasis and lymph node metastasis, so let’s take a look at them in turn.
Hematogenous metastases
Bloodstream metastasis is the most common route of liver cancer metastasis, and the most common sites of metastasis are lung, bone, brain, adrenal gland, etc.
Lung metastasis from hepatocellular carcinoma
Lung metastases from hepatocellular carcinoma may have no specific manifestations in the early stage, and some patients may have symptoms such as dry cough, coughing sputum, or blood in sputum.
When the tumor enlarges and compresses the trachea, obstructive pneumonia and dyspnea may appear.
Bone metastasis of liver cancer
Bone metastases from liver cancer are mostly in the thoracic and lumbar spine, and the iliac bone, hip bone, and rib cage are also good sites.
The main symptoms of bone metastases are pain and dysfunction of the corresponding area, for example, metastasis to the lumbar spine can cause low back pain, and in severe cases, paraplegia.
Brain metastases from hepatocellular carcinoma
Brain metastases from hepatocellular carcinoma mainly manifest as headache, nausea, and vomiting, and when the metastases compress brain tissue, they can cause corresponding dysfunction, for example, compression of the optic nerve can cause blindness in one eye.
Intravascular cancer emboli
Notably, some patients develop intravascular cancer emboli, such as portal vein cancer emboli and inferior vena cava cancer emboli. Dislodged cancer emboli can cause serious complications such as pulmonary embolism or even sudden death.
- Portal vein cancer embolism can block the blood flow in the portal vein causing liver function impairment and portal hypertension;
- Inferior vena cava cancer embolus can affect the inferior vena cava reflux and cause inferior vena cava obstruction syndrome, which manifests as lower limb edema and ascites.
Lymph node metastasis
The most likely site of lymph node metastasis from hepatocellular carcinoma is the hilar lymph nodes, which can also metastasize to the para-aortic lymph nodes, peripancreatic lymph nodes, and body surface lymph nodes.
The enlarged lymph nodes compressing the hilar bile ducts can cause obstructive jaundice; compression of the abdominal plexus can cause low back pain; and enlarged lymph nodes on the body surface can be palpated at the corresponding sites.