Primary liver cancer is one of the most common malignant tumors of the digestive system, which seriously threatens people’s life and health. The incidence rate of liver cancer is higher in men than in women, and there are more than 600,000 new liver cancer patients worldwide every year, ranking fifth among malignant tumors. The reason for the high incidence of liver cancer in China is that there are many people suffering from hepatitis B and the incidence of hepatitis C has been on the rise in recent years, and liver cancer mostly arises on the basis of cirrhosis after chronic hepatitis B and C. Classification Primary liver cancer can be divided into hepatocellular liver cancer, cholangiocellular liver cancer and mixed liver cancer according to the pathological classification. In China, the main type of the disease is hepatocellular hepatocellular carcinoma, which accounts for more than 90% of primary hepatocellular carcinoma. According to the morphology of the tumor, it can be divided into nodular, massive and diffuse hepatocellular carcinoma. Hepatocellular liver cancer Pathogenesis It can be said that liver cancer is a very important type of malignant tumor in our country. Why do you say so? There are about 650,000 new cases of liver cancer worldwide each year, and more than half of them occur in our country. And in Asia, we account for more than 80% of the new cases each year. Why is this the case? It starts with the causes of liver cancer. Liver cancer usually occurs on the basis of long-term chronic liver disease, and by long-term chronic liver disease, I mean mainly cirrhosis of the liver here. In Europe, it is mainly alcoholic cirrhosis caused by long-term alcoholism, while in China, it is mainly cirrhosis after chronic viral hepatitis caused by hepatitis B and C virus infection. Of course, in some areas in the south of China, there is also liver cancer caused by the consumption of moldy food containing aflatoxin, and water pollution is also a reason for the high incidence of liver cancer in some areas of China. It is worth mentioning that various causative factors can synergize with each other to aggravate the disease and increase the occurrence of liver cancer. In China, the overall population infected with hepatitis B virus is over 10%, and the population infected with hepatitis C virus is also on the rise in recent years. Compared with other types of hepatitis, hepatitis B and C can easily become chronic, and some people will develop cirrhosis or even liver cancer. Clinical manifestations After getting hepatocellular carcinoma, especially in the early stage, there are often no obvious specific symptoms. Even some symptoms, such as right upper abdominal discomfort, abdominal distension and weakness, are often symptoms of cirrhosis rather than liver cancer itself. By the time symptoms such as palpable abdominal lumps and pain appear, the best time for treatment is often lost. Diagnosis and differentiation 1.AFP: AFP is the most commonly used and the most simple and practical detection technique. On the basis of viral hepatitis, if AFP is elevated, especially if AFP is more than 400μg/L, the possibility of liver cancer should be highly suspected, and imaging-related examinations should be improved as early as possible to achieve early detection, early diagnosis and early treatment. However, not all liver cancer patients have elevated AFP, about 30% of liver cancer patients do not have elevated AFP. Therefore, for patients with chronic liver disease, even if AFP is normal, we should not take it lightly. 2.Ultrasound: Ultrasound is a non-invasive examination without any adverse effects on human tissues, simple, intuitive, accurate, inexpensive, convenient, non-invasive and widely used for liver cancer screening and post-treatment follow-up. Ultrasound can show the size, shape and location of tumor, and the diagnostic rate of large hospitals can reach over 90%. In addition, benign lesions such as liver cysts and hepatic hemangiomas can also be identified through ultrasound examination. In recent years, the application of ultrasonography technology has greatly improved the diagnostic value of ultrasonography for tumor diseases of the liver. 3.CT (computerized X-ray tomography): CT is now an important conventional means for liver cancer diagnosis. Enhanced CT scan of abdomen can clearly show the size, number, morphology, location, boundary, richness of blood supply of tumor, and the relationship between tumor and important structures in liver. It is important for the clear diagnosis of liver tumor and the differential diagnosis with other benign liver occupancies. It can also clarify the stage of liver cancer, which is important for guiding the treatment and judging the prognosis. The accuracy and objectivity of CT are higher than ultrasound, and the application of enhanced scan can improve the resolution and the accuracy of diagnosis. 4.MRI (magnetic resonance imaging): MRI can improve the detection rate of small hepatocellular carcinoma, and can be more helpful in differentiating hepatocellular carcinoma from some benign neoplastic lesions, such as focal nodular hyperplasia of the liver (FNH) and hepatic adenoma, etc. In clinical practice, MRI is often used as an important supplement to CT examination. 5.Digital subtraction angiography (DSA) hepatic arteriogram: DSA hepatic arteriogram is an invasive test, which can clearly show the small lesions and tumor blood supply in the liver, and can be used to block the tumor feeding vessels by injecting iodine oil to achieve the treatment purpose after clear diagnosis. However, hepatic arteriography is an invasive test and should only be considered when other tests fail to confirm the diagnosis and accurately assess the condition. 6.PET/CT: PET/CT scan can understand the overall condition of the patient and evaluate the metastasis of the tumor, and more comprehensively judge the stage and prognosis of the tumor. However, it is more expensive and requires injection of radioactive drugs, so it should not be used as the first choice for examination and screening. 7.Liver aspiration pathology: Pathological aspiration examination has definite diagnostic significance and is mostly done under the guidance of B-ultrasound or CT at present. However, liver puncture is an invasive examination and is suitable for patients whose diagnosis cannot be confirmed even after various examinations. In general, patients with chronic hepatitis B and C should have regular checkups if possible, and AFP and abdominal ultrasound should be checked every six months. For patients with elevated AFP and abdominal ultrasound with high suspicion of liver cancer, other tests such as CT and MR should be performed as appropriate according to the specialist’s opinion. Treatment of liver cancer mainly includes surgery, local ablation therapy, interventional therapy, radiotherapy and drug therapy. Surgery includes surgical resection and liver transplantation; local ablation therapy includes commonly used radiofrequency, microwave, freezing and sea support; interventional therapy is a treatment method to inject drugs into the liver through catheter to directly act on the tumor; and drug therapy includes targeted therapy and chemotherapy. Targeted therapy is a field that has progressed relatively rapidly in recent years in the treatment of tumors. In the treatment of liver cancer, it is mainly sorafenib, which can serve to inhibit tumor growth, thus achieving the effect of delaying the disease, prolonging survival and improving survival quality. It is important to emphasize here that unlike the treatment of other tumors, the treatment of hepatocellular carcinoma often involves both the underlying liver lesion and the tumor, requiring synergistic consideration. The treatment plan requires individualized treatment and should never be one model or generalized. For the same tumor, different patients may have different treatment methods that are more suitable for them, which is often referred to as “individualized treatment”. In addition, Chinese medicine treatment, whether combined with other treatments or applied alone, has a certain effect on reducing pain, improving immune function, enhancing one’s own anti-tumor ability and improving symptoms. Problems to be noted after surgery Like all other malignant tumors, there is also the problem of recurrence and metastasis after liver cancer surgery. Therefore, you must follow the doctor’s instructions and go to the hospital for regular checkups. Generally speaking, the examination mainly consists of two parts, namely imaging examinations such as ultrasound, CT, MRI and chest X-ray, and laboratory tests such as AFP, CA19.9, liver function and blood picture. Usually, in the first two years after surgery, the examination is done every three months; after two years, it can be changed to every six months according to the situation. Unlike other tumors, primary hepatocellular carcinoma also requires liver preservation and antiviral treatment after surgery according to liver function and viral testing. This treatment is best performed by hepatobiliary surgeons in collaboration with hepatologists. Prognosis Like other tumors, the outcome of liver cancer treatment depends mainly on early detection, but the appropriate and “individualized” treatment plan for the patient is also an important factor affecting the patient’s prognosis. It should also be noted that the extent of the underlying liver disease is also a very important factor in the prognosis of the patient. Disease prevention For the aforementioned high-risk groups of liver cancer, regular checkups for early detection are important; active treatment of underlying liver disease and maintaining a good lifestyle are even more important to reduce or even prevent the occurrence of liver cancer. People who are infected with hepatitis B and C viruses should actively go to liver disease hospitals for examination and take necessary antiviral and liver-protective treatments to prevent the progress of liver diseases; meanwhile, maintaining good mood, optimistic mental state and positive life attitude, quitting alcoholism, smoking, staying up late at night and other bad lifestyles, adjusting poor diet structure and life rules, and actively exercising are all important for liver cancer and some other malignant tumors. These can play a positive role in preventing liver cancer and other malignant tumors, and even many other diseases. Bile duct cell carcinoma In China, the main type of primary liver cancer is hepatocellular liver cancer, while bile duct cell carcinoma only accounts for about 10% of this disease. Unlike hepatocellular liver cancer, cholangiocarcinoma often occurs in normal liver without a history of hepatitis B, C or cirrhosis. The clinical picture can be dominated by jaundice, liver masses and dilated intrahepatic bile ducts. For tumor marker tests, alpha-fetoprotein (AFP) is often in the normal range, while CA19.9 and others are often elevated. For diagnostic imaging, ultrasound, CT, and MRI are the main tools, while PET-CT of the disease is more valuable than hepatocellular liver cancer for stage assessment. The treatment of this disease is based on surgical resection in the early stage. For patients who lose the chance of radical surgery, various yellowing reduction, liver preservation and symptomatic treatment means can play a role in improving the quality of survival and prolonging survival.