1.What is primary liver cancer? Does it have a high incidence?
Primary carcinoma of the liver is one of the common malignant tumors in China. It has a high mortality rate, ranking third after stomach and esophagus in the order of death from malignant tumors, and second after stomach cancer in some rural areas. Every year, about 110,000 people die of liver cancer in China, accounting for 45% of all liver cancer deaths worldwide. In recent years, the annual incidence rate of some areas with high incidence of liver cancer has started to decline, but there are still some areas where the incidence rate remains high and even tends to increase.
2.Why is the incidence rate of liver cancer gradually increasing?
There are several reasons why the incidence rate of liver cancer in some areas of China is on the rise: First, hepatitis B virus infection is the main causative factor of liver cancer, and there are many patients with chronic hepatitis B in China, and the base of such precancerous lesions is large. Some patients who have had hepatitis and existing hepatitis are being transformed into liver cancer one after another. Secondly, besides hepatitis virus infection, aflatoxin and drinking water pollution, with the development of the economy, environmental pollution is becoming more and more serious, and new cancer-causing factors will be generated. Third, the average life expectancy of the population is now generally increasing, and the probability of cancer is also increasing. Fourthly, in the past, due to the limitation of conditions, some patients died before they could be clearly diagnosed with liver cancer. In recent years, with the development of medical science, the detection rate of lesions has relatively increased due to the increasing means of examination. Fifthly, the mortality rate of other tumors such as breast cancer, cervical cancer and esophageal cancer has decreased significantly, while the death rate of liver cancer has increased relatively as a proportion of all malignant tumors due to its high malignancy and poor treatment effect.
3.What are the causes of liver cancer?
The causes of liver cancer are not very clear so far, but are considered to be the result of the synergistic effect of many factors, mainly related to hepatitis B virus, hepatitis C virus, aflatoxin, drinking water pollution, lack of certain trace elements, genetic factors and alcoholism, etc.
HBV infection is the main causative factor of liver cancer, and the rate of HBV infection in liver cancer patients is as high as 90%, and the probability of liver cancer in HBV-infected patients is tens of times higher than that in non-HBV-infected patients. And hepatitis C virus is considered to be one of the main causative factors in the development of liver cancer in developed countries. The detection rate of HCV in the serum of HBsAg-negative liver cancer patients in Japan is as high as 76.2%, and the positive rate of HCV antibodies in liver cancer patients in Spain is as high as 63%. HCV infection is mostly through the blood route, and with the increased application of blood products, HCV infection is also on the rise in China.
② Aflatoxin is an important carcinogenic factor in the occurrence of hepatocellular carcinoma. Its contamination is mostly found in moldy peanuts and corn. The high occurrence and mortality of liver cancer in warm and humid areas is because of the hepatocarcinogenic effect of aflatoxin.
③ Drinking water pollution is associated with liver cancer. Among the harmful substances that pollute water, biological algae toxins have been proven to cause liver cancer. Some chemical substances such as nitrosamines, azo mustards, organophosphorus pesticides and other contaminated water sources are suspected carcinogens.
Trace elements are also related to the occurrence of liver cancer. It has been reported that serum selenium level is lower in liver cancer than in cirrhosis, lower in cirrhosis than in chronic hepatitis, and lower in chronic hepatitis than in normal. The prognosis of liver cancer patients with preoperative blood selenium level close to that of healthy people is better, and vice versa, the prognosis is poor.
⑤ In recent years, with the development of chromosome analysis technology and molecular biology research, it has been confirmed that liver cancer has obvious family aggregation and genetic susceptibility. Liver cancer is affected by the combination of genetic and environmental factors, and may belong to a polygenic genetic disease.
(6) Alcohol consumption, long-term alcohol consumption can promote liver sclerosis or accelerate the development of liver cancer. If hepatitis B virus and hepatitis C virus carriers drink alcohol, alcohol can promote the integration of hepatitis B virus and hepatitis C virus into liver cells, causing normal liver cells to mutate and become liver cancer cells. Studies have found that acetaldehyde, a metabolic intermediate produced by drinking liquor in the body, is closely related to the occurrence of cancer, so heavy drinkers should try to control the amount of alcohol to reduce the damage to the liver.
4.What is the relationship between liver cancer, hepatitis and cirrhosis?
The relationship between chronic hepatitis – cirrhosis – liver cancer has attracted widespread attention. Data show that 20% of cirrhotic patients in China have previous history of hepatitis; 56% of them can be found positive indicators of hepatitis B and C virus infection; and 16.5%-51.5% of cirrhotic patients can develop into liver cancer; 26% of people in high incidence areas of liver cancer may be hepatitis B patients or long-term hepatitis B and C virus carriers. Thus, the development of liver cancer is closely related to hepatitis and liver cirrhosis.
5.How to prevent liver cancer?
The prevention of liver cancer should start from two aspects.
Firstly, to prevent liver cancer, we have to change bad habits. The occurrence of cancer is related to bad habits and diet. The key is to prevent hepatitis B, alcohol consumption, water pollution and moldy food, which are the four major factors in the development of liver cancer. ① First of all, prevention of hepatitis B. Mainly, we should inject hepatitis B vaccine, strengthen the management of blood products and medical devices, interrupt mother-to-child transmission, and avoid unclean sex and drug abuse. ② Avoid excessive alcohol consumption. Drinking alcohol damages health, especially to the liver, pancreas and stomach. ③In areas with serious water pollution, residents should drink tap water as much as possible in their daily lives. ④Liver cancer caused by moldy food should be prevented despite the decreasing trend. Avoid eating moldy food and try to eat fresh food; minimize fried food and note that some stale oils contain malondialdehyde, which can also mutate the structure of proteins and cause the cells of mutated proteins to lose their normal function and transform to initial cancer cells. In addition, in modern society, people are generally under high pressure, if they suffer a major mental shock and fail to adjust their mindset, it is also easy to trigger liver cancer, so they should pay attention to their mental health. Drinking water conditions, prevention of food mold and prevention and control of hepatitis.
Secondly, it is to monitor the high-risk group. The so-called high-risk groups of liver cancer refer to those who are carriers of hepatitis B virus, hepatitis B patients, people with family history of liver cancer, and the natural population in the high incidence area of liver cancer. These people should preferably have ultrasound or blood sampling every 3 months if they have the conditions. The reason why we emphasize the need for regular checkups is to help people detect liver cancer at an early stage. In fact, early stage liver cancer is not scary at all, this is because the biological characteristics of liver cancer are special, and with treatment, early stage liver cancer has very few distant metastases. However, early stage liver cancer is almost asymptomatic, and many people are easily misdiagnosed as stomach pain when abdominal pain appears at the beginning, but when they go to the hospital for treatment with increasingly severe abdominal pain or even symptoms such as bloating and yellowing, the detected liver cancer is often in the middle or late stage, and the effect of treatment at that time will be greatly reduced.
6.What are the symptoms of liver cancer?
The onset of liver cancer is relatively insidious, and there are usually no symptoms in the early stage. When patients show obvious clinical symptoms, the disease is often in the middle and late stage. 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 epigastric 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.
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, with the incidence rate exceeding 50%. The pain in liver area is usually located in the right rib area or under the fenestra, 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 be relieved by itself for a short period of time. The pain is mainly caused by the rapid enlargement of the tumor, which compresses the peritoneum of the liver and produces pulling pain.
In a few patients, the sudden onset of severe pain in the liver area spontaneously or after liver puncture is mostly due to the rupture and bleeding of cancer nodules located on the surface of the liver. If it is accompanied by blood pressure drop and shock, and 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 involves the transverse septum, the pain radiates to the right shoulder or right back, which may be mistaken for shoulder arthritis; if the tumor is located in the posterior part of the right lobe, it may sometimes cause lumbar pain; if the tumor is located deep in the liver parenchyma, the pain is rarely felt.
Digestive tract symptoms
Decreased appetite, epigastric fullness after meals. Ambiguous gas, indigestion and nausea are common digestive 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 high incidence and is 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.
Fever
A considerable number of liver cancer patients will have sweating and fever. Most of the fevers are low to moderate fever, while a few patients may have high fever, above 39℃, usually not accompanied by chills. Most of the fever in liver cancer is cancer fever, which is caused by the release of pyrogen into the blood circulation after the necrosis of tumor tissue. Due to low resistance, tumor patients can easily be combined with infections and may also have fever, which is not easily distinguished from cancer fever of liver cancer.
Lethargy 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 damaged liver cells 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 the decrease of digestion and absorption function. With the development of the disease, the degree of emaciation may increase, and in serious cases, cachexia may appear.
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 limbs, and the water can ooze out from the skin of thighs. The main cause of lower limb edema is the obstruction of venous return by ascites compression of lower limb veins or cancer thrombus. Mild edema can also be caused by low plasma albumin.
Bleeding tendency
Patients with hepatocellular carcinoma often have bleeding tendency such as gum bleeding and subcutaneous bruising, which are mainly due to impaired liver function and abnormal blood clotting 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.
Primary liver cancer starts insidiously and lacks typical symptoms in the early stage. Some patients even have advanced liver cancer, but the symptoms are still not obvious. Early cases detected by AFP screening may have no symptoms and signs, which is called subclinical liver cancer. Patients who have symptoms and seek medical treatment by themselves are mostly in the middle and late stages, and often have symptoms such as pain in the liver area, loss of appetite, weakness, emaciation and hepatomegaly. Liver pain is caused by the rapid growth of tumor and the pulling of liver envelope. If the lesion invades the diaphragm, the pain may involve the right shoulder. When the cancer nodule ruptures, it may cause sudden and severe pain, and there are signs and symptoms of peritonitis. If the bleeding volume is large, it may cause syncope and shock. ②hepatomegaly About 90% or more patients have enlarged liver with progressive enlargement, hard texture, uneven presentation, nodules or giant lumps of different sizes, blunt and uneven margins, and often with different degrees of pressure pain. When liver cancer protrudes under the right costal arch or under the saber process, the epigastrium may show local elevation or fullness. If the cancer is located on the diaphragm, the main manifestation is that the diaphragm is elevated and the lower edge of the liver is not enlarged. As the arterial vessels of hepatocellular carcinoma are rich and twisted, or the inner diameter of artery suddenly narrows due to the compression of hepatic artery or abdominal aorta by huge carcinoma, blowing wind-like vascular murmur can sometimes be heard on the abdominal wall close to the tumor. ③Jaundice usually appears in late stage, which can be caused by hepatocellular damage, or due to compression or invasion of bile ducts near hepatic hilar by cancer mass, or obstruction of bile duct caused by shedding of cancer tissue and blood clots. ④ Patients with liver cancer accompanied by cirrhotic portal hypertension may show splenomegaly, ascites, and formation of venous collateral circulation. Ascites increases quickly and is usually leaking fluid. Hemorrhagic ascites is mostly caused by cancer invading the liver peritoneum or breaking into the abdominal cavity, and occasionally caused by peritoneal metastatic cancer. ⑤ Systemic manifestations of malignant tumor include progressive wasting, fever, loss of appetite, weakness, malnutrition and cachexia, etc. In a few patients with liver disease, there can be special systemic manifestations called concomitant cancer syndrome, with hypoglycemia and erythrocytosis more common, and other rare ones include hypercalcemia, hyperlipidemia and carcinoid tumor. (6) Metastasis symptoms such as lung, bone and thoracic metastasis can produce corresponding symptoms. Thoracic metastasis is more common on the right side, and there may be pleural effusion sign. Bone or spine metastasis may have local pressure pain or nerve compression symptoms, and intracranial metastasis cancer may have neural localization signs.
7.What tests should be done when liver cancer is suspected?
The most basic examination is liver ultrasound and blood test for AFP; ultrasound can show tumors over 2cm, and combined with AFP test can detect most early liver cancers. Those with suspicion need further CT or hepatic angiography, and detection of liver cancer markers such as GGT2, AFU, AP, etc.
8.How should liver cancer be treated?
At present, there are five main types of treatment methods for liver cancer: surgery, interventional therapy, radiation therapy, drug therapy and liver transplantation. Surgical resection is still the most effective treatment for liver cancer. With the continuous improvement of surgical methods, from regular lobectomy to irregular lobectomy, bloodless liver resection and in situ liver transplantation, the surgical resection rate has been greatly improved. However, due to the insidious onset of hepatocellular carcinoma, about 70% of the hepatocellular carcinoma presented to the clinic can no longer be surgically resected, while the recurrence rate in the liver after surgery is also high.
②The rise of interventional therapy in recent years has enabled most patients with inoperable liver cancer to improve their symptoms and prolong their survival, and some of them can be cured, thus improving the cure rate of liver cancer. Currently, the main interventional methods applied in liver cancer treatment are hepatic artery embolization chemotherapy, anhydrous ethanol injection, radiofrequency ablation, etc., all of which have good therapeutic effects. Especially, hepatic artery embolization chemotherapy is mainly applied to patients who cannot be operated in the middle and late stages, and the tumor shrinks or disappears after the treatment.
③ Primary hepatocellular carcinoma is not very sensitive to radiation therapy, while the adjacent organs are vulnerable to radiation damage, so the effect of radiotherapy in the past is not very satisfactory. In recent years, the application of new radiotherapy equipment such as X-knife, γ-knife and proton knife, the improvement of positioning technology such as conformal radiotherapy stereotactic radiotherapy, and the technology of radioactive particle implantation are the reapplication of radiotherapy in this treatment.
④ Drug therapy. Systemic chemotherapy has little effect on primary liver cancer, so chemotherapy is generally not advocated. Biological immunotherapy and traditional Chinese medicine can inhibit tumor growth or shrink tumor to a certain extent, improve clinical symptoms and prolong patient’s life. ⑤ Liver transplantation. Due to the shortage of liver source, as well as recurrence and metastasis and expensive, liver transplantation is not recommended at present.
The above treatment methods have their own advantages and disadvantages, and the effect of one method alone is not satisfactory, and multiple methods can be applied together to achieve the best effect. How to organically combine interventional therapy with tumor surgery, chemotherapy, biological therapy and other therapeutic methods to complement each other’s strengths and improve the efficacy is the urgent need of liver cancer treatment at present. Clinical research shows that comprehensive treatment of liver cancer is never the simple addition of various treatment methods, but the organic combination of various treatment methods through multidisciplinary cooperation according to the patient’s condition needs, so that each liver cancer patient can obtain the optimal treatment plan, thus achieving the best effect of 1+1〉2.
For example, microscopic cancers invisible to the naked eye may remain after resection of hepatocellular carcinoma. The unresectable hepatocellular carcinoma can be shrunk after hepatic artery embolization chemotherapy.
Comprehensive treatment has an extremely broad development prospect. Professor Tang Zhaoyou, academician of the Chinese Academy of Engineering and director of the Institute of Liver Cancer of Shanghai Medical University, pointed out that one of the tasks of modern medicine is how to achieve 1+1〉2 and avoid the effect of 1+1〈2 in the comprehensive treatment. In conclusion, the occurrence of hepatocellular carcinoma is the result of many different factors.
In conclusion, the occurrence of hepatocellular carcinoma is the result of the combined effect of multiple pathogenic factors, and at the same time, the rapidly changing medical technology provides various treatment methods for hepatocellular carcinoma patients.
9.How is the treatment effect of liver cancer?
Liver cancer is prone to recurrence and requires lifelong treatment When it comes to liver cancer treatment, many patients with advanced liver cancer can only “wait for death” at home because they are inoperable. In fact, with the improvement of treatment technology, it used to be said that patients with liver cancer can only live for half a year at most, but nowadays, there are many liver cancer patients who can survive for more than one year, three years or even long term. Clinical practice proves that through comprehensive treatment, advanced liver cancer patients can achieve the purpose of improving life quality and prolonging survival, while the 5-year survival rate of early liver cancer patients can even reach 70%~80%. In recent years, our hospital has adopted the triple therapy of “vascular intervention, anhydrous alcohol injection and immunomodulation”, which combines local treatment and systemic treatment, and helps to eliminate the evil to treat patients with middle and late stage liver cancer who have lost the chance of surgery, which can effectively control the growth of liver cancer, prolong patients’ life and improve their life quality. In addition to early and comprehensive treatment, we believe that liver cancer patients should also be prepared for long-term battle. This is because the recurrence rate of liver cancer is very high after cure, and most patients need to be reviewed every 3 months or 6 months after discharge from the hospital after cure.
10.Dietary precautions for liver cancer
Patients with liver cancer should adopt small amount of multiple meals, avoid greasy food, and give light and tasty food with fresh vegetables, fruits and less stimulating food. More cooking methods such as steaming, stewing, boiling, blanching and mixing should be used, and the amount of various seasonings should be reduced.
When chemotherapy is given to postoperative patients, there will be many symptoms, which are often chemotherapy reactions, poor nausea, nausea, vomiting, reduced white blood cells, hair loss, etc.. The diet should be adjusted gradually according to the patient’s specific situation, with a light, thick liquid diet with less oil. We should pay attention to the cooking method, the food should be extremely fine and soft, easy to swallow, and easy to digest and absorb, we should pay attention to the vitamin, mineral and trace element supplementation, and if necessary, we can use fruits to fill the hunger.