I. Disease Concept
Liver cancer is one of the common malignant tumors in China, and it is one of the malignant tumors with high malignancy degree, ranking as the second cancer “killer” in China, commonly found in middle-aged men. Because of its high malignancy and fast progress, patients usually have little discomfort in the early stage, but once symptoms appear, they are often in the late stage. Therefore, the treatment is difficult and ineffective, and the survival time is only 6 months after the onset of the disease, so it is called “the king of cancer”.
Etiology and pathogenesis
It is mostly believed that it is related to the combination of various factors, and this year, the research is focused on hepatitis B and C viruses, aflatoxins and other chemical carcinogens.
1.Viral hepatitis About one-third of primary liver cancer patients have a history of chronic hepatitis.
2.Cirrhosis The incidence of primary liver cancer combined with cirrhosis is very high, and liver cancer with cirrhosis is mostly large nodular. This type of cirrhosis is mostly post-hepatitis (post-necrosis) cirrhosis caused by viral hepatitis. Hepatocellular carcinoma may occur in the process of hepatocyte regeneration, that is, carcinogenesis through hepatocyte destruction – proliferation – heterogeneous proliferation.
3.aflatoxin Aflatoxin has a strong carcinogenic effect on rats, ducks, guinea pigs and other animals. Animal experiments have proved that aflatoxin B1 is the strongest carcinogen for liver cancer.
4.Other chemical carcinogenic factors Animal experiments have proved that some chemicals such as nitrosamines and azo benzenes can cause liver cancer in many animals.
5.Parasitic infection The parasitic intrahepatic small bile ducts of Chinese branchial testes stimulate the proliferation of bile duct epithelial cells, and some of them may become carcinoma of bile duct cells.
6.Other pathogenic factors Genetic factors Hepatocellular carcinoma can sometimes appear as a family gathering phenomenon, and many families live together and are related to each other by blood. The relationship between trace elements, trace elements copper and zinc, and liver cancer is noteworthy.
III. Clinical manifestations
1.Subclinical liver cancer can be divided into the following according to the development of liver cancer
(1) Pre-subclinical stage, which means patients have no symptoms and signs and are difficult to be detected clinically.
②Subclinical stage, the patient still has no symptoms and signs, and the tumor is about 3~5 cm.
Once the clinical manifestation of liver cancer appears, it has already reached the middle stage, at which time the disease develops rapidly and jaundice, ascites, lung metastasis and even extensive metastasis and advanced manifestation of cachexia may appear soon. When hepatocellular carcinoma develops to advanced stage, the diameter of the tumor has reached about 10 cm, which is difficult to be cured.
2. Clinical manifestations of middle and late stage
Pain in the liver area Pain in the right upper abdomen is the most common and an important symptom of the disease, which is persistent or intermittent, mostly dull or distending, and becomes unbearable as the disease develops;
②hepatomegaly;
③Vascular murmur;
④ Portal hypertension signs Liver cancer is mostly accompanied by cirrhosis, so it often shows portal hypertension, and ascites is a late manifestation;
(5) Jaundice often appears in the late stage, mostly due to bile duct obstruction caused by cancer or enlarged lymph nodes pressing on the bile duct;
(6) Systemic manifestations of malignant tumor Patients often have progressive wasting, weakness, loss of appetite, abdominal distension, diarrhea, malnutrition and cachexia, etc;
Some patients show 1) hypoglycemia, 2) erythrocytosis, 3) hypercalcemia, 4) other symptoms: hepatic porphyria, abnormal fibrinogenemia, thrombocythemia, hyperlipidemia, etc;
8) Metastasis symptoms If lung, bone, brain or chest metastasis occurs, corresponding symptoms can be produced.
IV. Health care guidance
1.Appropriate rest;
2.Mediate diet and strengthen nutrition. Eat a high-protein, high-vitamin, low-fat, easy-to-digest diet according to personal preference, and have small and frequent meals. Choose milk, eggs, fish, lean meat, soy products and other high-quality protein foods, which should be rotated in the daily diet. Easy-to-digest mono- and disaccharides such as glucose, sucrose, honey and fruit juice can be used appropriately to increase liver glycogen reserves. Pay attention to the supplementation of yeast and B vitamins. Avoid alcohol and all spicy and stimulating foods, such as celery, leek, sweet potato, soft drinks, etc;
3.Apply anti-cancer and liver protection drugs on time;
4.Regular follow-up checkups to understand the changes of liver function and recurrence of disease. After surgery, patients should also pay attention to the results of methotrexate tracking test, and observe whether there is metastasis of liver cancer;
5.Patients should enhance their confidence to overcome the disease and cooperate with doctors to increase the treatment effect.