Hepatocellular carcinoma, i.e. malignant tumor of liver, can be divided into two categories: primary and secondary. Primary liver malignant tumors originate from epithelial or mesenchymal tissues of the liver, and the former is called primary liver cancer, which is a highly prevalent and harmful malignant tumor in China; the latter is called sarcoma, which is less common compared with primary liver cancer. Secondary or metastatic liver cancer refers to the invasion of malignant tumors from multiple organs of the body to the liver.
1. Pain in liver area
Most patients with mid- to late-stage hepatocellular carcinoma have pain in the liver area as the first symptom, with an incidence rate of more than 50%. The pain is usually located in the right rib area or under the saber process, and the nature of pain is intermittent or continuous hidden pain. Dull pain or stabbing pain. For a period of time before the pain, the patient may feel discomfort in the right upper abdomen. 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 tumor, which compresses the liver peritoneum and produces pulling pain.
Pain may vary depending on the location of tumor growth. Tumor located in the left lobe often causes pain in the middle and upper abdomen; tumor located in the right lobe causes pain in the right quarter rib area; when tumor involves the transverse septum, pain radiates to the right shoulder or right back, which is easily mistaken for shoulder arthritis; when tumor is located in the posterior part of the right lobe, it sometimes causes lumbago; if tumor is located in the deep part of liver parenchyma, pain is rarely felt.
2.Digestive tract symptoms
About 37% of liver disease patients mistook it for “stomach disease” at the early stage of the disease and missed the treatment. Decreased appetite, upper abdominal fullness after meals. The common digestive tract symptoms of liver cancer are gas, indigestion and nausea, 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.
3.Fever
A considerable number of liver cancer patients will have sweating and fever. Most of the fever is low to moderate fever, and a few patients may have high fever, above 39℃, which is 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 are easily combined with infections and fever may also appear. It is sometimes not easy to distinguish the fever from cancer fever of liver cancer, which can only be determined by combining with blood picture and observing the effectiveness of antibacterial treatment.
4.Loss of weight and fatigue
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, which 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 necrosis of liver cancer tissue.
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 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 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 important cause of death in patients with hepatocellular carcinoma.
6. Lower limb edema
Patients with hepatocellular carcinoma with ascites often have lower limb edema, which may occur in the ankle in mild cases or 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 extremity edema is the obstruction of venous return by ascites compression of lower extremity veins or cancer embolism. Mild edema can also be caused by low plasma albumin.
7.Acute abdominal disease
The rupture of cancer nodules 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 the manifestation of blood pressure drop or even shock, which is different from general acute peritonitis.