What is hepatocellular carcinoma?
Liver cancer includes primary liver cancer and secondary liver cancer (i.e. metastatic liver cancer). Secondary liver cancer refers to primary cancer or sarcoma from various organs of the body that metastasizes to the liver.
Primary hepatocellular carcinoma refers to carcinoma occurring in hepatocytes and intrahepatic bile duct epithelial cells, which is one of the most common malignant tumors in human. Among liver cancers in China, hepatocellular carcinoma (HCC) accounts for about 80%-90%, followed by cholangiocellular carcinoma and mixed hepatocellular-cholangiocellular carcinoma. Malignant tumors that originate from other cellular components of the liver are rare. Hepatocellular carcinoma is characterized by insidious onset, long latent period, high malignancy, rapid progression, aggressiveness, easy metastasis and poor prognosis. Its incidence rate has been increasing year by year.
Hepatocellular liver cancer is an important cause of cancer death worldwide, and most hepatocellular liver cancers occur with a background of chronic liver disease, such as viral hepatitis (type B or C) or alcohol abuse. Cirrhosis may govern the clinical course and determine the prognosis.
What is the basis for confirming the diagnosis of hepatocellular carcinoma?
Although biochemical, immunological and imaging diagnosis of liver cancer has been greatly developed, to determine the nature of the tumor, it still relies mainly on pathological diagnosis. Pathological examination is the most accurate and reliable method to diagnose tumor. It is to directly take the tissue block of the lesion and make a section to observe the cell morphology and structure under the microscope to determine the nature of the tumor.
Pathology is usually divided into two major parts: histopathology and cytopathology. Pathological diagnosis can not only determine the benignity and malignancy of tumor and its prognosis, but also provide a reliable basis for treatment. However, pathological diagnosis also has limitations. Because the biopsy specimen, macroscopic sampling and sectioning are all sample examinations, what is finally seen under the light microscope is only a very small part of the lesion, and sometimes it cannot replace the whole lesion. In addition, the reliability of pathological diagnosis is also related to the selection of pathological specimens. Sometimes there are also false negative results. If the clinical diagnosis is not consistent with the pathological diagnosis, the pathological diagnosis should be reviewed in a timely manner, and if the pathological diagnosis is correct, the selection of the pathological specimen can be considered appropriate. If necessary, re-take the material and do pathological diagnosis again. In order to avoid misdiagnosis and delaying the time of treatment.
Can malignant tumor of liver be treated?
Liver cancer is a preventable and treatable common disease. It is not curable, especially in the middle and late stages, but if detected and treated early, most tumors can be cured. Many people think that liver malignancy is an incurable disease and once it is diagnosed, it is a death sentence. No, the answer is no. With the continuous development of liver cancer research, people’s understanding of liver cancer is getting deeper and deeper, and the methods of preventing and treating liver cancer are gradually increasing and becoming more and more perfect.
Nevertheless, in real life, it is still quite common to talk about cancer and consider liver cancer as an “incurable disease”. The reasons for this situation are many. Firstly, because the old concept still remains in people’s mind and most of the liver cancer patients died in the past, therefore, liver cancer is labeled as “incurable disease”; secondly, because the treatment of liver malignant tumor is more difficult, people often equate “difficult to cure” with “incurable”; because liver cancer develops rapidly and it is difficult to detect it in the early stage, after it is diagnosed, some original effective treatment methods can no longer work completely or even lose their functions. Because of the difficulty in early detection, some effective treatment methods can not fully function or even lose their functions after diagnosis, which often results in the phenomenon of “ineffective treatment”; and because of the long-standing fear of liver cancer, people are reluctant to think about it even if they have found some clinical suspicious signs, and they always think “it is impossible” in their mind, which eventually leads to the delay of the disease and the cure is too late. Another important point is that our health propaganda work is not enough, and we have not been able to tell the general public the basic knowledge of prevention and treatment of liver cancer and the current technological progress of diagnosis and treatment in a timely and easy-to-understand form.
As people’s awareness of cancer prevention and fighting against cancer increases and their knowledge of tumor prevention and treatment continues to be mastered, coupled with the continuous improvement of current diagnostic and treatment technologies, thousands of liver cancer patients are in the process of recovery.
At present, it is believed that if patients with liver malignant tumors can achieve the “three early stages”, i.e. early detection, early diagnosis and early treatment, the treatment effect is satisfactory. It is possible to cure liver cancer, which is known as “the king of cancer”, and the five-year cure rate of early stage microscopic liver cancer can reach over 70%.
Why do people get liver cancer?
The cause of liver cancer is very complicated, but now it is proven to be a genetic lesion. People are made up of genetic code, and genes determine the occurrence and development of lesions. Of course, the living environment, dietary habits, social pressure, and emotional changes are factors that can have an impact on any disease, including tumors. For example, consumption of moldy food (corn and peanuts contain aflatoxin) or contaminated drinking water (contains algae toxin), and of course, bad habits such as smoking and alcohol abuse are also related to the occurrence of liver cancer. Another cause of hepatocellular carcinogenesis is viral infection (type B or C), for example, hepatitis B virus infection is an important cause of hepatocellular carcinoma in our country. In most cases, there is no single cause for the development of tumors.
What can I do to prevent not getting liver cancer?
The policy of “change water, mold and hepatitis prevention” has been adopted in areas with high incidence of liver cancer in China, and the main measure to prevent liver cancer in the world is hepatitis B vaccine.
How to detect liver cancer at an early stage and contain it at the initial stage?
The most important thing is to raise awareness of self-care. For example, people at risk in high incidence areas or those who already suffer from chronic hepatitis should have regular medical checkups to help early diagnosis of cancer.
Is liver cancer hereditary?
Liver cancer is not equivalent to a genetic disease. However, there are genetic factors in its development. Liver cancer is a multifactorial and multi-stage disease, and the cause of liver cancer is still not very clear.
Is liver cancer contagious?
In principle, it is not contagious, but it may be related to infectious diseases in the process of development. For example, hepatitis B itself is contagious, and in China, it is an important cause of liver cancer, and many liver cancer patients have hepatitis B in the early stage. We can say that some liver cancers are caused by infectious diseases, but direct transmission of liver cancer does not usually exist. However, the occurrence of liver cancer is a family aggregation phenomenon, for example, the mother has active hepatitis leading to cirrhosis, which develops into liver cancer; due to the “vertical transmission” of mother’s hepatitis, the child is infected with hepatitis after birth and does not receive timely and effective treatment.
Should I take rest or exercise if I have liver cancer?
During the recovery period, it is important to listen to the doctor’s advice on whether to rest or to exercise more, and the two aspects are not separate. Doctors do not advocate that patients should be disconnected from society and lie down at home to recuperate, but proper participation in exercise and socialization is beneficial to recovery.
Do I have to suffer from deadly pain if I have liver cancer?
Patients with mid- to late-stage liver cancer will have painful symptoms, but not necessarily everyone is in pain.
What are the more obvious symptoms of liver cancer patients?
The symptoms of liver cancer are not obvious in the early stage, and even for a long time after the disease has developed, the patient will not feel anything. Only when the disease has progressed to a certain level will symptoms such as pain in the liver area, loss of appetite, fatigue and weakness, and gradual loss of weight gradually appear. At advanced stage, jaundice, ascites, vomiting blood, coma and other symptoms will appear. A huge swelling can often be felt in the upper abdomen of liver cancer patients, but at this time, it has already reached the middle and late stage, and even metastasized to the lungs and other places.
The common clinical staging standard of liver cancer in China is: early stage, which refers to patients without symptoms and signs of liver cancer (such as feeling lumps, etc.). Because there is no manifestation, it is also called “subclinical stage”. Late stage refers to cases with jaundice, ascites or extrahepatic metastases. Those between early stage and advanced stage are called intermediate stage. Simply put, early stage liver cancer has no symptoms, while those with symptoms are not early stage liver cancer.
What are the most common clinical symptoms of liver cancer?
1. Pain in liver area: it is the most common, mostly in the form of persistent dull pain or swelling pain, which is caused by the rapid growth of cancer that tenses the liver envelope. If the tumor invades the diaphragm, the pain can be radiated to the right shoulder or right back. Tumor growing backward to the right can cause right back pain. Sudden onset of severe abdominal pain and peritoneal irritation sign indicates subperitoneal bleeding or rupture of cancer nodules into the abdominal cavity.
2.Gastrointestinal symptoms: loss of appetite, indigestion, nausea, vomiting and diarrhea, etc., which are easily ignored because of lack of sexual specificity.
3, weakness, emaciation, general debility. A few patients in the late stage may show cachexia.
4.Fever: generally low fever, occasionally above 39℃, continuous or afternoon low fever or chills type high fever. The fever is related to the absorption of necrotic products of cancer tumor. Biliary tract infection can be complicated by cancer compression or invasion of bile duct.
5.Symptoms of metastasis: there are corresponding symptoms in the place of metastasis of tumor, which sometimes become the first symptoms of liver cancer. For example, metastasis to lung may cause coughing and hemoptysis, and pleural metastasis may cause chest pain and bloody pleural fluid. Pulmonary infarction can be caused by cancer embolism in pulmonary artery or hair branch, which can suddenly cause severe respiratory difficulty and chest pain. The obstruction of inferior vena cava by cancer embolus may cause severe edema of lower limbs and even decrease of blood pressure; the obstruction of hepatic vein may cause Budd-Chiari syndrome and edema of lower limbs. Metastasis to bone may cause local pain or pathological fracture. Metastasis to the spine or compression of spinal nerves may cause local pain and paraplegia. Intracranial metastasis may cause localized symptoms and signs, and intracranial hypertension may lead to brain herniation and sudden death.
6.Other systemic symptoms: endocrine or metabolic syndromes caused by metabolic abnormalities of the cancer itself or various effects of the cancer tissue on the body are called companion cancer syndrome, which sometimes may precede the symptoms of liver cancer itself. The common ones are spontaneous hypoglycemia, erythrocytosis, and other rare ones are hyperlipidemia.
What are the tests for hepatocellular carcinoma?
Cases with typical clinical symptoms and manifestations are not difficult to diagnose, but they are often in advanced stage. The current diagnostic means are
1.Tumor marker detection: tumor markers are certain substances produced and released by cancer cells, which exist in tumor cells or in patients’ body fluids. Such as alpha-fetoprotein (AFP) (for liver cancer, AFP is still the most specific marker and the main indicator for diagnosing liver cancer), r-GT2, AP, AFU, etc.
2.Ultrasound imaging: It has been widely used for screening liver cancer, which is beneficial to early diagnosis.
3.Computed tomography (CT) scan: Among various imaging examinations, CT can best reflect the morphological manifestations of liver pathology, such as the size, shape, location, number of lesions and whether there is bleeding and necrosis within the lesions. CT is currently the best method to diagnose small hepatocellular carcinoma and microhepatocellular carcinoma.
4.Magnetic resonance imaging (MRI): It can clearly show the internal structural features of hepatocellular carcinoma, and is valuable for showing daughter tumors and tumor emboli.
5.X-ray hepatic angiography: it is often used to diagnose small hepatocellular carcinoma.
6.Radionuclide liver imaging
7.Hepatic tissue biopsy or cytological examination: In recent years, biopsy or fine needle aspiration for histological or cytological examination under real-time ultrasound or CT guidance is currently an effective method to obtain a definite diagnosis of small hepatocellular carcinoma under 2cm in diameter.
Therefore, for any middle-aged patients with history of liver disease, especially male patients with unexplained liver pain, wasting and progressive hepatomegaly, AFP measurement and optional above mentioned tests should be performed for early diagnosis.
What are the treatment methods of liver cancer?
As for treatment, early surgical resection is still the best way to eradicate primary liver cancer. The indications for surgery are: clear diagnosis, estimated lesion limited to one lobe or half lobe; good liver function compensation, prothrombin time not less than half of normal, no obvious jaundice, ascites or distant metastasis; good heart, lung and kidney function, and able to tolerate surgery. Radiation therapy, in recent years in the technology of local or semi-hepatic mobile strip field irradiation, some lesions are more limited, liver function is good in early cases, such as can tolerate more than 40Gy radiation dose, the efficacy can be significantly improved. Chemotherapy is mostly used for hepatic artery cannulation chemotherapy, hepatic artery embolization or chemoembolization. Biological and immunotherapy, after surgical resection or chemotherapy or radiotherapy kill a large number of cancer cells, the application of biological immunotherapy can play a role in consolidating and enhancing the therapeutic effect. When combined with chemotherapy and radiotherapy, TCM treatment focuses on supporting the righteousness, strengthening the spleen and nourishing Yin, which can improve the symptoms and enhance the therapeutic effect.
What are the recommendations for the healing of liver cancer?
In recent years, due to the advancement of diagnosis and treatment methods, more patients with this disease have been diagnosed and treated early, and the radical resection rate and 5-year survival rate of early-stage hepatocellular carcinoma have been significantly increased. The prognosis is good if the tumor is less than 5cm and can be operated early; the prognosis is good if the cancer envelope is intact and there is no cancer thrombus formation; the prognosis is good if the body has good immune status; the prognosis is poor if there is combined cirrhosis or liver cancer metastasis; the prognosis is poor if there is gastrointestinal bleeding or liver cancer rupture; the prognosis is poor if the ALT is significantly increased.
Therefore, active prevention and treatment of viral hepatitis and cirrhosis, and attention to food and water hygiene are the measures that should be taken at present. Especially for high-risk groups (hepatitis history for more than 5 years, positive marker for hepatitis B or C virus, over 35 years old) testing AFP combined with ultrasound phenomenon examination 1-2 times a year is the basic measure to detect early liver cancer.
What is the five-year survival rate that doctors often talk about?
In order to count the survival rate of cancer patients and compare the advantages and disadvantages of various treatment methods, the medical profession adopts the situation that most patients have a clearer prognosis as a statistical indicator, which is often referred to as five-year survival rate by doctors.
Five-year survival rate refers to the proportion of patients who survive for more than five years after various comprehensive treatments for a certain tumor. The five-year survival rate has some scientific validity. After the treatment of a certain tumor, some of them may develop metastasis and recurrence, and some of them may die because the tumor enters advanced stage. Metastasis and recurrence mostly occur within three years after radical surgery, accounting for about 80%, and a small proportion occurs within five years after radical surgery, accounting for about 10%. Therefore, the chance of recurrence is rare if there is no recurrence within five years after radical surgery for various tumors, so the five-year survival rate is often used to indicate the efficacy of various cancers. Within five years after surgery, it is important to consolidate treatment and regular checkups to prevent recurrence, and even if there is metastasis and recurrence, it can be treated early. In addition, three-year survival rate and ten-year survival rate are also used to indicate the efficacy of treatment.
How to face liver cancer?
At present, 30% of the tumor patients who died were “scared” to death. And 70% to 80% of tumor patients have psychological disorders, mainly manifested as depression, anxiety, irritability and fear. Besides cancer, psychological factors are becoming an important factor to kill the life of tumor patients.
Psychological disorders are closely related to two major factors. One is the malignancy degree of cancer, and the other is the psychological quality of patients. When lung, liver and pancreas are suffering from cancer, clinical treatment is only one aspect, more important is to overcome the bad psychology and construct a psychological defense against cancer, which is crucial to strengthen their immunity and stop and delay the progress of the disease.
A lot of facts show that cancer patients maintain an optimistic attitude towards life, establish confidence in overcoming the disease and firmly believe in their own recovery ability, which is the primary prerequisite for overcoming cancer.
In cancer clinics, we often encounter some patients whose psychological symptoms are greater than pathological symptoms. They refuse laboratory tests due to fear before diagnosis and delay the diagnosis time again and again; after the diagnosis, they weep and weep and think of everything; after the follow-up, they are worried and always suspect that the cancer has deteriorated …… These are all cancer-phobic psychology. In fact, patients should have a correct understanding of the natural course of cancer. With the rapid development of science and technology, the current treatment methods and efficacy of many middle and late stage cancers are constantly breaking through and improving.
Many patients may feel desperate after knowing that they have cancer, which is obviously developed from fear. Due to the lack of confidence in fighting against the disease and the attitude of letting the disease go, coupled with the lack of attention to the routine of daily life, many patients become depressed, some even drink and indulge in alcohol and give up on themselves, and their spirit is on the verge of collapse.
Physical exercise should not be taken lightly. During the recovery period of cancer patients, self-exercise can mobilize patients’ subjective initiative, which is good for both body and mind; physical exercise is also a kind of adjuvant therapy, which is both local and systemic therapy, and plays an exercise role for the whole body organs through local muscle movement; physical exercise can also strengthen the body’s resistance to disease, reduce complications after treatment and prevent other diseases.
On the other hand, the patient’s family also has an undervalued influence on the patient. In terms of psychology, the patient’s family members should actively learn the knowledge about tumor and participate in some mutual help organizations with the patient to exchange ideas and encourage each other.
People often say: “The biggest enemy of a person is himself”, “In fact, no one can bring you down, the only one who can bring you down is yourself”.
While treating the physical pain of patients, oncologists have the obligation to help patients do a good job in psychological rehabilitation and let them build up confidence to overcome the disease. People have various attitudes and psychological activities during illness, some are open and optimistic, while many are fragile and desperate. For the same disease and the same period of illness, the former has a better prognosis than the latter because their immune status is different. Even if the drug enters the body, it depends on the patient’s active mobilization for it to work, so it is clear that the patient’s mental state plays a very important role.