What is hepatocellular carcinoma?
Primary liver cancer is a malignant tumor that occurs in hepatocytes or bile duct cells. Primary hepatocellular carcinoma is one of the common malignant tumors in China. It has the third highest mortality rate among malignant tumors.
What Causes Liver Cancer
The etiology and pathogenesis of primary liver cancer have not been determined so far. In recent years, research has focused on hepatitis B and C viruses, aflatoxins and other chemical carcinogens.
About one-third of patients with primary liver cancer have a history of chronic hepatitis. Domestic census found that the incidence of hepatitis is also high in areas with high incidence of primary liver cancer. The fact shows that there is a causal relationship between viral hepatitis B and liver cancer.
Cirrhosis The incidence of primary liver cancer combined with cirrhosis is very high, about 50-90% according to domestic statistics, while cirrhosis combined with liver cancer is 30-50%.
Aflatoxin Aflatoxin has a strong carcinogenic effect on rats, ducks, guinea pigs and other animals. Dynamic epidemiological survey found that in some areas with a high incidence of liver cancer, grain, oil, food (such as corn, wheat, soybeans, peanuts, etc.) by aflatoxin B1 contamination is often more serious, and less common in low incidence areas. These all suggest that aflatoxin may be a factor for the prevalence of liver cancer in certain areas.
Parasitic infections The parasitic intrahepatic small bile ducts of Chinese branchial schistosomes stimulate the proliferation of bile duct epithelial cells, which may become bile duct cell carcinoma.
In addition, the occurrence of liver cancer is related to genetic factors and the lack of certain trace elements and nutrients.
What are the symptoms of liver cancer?
(I) Pain in liver area Pain in right upper abdomen is the most common and an important symptom of the disease, which is persistent or intermittent, mostly pure pain or distension, and becomes unbearable as the disease progresses. The site of hepatic pain is closely related to the site of the lesion.
(ii) Hepatomegaly Hepatomegaly is progressive, hard, uneven surface, with nodules or giant masses of different sizes, with blunt and neat margins, often with varying degrees of pressure pain on palpation, and sometimes patients can find it on their own and seek medical attention.
(C) Vascular murmur About half of the patients can hear blowing wind-like vascular murmur in the corresponding area, this sign is quite diagnostic, but it is not significant for early diagnosis.
(IV) Portal hypertension signs Liver cancer is mostly accompanied by cirrhosis, so it often shows portal hypertension, splenomegaly and ascites are the late manifestations, and the growth of ascites can be accelerated by cancer thrombus in portal vein and hepatic vein.
(e) Jaundice often appears in late stage, mostly due to biliary obstruction caused by cancer or enlarged lymph nodes pressing on bile ducts.
(vi) Systemic manifestations of malignant tumor Patients often have progressive wasting, weakness, loss of appetite, abdominal distension, diarrhea, malnutrition and cachexia, etc.
(vii) Concomitant cancer syndrome Some patients show ① hypoglycemia. (ii) Erythrocytosis. Hypercalcemia may appear, such as drowsiness, mental abnormality, coma, etc. It is often misdiagnosed as hepatic encephalopathy or brain metastasis.
(H) Metastatic foci symptoms If lung, bone, brain or chest metastases occur, corresponding symptoms can be produced. Complications
Upper gastrointestinal bleeding accounts for about 15% of the causes of death and is often caused by the rupture of varices in the middle and lower esophagus or fundus of the stomach. If hepatocellular carcinoma invades the bile duct, it may lead to biliary bleeding, which also manifests as vomiting blood and black stool.
Hepatic coma (hepatic encephalopathy) accounts for about one-third of the causes of death, and is often a manifestation of the terminal stage of hepatocellular carcinoma.
Rupture and bleeding of hepatocellular carcinoma nodes
About 10% of liver cancer patients die due to rupture of cancer nodules, which is the most urgent and serious complication of liver cancer. If it ruptures into the abdominal cavity, it will cause acute abdominal pain and peritoneal irritation signs. A small amount of bleeding may manifest as bloody ascites, while a large amount of bleeding may lead to shock or even rapid death.
Secondary infections Patients with primary liver cancer have weakened resistance due to long-term consumption and bed rest, especially after chemotherapy or radiotherapy when white blood cells are reduced, they are prone to various infections, such as pneumonia, intestinal infection, mycobacterial infection and sepsis, etc.
What tests are needed for liver cancer?
1.Conventional CT, MRI and other imaging examinations can reach 90% or more for liver cancer.
2.Ultrasound examination is also important for the size, shape and location of tumor.
3.Serum enzymology and tumor markers such as serum alpha-fetoprotein (AFP) are relatively specific for the diagnosis of hepatocellular carcinoma.
4.Liver aspiration cytology is of confirmatory value for the diagnosis of hepatocellular carcinoma. In addition, selective hepatic artery and hepatic arteriography, radionuclide liver scan and other tests are also valuable for the diagnosis of hepatocellular carcinoma.
Treatment of liver cancer
China attaches great importance to the research on prevention and treatment of hepatocellular carcinoma, and the methemoglobin census has created favorable conditions for the three early stages, which has increased the chance of early surgical resection.
I. Surgical treatment
(a) Surgical resection is the best method to treat early stage liver cancer.
(2) Liver transplantation has made great progress.
Interventional treatment
Percutaneous puncture super-selective hepatic artery cannulation angiography and simultaneous injection of chemical drugs and embolization materials such as gelatin sponge can achieve the same effect as surgical ligation and cannulation chemotherapy, and can be repeatedly performed.
Chemotherapy
CDDP is the first choice as the more effective drug for hepatocellular carcinoma, and 5-Fu, adriamycin (ADM) and its derivatives, etc. are also commonly used. The use of hepatic artery administration and/or embolization, as well as the application of internal and external radiation therapy are more common and have more obvious effects. For some patients with intermediate and advanced hepatocellular carcinoma without surgical indications, and those who are not suitable for hepatic artery intervention due to portal vein trunk obstruction and some patients after palliative surgery, combined or sequential chemotherapy can be used.
IV. Radiotherapy
Due to the progress of radiation source, radiation equipment and technology, and the accurate positioning of various imaging examinations, the status of radiation therapy in the treatment of liver cancer has been improved, and the efficacy has also been improved. Radiation therapy is suitable for unresectable hepatocellular carcinoma with limited tumor, and its efficacy is usually better if a larger dose can be tolerated.
V. Chinese medicine treatment
Adopt the treatment of activating blood circulation, softening and dispersing hard nodules, clearing heat and detoxifying. It can mobilize the immune function of the body, improve the symptoms, reduce the toxic side effects of chemotherapy and radiotherapy, improve the quality of life of patients and prevent further deterioration of the disease.