liver tumor
Introduction
Introduction to liver tumors A liver tumor is a tumor lesion that occurs in the liver. The liver is one of the most common sites for tumors. Benign tumors are rare, and metastatic tumors are more common in malignant tumors. Primary tumors can occur in hepatic cord, biliary epithelium, blood vessels or other mesoderm tissues. Most metastatic tumors are metastatic carcinomas, and a few are metastatic sarcomas. basic knowledge The proportion of illness: 0.002% Susceptible people: people who have eaten mildew food, nitrosamine-containing foods for a long time, and people who drink alcohol Mode of infection: non-infectious Complications: jaundice ascites osteoporosis fracture anemia
Cause
Causes of liver tumors
(1) Causes of the disease
The cause of liver cancer, after many studies, although there is a certain understanding, but its reasons have not been known so far, the current research believes that the cause of the disease:
Cirrhosis of the liver
About 80% of patients with hepatocellular carcinoma have hepatitis cirrhosis, and most patients have large nodular cirrhosis, which may be due to hepatocyte degeneration and necrosis, interstitial connective tissue hyperplasia, fibrosis, and residual hepatocyte nodular regeneration. Forming leaflets, which can be mutated during repeated hyperplasia and eventually lead to cancer.
2. Viral hepatitis
The relationship between hepatitis B and liver cancer is relatively close. In HbsAg-positive patients, the incidence of liver cancer is significantly higher than that of HbsAg-negative disease. Hepatitis C is also closely related to the occurrence of liver cancer.
3. Food containing aflatoxin
After being ingested, it is absorbed through the digestive tract and reaches the liver, causing degeneration and necrosis of the liver cells, which in turn proliferate and become cancerous.
4. Chemical carcinogens
Nitrate and nitrite are now known.
5. The immune status of the body
The occurrence of liver cancer is generally associated with low immune function of antibodies, especially in relation to low cellular immune function.
(two) pathogenesis
Hepatoblastoma is mostly a single lesion located in the right lobe of the liver with or without an envelope. The cut surface is gray to brown, with bleeding, ossification and necrosis. In 1967, Ishak and Gkunz divided hepatoblastoma into two types: Epithelial and epithelial-mesenchymal, pure epithelial tumors are nodular, uniform and uniform, consisting of two types of cells, one of which is a fetal cell, shaped like fetal liver cells, often arranged in two cell-thick irregularities Liver plate, different in cell size, but often smaller than normal hepatocytes, cytoplasmic eosinophilic, glycogen-containing, nuclear round or oval, basophilic, with a few mitotic figures, and secondly embryonic cells, slightly differentiated Poor, arranged in bundles, small cells with deep staining, less cytoplasm, little or no glycogen, deep nuclear staining, common mitotic figures, mixed tumor sections separated by collagen fibers and lobulated, visible fetal cells And embryonic cell distribution, supported by reticular fibers, primitive mesenchymal cells are long fusiform, cytoplasm is less, bone-like tissue is visible, in recent years, CCSG (Children's Cancer Study Group), SWOG (Southwest Oncology Group) and POG ( Paediatric Oncology Group) According to the recommendations of Weinber and Finnegold, hepatoblastoma is divided into fetal type, embryo type, thick beam type and small cell undifferentiated type (inter-variant type). Hepatocellular carcinoma contains well-differentiated large-angle cells with eosinophilic cytoplasm, cells. The structure of the hepatic cord is formed, surrounded by vascular sinus. Both tumors can be seen with extramedullary erythrocyte hyperplasia, and more often the right lobe of the liver. About half of the patients invade the right and left lobe or are multicentric, most often transferred to It is not uncommon for the lungs to spread locally in the abdominal cavity. It is less common to transfer to the central nervous system.
Prevention
Liver cancer prevention
1, pediatric hepatocellular carcinoma often complicated by cirrhosis or the original liver parenchymal lesions. For example, cases of hepatic malignant tumors that occur secondary to biliary atresia and cytomegalovirus cirrhosis should be actively prevented.
2. For men 35 years old, those with high risk of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection and alcohol abuse are generally examined every 6 months.
3. For patients with AFP>400 g/L and no hepatic occupying by ultrasonography, CT (or) magnetic resonance imaging (MRI) should be performed after excluding pregnancy, active liver disease and gonad embryo-derived tumors. If AFP is elevated but does not reach the diagnostic level, in addition to the above-mentioned circumstances that may cause AFP increase, the dynamic changes of AFP should be closely followed to shorten the interval of ultrasound examination to 1 to 2 months. CT and if necessary (or) MRI examination.
4. If liver cancer is highly suspected, digital subtraction angiography (DSA) is recommended for hepatic arterial iodine angiography. Should be highly alert to anorexia, fatigue, poor mental, long-term low fever, edema, liver pain and other symptoms, so early detection.
Complication
Liver tumor complications Complications jaundice ascites osteoporosis fracture anemia
Often complicated by jaundice, ascites, osteoporosis, can lead to multiple fractures, anemia and thrombocytosis.
Once a liver has a malignant tumor, it will lead to serious life-threatening consequences. Because the liver has a rich blood supply, it is closely related to the important blood vessels of the human body, and the liver malignant tumors are concealed and grow rapidly. Therefore, the treatment is very difficult, and the overall efficacy and prognosis are not very satisfactory.
Symptom
Hepatic tumor symptoms Common symptoms Hepatomegaly, jaundice, ascites, oxygenation, insufficient thrombocytopenia, high heat heart failure, osteoporosis, dyspnea, alpha-fetoprotein
1. Children often have irregular localized hepatomegaly as the initial symptom. The mass is located in the right abdomen or right upper abdomen. It is often recorded in the history that the tumor grows rapidly, some can reach the umbilicus or beyond the midline, the surface is smooth, the edge is clear, and the hardness is medium. Slightly move left and right, no tenderness, in addition to mild anemia in the early stage, the general condition is good, in the late stage, jaundice, ascites, fever, anemia, weight loss, venous engorgement can be seen in the abdominal wall, and breathing can be caused by a huge mass in the abdomen. Difficulties, about 20% of cases of hepatoblastoma have osteoporosis, and severe cases can lead to multiple fractures.
2, many patients have anemia and thrombocytosis at the time of treatment, especially in children with hepatoblastoma, liver function of children with hepatoblastoma is often normal, but cases of hepatocellular carcinoma are complicated by hepatitis or cirrhosis, serum bilirubin Alkaline phosphatase and transaminase may increase, 60% to 90% of hepatocellular carcinoma cases and more than 90% of hepatoblastoma cases have increased alpha-fetoprotein, and hepatoblastoma urinary cystosine (Cistathionine) excretion increase.
3. Other primary liver tumors are common cavernous hemangioma and vascular endothelial cell tumor. The former can compress liver tissue due to tumor growth, degeneration of liver cells, and sometimes arteriovenous short circuit in tumor, which can cause heart failure in children. Or death due to tumor rupture, small hemangiomas grow slowly, no clinical symptoms.
4, vascular endothelial cell tumor is malignant, there is sinusoid formation in the liver, clinical pain, high fever and jaundice, slow course, but the prognosis is not good.
5, liver hamartoma, teratoma and single or multiple liver cysts are extremely rare.
Examine
Liver tumor examination
The continuous development of serology and imaging provides various methods for the early diagnosis of subclinical liver cancer. Clinically, serological diagnosis is called "qualitative diagnosis", imaging diagnosis is called "positioning diagnosis", needle biopsy or exfoliated cell examination. A comprehensive application of these methods called "pathological diagnosis" can improve the accuracy of the diagnosis.
1. Alpha-fetoprotein (AFP) detection
AFP has an accuracy rate of about 90% for hepatocytes, and its clinical value is:
(1) Early diagnosis: It can diagnose subclinical lesions, and can make a diagnosis about 8 months before symptoms appear.
(2) differential diagnosis: because 89% of patients with hepatocellular carcinoma have AFP greater than 20ng/ml, so alpha-fetoprotein is lower than this value and there is no evidence of other liver cancer, which can rule out liver cancer.
(3) It helps to reflect the improvement and deterioration of the condition. The rise of AFP indicates deterioration, and the decline is improved if the clinical condition is improved.
(4) It is helpful to judge the thoroughness of the surgical resection and predict the recurrence. If the AFP drops to the normal value after the operation, the resection is complete, and the resuscitation prompts the recurrence. It can also be done 6 to 12 months before the recurrence symptoms appear. Forecast.
(5) It is helpful to evaluate various treatment methods. The higher the AFP conversion rate after treatment, the better the effect.
AFP false positives, not all AFP-positive patients have liver cancer, AFP false positives are mainly seen in hepatitis, cirrhosis, which account for 80% of false positive cases, in addition to gonad embryo cancer, digestive tract cancer, pathological pregnancy, Hepatic vascular endothelium, malignant hepatic fibrosis, etc., diagnosis of AFP-negative patients, AFP-negative can not exclude the diagnosis of liver cancer, enzymology can be performed, among which the clinical significance is: 1 anti-trypsin (AAT), - Glutamate transferase (-GT), carcinoembryonic antigen (CEA), alkaline phosphatase (AKP), etc., these serological test results may rise in patients with liver disease, but not specific.
2. Liver biopsy
For the diagnosis is basically clear, liver puncture can be not performed, because liver puncture has certain complications, the most common is hemorrhage. In addition, the needle will pass through the portal vein or hepatic vein and biliary tract during liver puncture. In this case, there may be Cancer cells are brought into the blood vessels, causing metastasis.
3.B Ultra
Can show tumors larger than 1cm, the diagnostic accuracy is 90%, can show tumor size, site morphology, number, hepatobiliary duct, portal vein, spleen, abdominal lymph nodes, etc., at the same time for the presence or absence of cirrhosis, splenomegaly can also make a diagnosis .
4.CT
The diagnostic accuracy rate for liver cancer is 93%, and the minimum resolution is 1.5cm. The advantage is that the size and location of the tumor can be directly observed, and the relationship between the portal vein and the hepatic vein can be diagnosed.
5. Angiography
Hepatic angiography can understand the blood flow of the lesion to determine the possibility and indication of the operation. It can display tumors of about 1.5 cm. It is the highest resolution in the current imaging diagnosis method, and it has the same identification of hepatic hemangioma. The important significance, in the clear diagnosis, can also understand the presence or absence of hepatic artery variability, which is very important for hepatectomy. If it is advanced liver cancer, it can be given embolization and/or chemotherapy. .
6. Compared with MRI and CT
Basically consistent, but helpful for some difficult to identify liver lumps.
7. Radionuclide scanning
Patients who are difficult to distinguish from hemangioma can be identified by blood flow scanning. Because of the low resolution of radiological scanning, it is rarely used to diagnose liver cancer.
8. Laparoscopy
Laparoscopy can be considered in patients who are difficult to diagnose, and the liver, liver surface mass and abdominal cavity can be directly observed.
9. X-ray inspection
X-ray fluoroscopy showed elevated right iliac crest, limited movement or limited bulging, 30% of cases in the X-ray film showed calcification in the tumor, about 10% of cases diagnosed with lung metastases.
Diagnosis
Diagnosis and identification of liver tumor
diagnosis
According to the clinical manifestations and laboratory and auxiliary examination results can be judged, clinical diagnosis points:
1. History of past hepatitis.
2. Liver pain and other clinical symptoms.
3. AFP>400 g/L for more than 4 weeks, or AFP>200 g/L for more than 8 weeks.
4. B-ultrasound, CT found that the liver has a space-occupying lesion, which can exclude metastasis or benign tumors.
Differential diagnosis
The primary difference between the cause of liver disease, whether it is a metabolic disease, benign liver tumors, such as hepatic cavernous hemangioma and liver metastases such as neuroblastoma, by alpha-fetoprotein determination, ultrasound detection and CT or nuclear magnetic can help diagnose.
Intravenous pyelography can be distinguished from retroperitoneal tumors such as nephroblastoma, neuroblastoma, and teratoma.
