liver cancer
Introduction
Introduction to liver cancer Liver cancer (livercancer) refers to malignant tumors that occur in the liver, including primary liver cancer and metastatic liver cancer. People's liver cancer is mostly referred to as primary liver cancer. Primary liver cancer is one of the most common malignant tumors in the clinic. According to the latest statistics, about 600,000 new liver cancer patients occur every year in the world, ranking fifth in malignant tumors. Primary liver cancer can be divided into hepatocellular carcinoma, cholangiocarcinoma and mixed liver cancer according to cell type. According to the morphology of the tumor, it can be divided into nodular, massive and diffuse. Liver cancer is the third most common malignant tumor with mortality after gastric cancer and esophageal cancer. The initial symptoms are not obvious. The late stage is mainly characterized by liver pain, fatigue, weight loss, jaundice and ascites. Clinically, Western medicine is generally used for surgery, radiotherapy and chemotherapy combined with traditional Chinese medicine. However, patients with advanced cancer have a lower cure rate due to the spread of cancer cells. Therefore, early detection, early diagnosis and early treatment of liver cancer should be done. basic knowledge The proportion of illness: the incidence rate is 0.06% Susceptible people: good for men aged 40-70 Mode of infection: non-infectious Complications: hepatic encephalopathy, ascites, jaundice
Cause
Cause of liver cancer
Viral hepatitis (50%) :
Epidemiological statistics show that areas where hepatitis B is prevalent are also high-risk areas of liver cancer. People who have had hepatitis B are 10 times more likely to have liver cancer than those who have not.
Alcohol (35%) :
As the saying goes, "drinking and hurting the liver", drinking is not the direct cause of liver cancer, but its role is similar to the catalyst, which can promote the occurrence and progression of liver cancer.
Dietary related factors (15%) :
The occurrence of liver cancer is closely related to living habits. Long-term consumption of mildew food, nitrosamine-containing foods, and trace element selenium deficiency are also important factors in promoting liver cancer.
In general, the cause of primary liver cancer has not been fully elucidated so far, but it has been shown to be closely related to the following factors:
1, viral hepatitis : long-term clinical observation found that hepatitis, cirrhosis, liver cancer is a trilogy of continuous migration and evolution. Recent studies have shown that viral hepatitis associated with liver cancer mainly includes hepatitis B (HBV) and hepatitis C (BCV), and among them, hepatitis B is the most common.
2, alcohol : people with long-term alcoholism and hobby are easy to induce liver cancer. This is because after alcohol enters the human body, it is mainly catabolized in the liver. The toxicity of alcohol to liver cells causes the liver cells to block the decomposition and metabolism of fatty acids, causing fat deposition in the liver and causing fatty liver. The more alcohol you drink, the more severe the fatty liver, which in turn causes liver fibrosis, cirrhosis, and liver cancer. If a large number of alcohol abusers in hepatitis patients will greatly accelerate the formation and development of liver cirrhosis, and promote the occurrence of liver cancer.
3. Diet-related factors : Aflatoxin B1 is a substance that has been proven to have a clear carcinogenic effect, mainly in mildewed foods such as corn, peanuts, and rice. In addition, when eating a large amount of foods containing nitrite, nitrite can not be discharged in time, can be converted into nitrosamines in the body, and foods with high nitrite content are smoked or salted meat products. For the sake of it, it has a clear carcinogenic effect. At the same time, the occurrence of liver cancer is also related to genetic factors, parasitic infections and other factors.
Prevention
Liver cancer prevention
Pay attention to the following points in your daily life:
1 to avoid mood swings, maintain an optimistic state of mind, should try to avoid or reduce the various stimulating activities that cause mood swings;
2 Avoid overwork: Excessive mental or physical labor can not only reduce the body's resistance to liver cancer, promote the recurrence or metastasis of cancer, but also increase liver function damage, leading to worsening of the disease;
3 quit bad lifestyles or habits: avoid smoking, avoiding mildewed food, and eating less cured meat products;
4 rules of life, daily life, outdoor activities, diet nutrition, physical exercise, regularization;
5 Avoid infection with hepatitis B and C. The prevention and treatment of liver cancer has a long way to go.
expert's point:
1. For patients with a history of liver disease such as hepatitis B and hepatitis C, blood AFP levels and liver B-mode should be reviewed regularly for early detection, early diagnosis and early treatment of liver cancer.
2. For patients with liver cancer based on the development of hepatitis, attention should be paid to the importance of antiviral therapy. Early antiviral therapy can effectively control the progress of liver cancer.
3. Once liver cancer is diagnosed, a reasonable individualized treatment plan for liver cancer should be selected according to the size and location of the tumor, the presence or absence of intrahepatic metastasis and the general condition of the patient. At present, surgical resection is still the most effective means of treatment of liver cancer. Multi-modal comprehensive treatment and multidisciplinary team combination therapy can significantly improve the prognosis of patients.
4, liver transplantation is a effective means of radical treatment of liver cancer, especially for small liver cancer patients with liver cirrhosis, liver function decompensation, but for advanced liver cancer should strictly grasp its indications.
5, regular review after liver cancer surgery is very important, should be regularly performed imaging examination and dynamic detection of AFP changes.
Complication
Liver cancer complications Complications, hepatic encephalopathy, ascites, jaundice
Complications are liver cancer in the course of treatment, due to the development of the disease or the treatment of traumatic treatment (such as surgery, radiotherapy, chemotherapy, etc.), the trauma of the organ, complications during the treatment, can be alleviated by Chinese medicine treatment . The complications are as follows. The deaths of many patients are caused by complications, not death from liver cancer.
Hepatocellular carcinoma rupture and hemorrhage: rupture and hemorrhage of primary liver cancer is a serious and fatal common complication of liver cancer patients, the incidence rate is about 5.46%-19.8%, which is also one of the main causes of death in liver cancer patients, accounting for the cause of liver cancer. 9%-10%, accounting for the fourth place in the cause of liver cancer death. Because the disease is sudden, sharp, and often accompanied by shock. Therefore, the treatment is difficult and the prognosis is poor. If not actively treated, most patients die rapidly.
Hepatic encephalopathy : Hepatic encephalopathy, also known as hepatic coma, or hepatic and brain syndrome, is a common complication of end-stage liver cancer. It is characterized by central nervous system dysfunction and metabolic disorders. It is mainly caused by mental retardation, disturbance of consciousness, nervous system signs and liver damage. It is also one of the common causes of death in liver cancer, causing about 30% of patients to die.
Ascites : Ascites is a type of localized edema, which means that too much fluid accumulates in the abdominal cavity. Under normal circumstances, there is a small amount of liquid in the abdominal cavity, about 200ml, which acts as a lubricating fluid. When the liquid volume exceeds 200ml, it can be called ascites. When the liquid in the abdominal cavity exceeds 150ml, the mobile voiced sound can be found positive in the physical examination. The mechanism of production of ascites is complicated, and it is related to the imbalance of fluid exchange between the body and the outside and the imbalance of fluid exchange inside and outside the blood vessel. Ascites can occur in a variety of malignant tumors, and ascites on the basis of tumors is called malignant ascites. Both primary liver cancer and secondary liver cancer are often associated with ascites, which is closely related to liver cirrhosis and portal hypertension.
Infection and cancerous fever : Liver cancer complications can be caused by liver cancer itself or often combined with cirrhosis, and can also be caused by anti-tumor treatment, often in the advanced stage of liver cancer, and is one of the main causes of death in liver cancer patients.
Astragalus : Astragalus is one of the common complications in patients with advanced liver cancer. The concomitant rate is about 29.6%-37.5%. Astragalus is a clinical manifestation of yellow staining of sclera, skin, mucous membrane and body fluid caused by increased plasma bilirubin concentration during bilirubin metabolic disorders. Bilirubin comes from the aging red blood cells in the body. Its production, metabolism and excretion are closely related to the liver. Any obstacle in any link can lead to jaundice caused by elevated blood bilirubin concentration. According to the cause of jaundice, it can be divided into three types: hemolytic jaundice, hepatic jaundice and obstructive jaundice.
Symptom
Symptoms of liver cancer Common symptoms Huangqi fatigue, weight loss, liver pain, loss of appetite, ascites, refractory ascites, collateral body, collateral circulation, collateral circulation
Liver pain, fatigue, anorexia, and wasting are the most characteristic clinical symptoms.
Early symptoms:
The early manifestations of liver cancer are very atypical and often overlooked. The following symptoms are available for reference:
1, appetite decreased significantly: abdominal swelling, indigestion, sometimes nausea, vomiting;
2, right upper abdomen pain: liver area may have persistent or intermittent pain, sometimes can be aggravated by body position changes;
3, fatigue, weight loss, unexplained fever and edema;
4, jaundice, ascites, skin itching;
5, often manifested as nosebleeds, subcutaneous bleeding and so on.
Middle and late symptoms:
The typical symptoms and signs of liver cancer generally appear in the middle and late stages, mainly liver pain, fatigue, weight loss, jaundice, ascites and so on.
1. Pain in the liver area: The most common is intermittent persistent dull pain or pain. The rapid growth of the cancer causes the liver capsule to tighten and the tumor invades the diaphragm muscle pain, which can be radiated to the right shoulder or right back; Tumors can cause right lumbar pain; sudden onset of severe abdominal pain and peritoneal irritation suggest a subcapsular hemorrhage of the cancer nodules or ulceration to the abdominal cavity.
2, digestive tract symptoms: decreased appetite, indigestion, nausea and vomiting and diarrhea due to lack of specificity and easy to be ignored.
3, fatigue, weight loss, systemic weakness in the late stage, a small number of patients may be cachectic.
4, fever: generally low thermocouple up to 39 ° C or more, showing continuous fever or afternoon low heat or relaxation type high fever. Fever is associated with the absorption of cancerous necrotic products. Cancer compression or invasion of the bile duct can be complicated by biliary infection.
5, metastases symptoms: tumor metastasis has corresponding symptoms, and sometimes become the initial symptoms of liver cancer. If transferred to the lungs can cause cough, hemoptysis; pleural metastasis can cause chest pain and bloody pleural effusion; tumor thrombus embolization of the pulmonary artery or hair branches can cause pulmonary infarction, sudden severe breathing difficulties and chest pain; tumor thrombosis obstruction of the inferior vena cava can occur severe lower limbs Edema, even blood pressure drops; Budd-Chiari syndrome can occur in the obstructed hepatic vein, and lower extremity edema can also occur; metastasis to the bone can cause local pain or pathological fracture; metastasis to the spine or compression of the spinal nerve can cause local pain and paraplegia; Intracranial metastases may present corresponding localized signs and symptoms, such as intracranial hypertension can cause cerebral palsy and sudden death.
6, other systemic symptoms: endocrine or metabolic syndrome caused by abnormal metabolism of cancer itself or various effects of cancer tissue on the body is called cancer syndrome, sometimes before the symptoms of liver cancer itself. Common ones are:
(1) Spontaneous hypoglycemia: 10 to 30% of patients may have ectopic secretion of insulin or insulin-like substances by hepatocytes, or tumor suppressor insulinase, or secrete an islet -cell stimulating factor, or excessive glycogen storage It can also be caused by excessive consumption of glucose by liver cancer tissue. Severe cases can cause coma and shock leading to death. Correct judgment and timely symptomatic treatment can save patients from death.
(2) polycythemia: 2 to 10% of patients may develop symptoms associated with increased erythropoietin in the circulation.
(3) Other rare hyperlipidemia, hypercalcemia carcinoid syndrome, early sexual and gonadotropin secretion syndrome, cutaneous porphyria and abnormal fibrinogenemia, etc., may be abnormal proteins with liver cancer tissue Synthetic ectopic endocrine and porphyrin metabolism disorders.
7, with cancer syndrome: due to the abnormal metabolism of the tumor itself, and then affect the body caused by endocrine or metabolic abnormalities, called cancer syndrome. Hypoglycemia, polycythemia is more common, and other rare high blood lipids, high blood calcium, precocious puberty, gonadotropin secretion syndrome, carcinoid syndrome.
8, liver cancer signs - jaundice. Astragalus is a common sign of advanced liver cancer, and diffuse liver cancer and cholangiocarcinoma are most prone to jaundice. The jaundice is caused by bile duct compression or invasive bile duct obstruction of the bile duct. It can also be caused by the hepatic hilar lymph node enlargement and compression of the bile duct. In a small number of cases, the liver cancer tissue grows into the bile duct, and the lumps block the bile duct, causing obstructive jaundice.
Examine
Liver cancer examination
Liver cancer examinations mainly include serum alpha-fetoprotein (AFP) and liver imaging. Alpha-fetoprotein is currently used and is the simplest and most practical. More than 60% of liver cancer cases in China have serum AFP>400 g/L, 95% of liver cancer patients have background of hepatitis B virus (HBV) infection, 10% have hepatitis C virus (HCV) infection background, and some patients have HBV and HCV overlap infection. Therefore, if the combination of AFP> 400 g/L on the basis of viral liver disease should be highly suspected of liver cancer, the imaging examination should be improved as soon as possible to achieve early detection, early diagnosis and early treatment.
1. The most commonly used is liver ultrasound examination. Ultrasound examination is non-invasive examination. It has no adverse effects on human tissues. Its operation is simple, intuitive and accurate, low cost, convenient and non-invasive, and widely used. It can be used for the screening and treatment of liver cancer. Follow-up.
2. CT has become an important routine for the diagnosis of liver cancer. Abdominal CT enhanced scan can clearly show the size, number, shape, location, boundary of the liver cancer, the richness of the blood supply of the tumor, and the relationship with the intrahepatic duct. For further clear diagnosis, it is differentiated from other benign liver occupying, and the liver cancer is clearly defined. The staged grading is important for guiding treatment and prognosis. The image analysis software can also reconstruct the various tubes in the liver, which can accurately track the blood vessels of each liver segment, the relationship between the tumor and the blood vessels, simulate the surgical resection plane, measure the volume of the pre-removed tumor and the residual liver volume, greatly improve Surgical safety.
3, liver-specific MRI can improve the detection rate of small liver cancer, and at the same time, it is helpful for the identification of liver cancer and liver focal hyperplastic nodules, hepatic adenomas, etc., and can be used as an important supplement for CT examination.
4, PET (positron emission computed tomography) - CT whole body scan can understand the overall situation and evaluate the tumor metastasis, more comprehensive judgment of tumor stage and prognosis, but the price is more expensive, generally not the first choice for examination.
5, selective hepatic angiography is an invasive examination, because liver cancer is rich in blood supply, hepatic artery blood supply is the main, so the choice of hepatic angiography can clearly show the small lesions of the liver and tumor blood supply, after a clear diagnosis can also By injecting lipiodol to block tumors to support blood vessels for therapeutic purposes, it is suitable for patients who have not been diagnosed after other tests. Patients with hepatitis B and C should be reviewed regularly. If possible, the body should be examined every year. Liver B ultrasound is the most basic examination.
Diagnosis
Diagnosis and identification of liver cancer
(1) Pathological diagnosis
1. Liver histology confirmed to be primary liver cancer.
2. Histological examination of extrahepatic tissue confirmed hepatocellular carcinoma.
(two) clinical diagnosis
1. If there is no evidence of other liver cancer, AFP convection positive or radioimmunoassay AFP>400mg/ml for more than four weeks and can exclude gestational gland embryogenic tumors and metastatic liver cancer.
2. B-type ultra-sonal imaging can show tumors with a diameter of more than 2cm, which has great value for early localization examination; electronic computed tomography (CT) can show tumors with a diameter of 1.0cm or more; radionuclide scanning can display Tumors with a diameter of 3-5 cm or more; other X-ray hepatic angiography and magnetic resonance imaging have certain value for the diagnosis of liver cancer.
3. Imaging examination has a clear intrahepatic mass-occupying lesion that can exclude hepatic hemangioma and metastatic liver cancer and has one of the following conditions:
1AFP>20mg/ml2 typical primary liver cancer imaging findings 3 no jaundice and AKP or r-GT increased significantly 4 distant metastatic lesions or bloody ascites or cancer cells in ascites 5 clear type B Hepatic cirrhosis with positive hepatitis markers.
Differential diagnosis of liver cancer
1. Secondary liver cancer: Compared with primary liver cancer, secondary liver cancer has a slow development and mild symptoms. Among them, it is the most secondary to gastric cancer, followed by lung, colon, pancreas, breast, etc. The cancerous foci are often transferred to the liver. Often manifested as multiple nodular lesions, alpha fetoprotein (AFP) detection, except for a few primary cancers can be positive in digestive cases, generally more negative.
2, cirrhosis: liver cancer occurs on the basis of cirrhosis, the two are often difficult to identify. Identification is based on detailed medical history, physical examination, and laboratory testing. The development of liver cirrhosis is slow and repeated, liver function damage is more significant, and serum alpha-fetoprotein (AFP) positive is more likely to be cancerous.
3, active liver disease: The following points help the identification of liver cancer and active liver disease (an acute and chronic hepatitis). AFP alpha-fetoprotein examination and SGPT alanine aminotransferase must be tested simultaneously.
4, liver abscess: manifested fever, liver pain, inflammation symptoms, white blood cell count often increased, liver area sputum pain and tenderness, left upper abdominal muscle tension, peripheral pleural wall often edema.
5, hepatic cavernous hemangioma: the disease is a benign space-occupying lesion in the liver, often due to physical examination B-mode ultrasound or radionuclide scanning and other accidental findings. The disease is more common in China. Differential diagnosis mainly depends on alpha-fetoprotein determination, B-mode ultrasound and hepatic angiography.
6, liver hydatid disease: patients with progressive liver enlargement, hard texture and nodule, most of the late liver is destroyed, clinical manifestations like macroscopic liver cancer.
7, extrahepatic tumors adjacent to the liver: such as gastric cancer, high abdominal retroperitoneal tumor, from the kidney, adrenal gland, colon, pancreatic cancer and retroperitoneal tumors are easily confused with primary liver cancer. In addition to the difference in alpha-fetoprotein, the history and clinical manifestations are different. Special ultrasound, CT, MRI and other imaging examinations, gastrointestinal X-ray examination can make differential diagnosis.
