What Is a Primary Tumor?

Primary liver cancer is one of the common malignant tumors in China, and it occurs in the southeast coastal areas. The median age of liver cancer patients in China is 40 to 50 years, and men are more common than women. Its etiology and pathogenesis have not been determined. With the early diagnosis and early treatment of primary liver cancer, the overall efficacy has improved significantly.

Basic Information

English name: primary hepatic carcinoma
Visiting department: Surgery, Oncology
Multiple groups: 40-50 years old male

Common causes: Associated with chemical carcinogens such as cirrhosis, viral hepatitis, and aflatoxin
Common symptoms: Pain in the liver area, general and digestive symptoms, hepatomegaly, symptoms of liver cancer metastasis

Causes of primary liver cancer

The etiology and pathogenesis of primary liver cancer have not been determined. Currently believed to be related to chemical carcinogens and environmental factors such as cirrhosis, viral hepatitis, and aflatoxin.

Clinical manifestations of primary liver cancer

Pain in the liver

More than half of the patients' pain in the liver area is the first symptom, and most of them are persistent dullness, tingling, or tenderness. This is mainly due to the rapid growth of the tumor, which increases the tension of the liver capsule. Cancers located on the top of the right lobe of the liver involve the diaphragm, and pain can involve the back of the right shoulder. Necrosis and rupture of liver cancer nodules can cause intra-abdominal hemorrhage and acute abdominal symptoms such as peritoneal irritation.

2. Systemic and digestive symptoms

The main manifestations are fatigue, weight loss, loss of appetite, and abdominal distension. Some patients may be accompanied by nausea, vomiting, fever, and diarrhea. In the later stage, anemia, jaundice, ascites, lower limb edema, subcutaneous bleeding, and cachexia occur.

3. Liver

The liver is large and progressive, with a hard texture, irregular edges, and uneven surfaces showing large and small nodules or large pieces.

4. Symptoms of liver cancer metastasis

If liver cancer metastasizes to lung, bone, brain, etc., it can produce corresponding symptoms. A small number of patients may have special manifestations such as hypoglycemia, erythrocytosis, hypercalcemia, and hypercholesterolemia. The main complications of primary liver cancer are hepatic coma, upper gastrointestinal bleeding, bleeding from cancer rupture and secondary infection.

Primary liver cancer examination

1. Detection of liver cancer serum markers

(1) Determination of serum alpha-fetoprotein (AFP) This method is relatively specific for the diagnosis of this disease. Radioimmunoassay for continuous serum AFP 400g / L, can exclude pregnancy, active liver disease, etc., you can consider the diagnosis of liver cancer. About 30% of patients with liver cancer are clinically AFP-negative. If the AFP heterogeneity is detected at the same time, the positive rate can be significantly increased.

(2) Hematology and other tumor markers can be used to check -glutamyl transpeptidase and its isoenzymes, abnormal prothrombin, alkaline phosphatase, and lactate dehydrogenase isoenzymes in liver cancer normal. But it lacks specificity.

2. Imaging examination

(1) Ultrasound examination can show the size, morphology, location of the tumor, and the presence of tumor thrombus in the hepatic vein or portal vein. The diagnostic compliance rate can reach 90%, which is a non-invasive examination method with good diagnostic value.

(2) CT examination CT has a high resolution, and the diagnostic compliance rate for liver cancer can reach more than 90%. It can detect tiny cancerous lesions with a diameter of about 1.0 cm.

(3) The diagnostic value of magnetic resonance imaging (MRI) is similar to that of CT, and it is better than CT for the differentiation of benign and malignant intrahepatic lesions.

(4) Selective celiac artery or hepatic arteriography . For tumors with abundant blood vessels, the lower limit of resolution is about 1cm, and the positive rate of small liver cancers less than 2.0cm can reach 90%. Because it is a traumatic examination, consider using it when necessary.

(5) Needle aspiration cytology for liver puncture Fine-needle aspiration under B-mode ultrasound guidance can help improve the positive rate. It is suitable for those who still can not confirm the diagnosis after various tests, but are highly skeptical.

Diagnosis of primary liver cancer

All patients who are middle-aged or above, especially those with a history of liver disease, should have detailed examination in a timely manner if they have unexplained liver pain, weight loss, and progressive liver disease. Imaging tests such as alpha-fetoprotein (AFP) testing and B-mode ultrasound can help diagnose and even detect early liver cancer.

Differential diagnosis of primary liver cancer

Primary liver cancer should be distinguished from cirrhosis, secondary liver cancer, benign liver tumors, liver abscesses, and tumors in organs adjacent to the liver, such as the right kidney and pancreas.

Primary liver cancer treatment

Individualized comprehensive treatment according to the different stages of liver cancer as appropriate is the key to improving efficacy; treatment methods include surgery, hepatic artery ligation, hepatic artery chemoembolization, radiofrequency, cryotherapy, laser, microwave, and chemotherapy and radiation therapy. Biological therapy, traditional Chinese medicine and traditional Chinese medicine for liver cancer also have many applications.

Surgical treatment

Surgery is the first choice and the most effective way to treat liver cancer. The surgical methods are: radical liver resection, palliative liver resection and so on.

2. Treatment of unresectable liver cancer

For unresectable liver cancer, according to the specific conditions, intraoperative hepatic artery ligation, hepatic artery chemoembolization, radiofrequency, freezing, laser, microwave and other treatments have certain effects. Primary liver cancer is also one of the indications for liver transplantation.

3. Chemotherapy

Laparotomy can not be removed, or as a follow-up treatment of palliative tumor resection, hepatic artery and / or portal vein pump (subcutaneous implantation device) can be used for regional chemoembolization; it is also feasible for those who are estimated to be unable to be removed Radiotherapy, selective intubation to the hepatic artery via the femoral artery, injection of embolic agents (usually iodized oil) and anti-cancer drugs for chemoembolization, some patients can get the opportunity of surgical resection.

4. Radiation therapy

For general conditions, liver function is good, without liver cirrhosis, no jaundice, ascites, hypersplenism and esophageal varices, cancer is more localized, there is no distant metastasis, and it is not suitable for surgical resection or recurrence after surgery Or, comprehensive treatment based on radiation therapy can be used.

5. Biotherapy

Commonly used are immune RNA, interferon, interleukin-2, thymosin, etc., which can be used in combination with chemotherapy.

6. Traditional Chinese Medicine and Chinese Medicine Treatment

It adopts the methods of dialectical treatment, attack and supplement, and is often applied in conjunction with other therapies. In order to improve the body's resistance to disease, improve systemic conditions and symptoms, and reduce adverse reactions to chemotherapy and radiotherapy.

Prognosis of primary liver cancer

With the advancement of early diagnosis, early treatment and liver surgery of primary liver cancer, the overall efficacy has improved. However, even after radical resection of liver cancer, 60% to 70% of patients within 5 years still have metastasis and recurrence. Postoperatively, AFP detection and ultrasound inspection are used to observe liver cancer recurrence and metastasis as soon as possible.