What Is Advanced Liver Cancer?

Liver cancer is a malignant tumor of the liver, which can be divided into two categories: primary and secondary. Primary liver malignancies originate from the epithelial or mesenchymal tissue of the liver. The former is called primary liver cancer, which is a high-risk and extremely harmful malignant tumor in China. The latter is called sarcoma, which is compared with primary liver cancer. Rare. Secondary or metastatic liver cancer refers to the invasion of the liver by malignant tumors originating from multiple organs throughout the body. It is more common in liver metastases of stomach, biliary tract, pancreas, colorectum, ovary, uterus, lung, breast and other organs.

Basic Information

nickname: Liver malignant tumor
English name: liver cancer
Visiting department: Oncology, Surgery
Multiple groups: Patients with hepatitis B and C, patients with viral hepatitis with cirrhosis, and family history of liver cancer

Common causes: Complex causes, family history, affected by environment, diet, virus infection, etc.
Common symptoms: Liver pain, bloating, poor appetite, fatigue, weight loss, etc.

Causes of liver cancer

The etiology and exact molecular mechanism of primary liver cancer is not completely clear. At present, its pathogenesis is considered to be a multi-factor, multi-step complex process, which is affected by dual factors of environment and diet. Epidemiological and experimental research data show that hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, aflatoxin, drinking water pollution, alcohol, liver cirrhosis, sex hormones, nitrosamines, trace elements, etc. All are related to the onset of liver cancer. Secondary liver cancer (metastatic liver cancer) can develop disease through different pathways, such as metastasis with blood, lymph fluid, or direct invasion of the liver.

Clinical manifestations of liver cancer

Primary liver cancer

(1) Symptoms The symptoms of early liver cancer are not specific, and the symptoms of advanced liver cancer are more common. The common clinical manifestations are pain in the liver area, abdominal distension, poor appetite, fatigue, weight loss, progressive hepatomegaly, or upper abdominal mass. Some patients have low fever, jaundice, diarrhea, upper gastrointestinal bleeding; acute abdominal symptoms after liver cancer rupture. There are also symptoms that are not obvious or only manifest as metastases.

(2) Signs Early liver cancer often has no obvious positive signs or only signs similar to cirrhosis. Signs of liver enlargement, jaundice, and ascites usually appear in advanced liver cancer. In addition, patients with liver cirrhosis often have liver palms, spider moles, enlarged male breasts, and lower limb edema. When extrahepatic metastases occur, the corresponding signs of each metastasis site may appear.

(3) Complications Common upper gastrointestinal bleeding, bleeding rupture of liver cancer, liver and kidney failure and so on.

2. Secondary liver cancer

(1) The clinical manifestations of primary tumors are mainly seen in patients without a history of liver disease. Liver metastasis is still early and no corresponding symptoms appear. The symptoms of primary tumors are mostly in the middle and late stages. Such patients with secondary liver cancer are mostly found in the examination and follow-up of the primary treatment.

(2) Clinical manifestations of secondary liver cancer Patients often complain of bloating, discomfort, or pain in the upper abdomen or liver area. As the disease progresses, the patient develops fatigue, poor appetite, weight loss, or fever. On examination, the enlarged liver may be palpable in the mid-upper abdomen, or the nodules may be hard and tender, and patients with advanced stage may have anemia, jaundice, and ascites. The clinical manifestations of these patients are similar to those of primary liver cancer, but they generally develop relatively slowly and to a lesser degree. They are most likely to be suspected and metastatic during various liver examinations. Further examination or primary tumors may be found during surgical exploration. Some patients were unable to find the primary cancer after multiple examinations.

(3) The clinical manifestations of both primary tumors and secondary liver cancer are mainly seen in the early stages of primary tumors and liver metastatic cancers. Patients have symptoms and signs similar to those of primary liver cancer in the liver. Clinical manifestations caused by tumors, such as colon and rectal cancer with liver metastases can be accompanied by defecation habits, changes in stool characteristics, and blood in the stool.

Liver cancer examination

1. Laboratory examination of primary liver cancer

(1) Detection of serum markers of liver cancer Determination of serum alpha-fetoprotein (AFP) 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. Examination of blood enzymes and other tumor markers -glutamyl transpeptidase and its isoenzymes, abnormal prothrombin, alkaline phosphatase, lactate dehydrogenase isoenzymes in the serum of liver cancer patients may be higher than normal. But it lacks specificity.

(2) Imaging examination 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%. CT examination 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. The diagnostic value of MRI is similar to that of CT. It is better than CT for the differentiation of benign and malignant intrahepatic lesions. 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 cancer <2.0cm can reach 90%. Needle aspiration cytology for liver puncture Fine-needle aspiration under B-mode ultrasound guidance can help improve the positive rate.

2. Secondary liver cancer

Most patients with secondary liver cancer have tumor markers within the normal range, but a few liver metastatic cancers from the stomach, esophagus, pancreas, and ovary may have elevated AFP. Symptoms are often accompanied by elevated ALP and GGT. The increase of CEA in carcinoembryonic antigen is helpful for the diagnosis of liver metastases. The positive rate of CEA in liver metastasis of colorectal cancer is as high as 60% -70%. Selective hepatic angiography can detect lesions with a diameter of 1 cm. Selective abdominal or hepatic arteriography mostly shows oligovascular tumors; CT manifests mixed uneven or low-density occupying space, typically showing "bull's eye" signs; MRI examination of liver metastatic cancer often shows uniform signal strength and side effects. Clear and frequent, a few have "target" sign or "bright ring" sign.

Liver cancer diagnosis

According to the cause of the disease, clinical manifestations, and test results, a clear diagnosis is made for different situations.

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.

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.

2. 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.

3. Radiotherapy

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 Or, comprehensive radiation-based treatment can be used.

4. Biotherapy

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

5. Chinese medicine and traditional 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.