What are the symptoms of liver cancer?

Clinical manifestations

The early manifestations of liver cancer are very atypical and often easily overlooked. The main symptoms are as follows:

1. Significant loss of appetite, abdominal distention, indigestion, and sometimes nausea and vomiting;

2. Dull pain in the right upper quadrant, which may persist in the liver area Or intermittent pain, sometimes aggravated by changes in body position;

3. General fatigue, weight loss, unexplained fever and edema;

4. Jaundice, ascites, and skin itching;

5. Often manifested as nose bleeding, subcutaneous bleeding, etc.

Some typical symptoms of liver cancer will only occur when the disease progresses to the middle and late stages, and by then the chance of surgery is often lost, so daily self-examination is very important. When you feel tired and weak and cannot be relieved, it is likely to be a sign of liver disease; a dull feeling in the pit of your heart, or a dull pain in the upper right side of the abdomen, a sense of pressure and discomfort, weight loss, and sometimes unexplained fever and jaundice. , you should go to the hospital for examination as soon as possible.

Diagnosis

1. If there is no other evidence of liver cancer, AFP convection method is positive or radioimmunoassay AFP>400mg/ml lasts for more than four weeks, and pregnancy, active liver disease, and gonad embryonic origin can be ruled out Sexual tumors and metastatic liver cancer.

2. B-mode ultrasound imaging can display tumors with a diameter of more than 2cm, which is of great value for early localization examination; computerized tomography (CT) can display tumors with a diameter of more than 1.0cm. ; Radionuclide scanning can show tumors with a diameter of 3-5cm; other X-ray liver angiography and magnetic resonance imaging have certain value in the diagnosis of liver cancer.

3. Imaging examination shows clear solid intrahepatic space-occupying lesions, which can rule out hepatic hemangioma and metastatic liver cancer and meets one of the following conditions: ①AFP>20mg/ml; ②Typical primary Imaging manifestations of liver cancer; ③ No jaundice but significantly increased AKP or r-GT; ④ Clear distant metastatic lesions or bloody ascites or cancer cells found in ascites; ⑤ Clear cirrhosis with positive hepatitis B markers .

Differential diagnosis

1. Secondary liver cancer (liver malignant tumor)

Comparing secondary liver cancer with primary liver cancer, the condition of secondary liver cancer It develops slowly and has mild symptoms. Most of them are secondary to gastric cancer, followed by cancers of the lung, colon, pancreas, breast, etc. that often metastasize to the liver. It often presents with multiple nodular lesions. The alpha-fetoprotein (AFP) test is generally negative except for a few cases where the primary cancer is in digestion.

2. Liver cirrhosis

Liver cancer often occurs on the basis of liver cirrhosis, and it is often difficult to differentiate between the two. The identification lies in detailed medical history, physical examination and laboratory tests. Liver cirrhosis develops slowly and relapses, liver function damage is more significant, and serum alpha-fetoprotein (AFP) positivity often indicates canceration.

3. Active liver disease

The following points are helpful in identifying liver cancer and active liver disease (acute and chronic hepatitis). AFP alpha-fetuin test and SGPT alanine aminotransferase must be tested at the same time.

4. Liver abscess

Signs of fever, pain in the liver area, symptoms of inflammation and infection, an increase in the number of white blood cells, obvious percussion and tenderness in the liver area, and tight left upper abdominal muscles , there is often edema in the surrounding chest wall.

5. Hepatic cavernous hemangioma

This disease is a benign space-occupying lesion in the liver, which is often discovered incidentally by B-mode ultrasound or radionuclide scan. The disease is more common in China. Differential diagnosis mainly relies on alpha-fetoprotein measurement, B-mode ultrasound and hepatic angiography.

6. Hepatic echinococcosis

Patients have progressive enlargement of the liver, with a hard and nodular texture. Most of the liver is destroyed in the advanced stage, and the clinical manifestations are very similar to primary liver cancer. .

7. Extrahepatic tumors adjacent to the liver

For example, gastric cancer and high retroperitoneal tumors in the upper abdomen, which come from the kidney, adrenal gland, colon, pancreatic cancer and retroperitoneal tumors, are easily related to the original tumor. Confused with recurrent liver cancer. In addition to the fact that alpha-fetoprotein is mostly negative, which can help differentiate, the medical history and clinical manifestations are different. In particular, imaging examinations such as ultrasound, CT, MRI, and gastrointestinal X-ray examination can make differential diagnosis.

8. Diffusion metastasis

(1) Hematogenous metastasis: Intrahepatic hematogenous metastasis is the earliest and most common, and can invade the portal vein and form tumor thrombus. Tumor thrombus detachment in the liver can cause multiple metastatic lesions. Tumor thrombus obstruction of the main portal vein can cause portal hypertension and refractory ascites. After liver cancer cells invade the hepatic vein, they can enter the systemic circulation and metastasize outside the liver, with the highest rate of lung metastasis. It can be transferred by blood to various parts of the body, most commonly in organs such as adrenal glands, bones, kidneys, and brain. Hepatocellular carcinoma is more common with hematogenous metastasis.

(2) Lymphatic metastasis: Local metastasis to the portal lymph nodes is the most common, and can also metastasize to supraclavicular, para-aortic, pancreatic, spleen and other lymph nodes. The majority of metastasis of cholangiocellular liver cancer is lymphatic metastasis. Lymphatic metastasis only accounts for 12.6% of the total number of metastases.

(3) Implantation metastasis occurs occasionally. For example, if an implant is implanted in the retroperitoneum and forms bloody ascites, women may still have metastatic ovarian cancer.

(4) Direct invasion: Liver cancer is generally less likely to directly infiltrate adjacent organs, but occasionally it can directly spread and infiltrate to adjacent tissues and organs, such as the diaphragm, stomach, colon, omentum, etc.

(5) Transfer of patients: Surgery is of little significance. If you are worried that the toxic side effects of radiotherapy and chemotherapy will cause greater damage to the patient's already weak body.