In a typical aspect of disease leading symptoms are noted such ones as progressive weakness, adynamia, appetite loss, cachexia, often nausea and vomiting. There is a carebaria and the constant pain in the right subcostal area, anemia develops. Liver quite rapidly increases in size, with its lower edge often determined on the level of the navel and below; with palpation it is moderately painful, stiff, hilly; sometimes is determined an isolated tumor node.
With the liver cancer development against the background of cirrhosis, symptoms of malignant neoplasms are prevalent in the clinical presentation of the disease; deterioration of the patient makes progress rapidly, increases pain in the liver, appears ascites, jaundice, fever, arises frequent nasal bleeding, often found skin telangiectasis.
In some cases of the primary liver cancer is a high non-treatment fever; symptoms of liver lesion appear later in these cases.
Asymptomatic form of primary liver cancer often goes like a chronic hepatitis B, without constant and typical clinical signs of cancer. In some cases, the clinical presentation of primary liver cancer may include symptoms of complications or signs of dissemination of tumor.
In the clinical symptomatology of complications are typical: obstructive jaundice (compression of main bile duct tumor or its metastases), splenomegaly, ascites, enlargement of subcutaneous veins of the front abdominal wall, gastrointestinal bleeding (compression of portal vein), and signs of rupture of the tumor, spontaneous or under the influence of minor injuries with intraperitoneal bleeding and subsequent peritonitis.
Metastatic liver cancer is mostly detected in the liver (intraorganic metastasis), in lymph nodes of the porta and omentulum, in splanchnic as well as other organs (lungs, pleura, peritoneum, kidneys, pancreas, bones).
From a clinical point of view and by liver cancer symptoms, there are primary and secondary (metastatic, sprouting from an adjacent organ) liver cancers.
Primary liver cancer looks like a single or multiple dense formation, with whitish color without clear boundaries. Tumor quickly extends to the blood vessels and spreads over the liver, where forms metastases. With cancer, which develops against the background of liver cirrhosis, malignant tumor takes diffuse form without nodes formation. Metastatic liver cancer appears like a tumor metastasis with a primary localization in other organs.
Treatment of primary liver cancer is currently being conducted by combined methods. The main method is a radical surgical intervention (typical lobectomy or hemihepatectomy, atypical resections of the liver) in combination with chemotherapy (methotrexate, thio-TEF, 5-fluorouracil) with the introduction of drugs through of umbilical vein or hepatic artery. However, the possibility of a radical operation is only available for one of five patients (depends on liver cancer symptoms and diagnosis).
In a specially equipped medical centers performed a liver transplant. Radiation therapy is usually not effective and can be used only in the postoperative period. There are currently carried out extensive researches to determine the effectiveness of immunization against hepatitis B as a way to prevent hepatocellular carcinoma.
The forecast for operated on the primary liver cancer, unfortunately, is not optimistic, no more than 9-19% of patients who experienced surgery are living up to 5 years after surgery. The transplantation of the liver is the best perspective for today.
If there are symptoms similar to liver cancer symptoms, then differential diagnosing of primary liver cancer is made with secondary (metastatic) tumors of the body, cirrhosis, and nonneoplastic liver diseases. Diagnosis of secondary tumors of the liver becomes evident when the primary focus identified.
By the differential diagnosis of primary liver cancer with cirrhosis helps reaction to alpha-fetoprotein, which is negative with cirrhosis, and liver scan clearly identifies nidal or diffuse its lesion.
Liver cyst of nonparasitic nature is round, with elastic consistency, and a clear roentgenological picture and the typical manifestations by radioisotope scanning of the liver. In the differential diagnosis of liver echinococcosis, anamnestic data is relevant, as well as eosinophilia and positive serological reactions. If there are suspicions about nephroblastoma or neuroblastoma, which located in the upper abdomen, then excretory urography and angiography are applied.
Recognition of liver cancer, especially in the initial stage, is difficult, since there are no specific liver cancer symptoms. Therefore, liver cancer is often diagnosed in the far-called stages. History data (fever, pain in the right side of the stomach, increasing of the liver) is important, as well as clinical examination (strain or increase of abdomen, expressed subcutaneous vasculature in the upper half of the abdomen, changing of the shape and size of the liver).
Laboratory researches show hypochromic anemia, leukocytosis, ESR acceleration, increase of transaminase and alkaline phosphatase.
Other techniques are widely used: diagnostic radioisotope and ultrasonic scanning of the liver, CT, MRI, laparoscopy with the sighting of liver biopsy, splenoportography, aortography, selective celiacography.
Primary liver cancer separated into main and diffuse forms. According to the cell type - in hepatocellular (hepatoma), emanating from the hepatocytes (liver cells), cholangiocellular (holangioma) emanating from the bile duct epithelium, mixed (holangiogepatoma) emanating from the cells of both types, and mesodermal tumors (mesenchymoma, angiosarcoma and lymphosarcoma). Hepatomas occur much more frequently than other forms of liver cancer.
The most common classification is on the basis of international standard TNM, taking into account the peculiarities of the anatomic structure of the organ, size of the primary focus, spread of intrahepatic metastasis (T element - the incidence of tumors, N element - the status of lymph nodes, M element - distant metastases) and liver cancer symptoms.
The etiology and mechanism of liver cancer development, as well as other cancers, are not sufficient determined. The influence of climate and geography, the nature of food, medical treatment are the factors of risk. The presence of aflatoxin in food products (carcinogenic mitoksin) sometimes affects the occurrence of primary liver cancer. Angiosarcoma of the liver is sometimes associated with endogenous anabolic hormones. Parasitic (amoebiasis, schistosomiasis, Opisthorchiasis, etc.) and viral diseases (viral hepatitis B, which is considered to be caused at least 80% of all cases of hepatocellular carcinoma), liver cirrhosis irrelatively of its reason may favour the occurrence of primary liver cancer.
There is a family predisposition to the liver cancer development, as well as a clear link between alcoholic cirrhosis and primary liver cancer. In present-day world, primary liver cancer in patients with alcoholism, in 80-90% of the cases develops against the background of gin-drinker’s liver.
Every year in the world with liver cancer become sick at least 250 000 people. Primary liver cancer is found in the 30-40 times less than metastatic. A particularly high frequency of primary liver cancer observed in Senegal, South Africa, China, India and the Philippines. In Russia, a primary liver cancer is found from 0.25 to 1% of deaths. Men sick liver cancer 4 times more likely than women. The disease may occur at any age, but more often after 40 years.
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