Liver cancer. Are there early symptoms of this disease?

Liver Cancer: Signs and Symptoms

The presence of a malignant tumor may be indicated by a number of health problems. As mentioned above, symptoms of early stage liver cancer are often completely absent and appear only when the disease begins to progress.

It should be noted that in most cases, malignant tumors develop in people with chronic viral hepatitis, as well as disturbances in the normal functioning of the organ due to alcoholism, obesity and other reasons. In this regard, the first symptoms of liver cancer are often mistaken for an exacerbation of these diseases.

Hepatic artery embolization

The liver has two sources of blood supply: the portal vein and the hepatic artery. Doctors block the hepatic artery with emboli. As a result, the healthy part of the liver does not suffer, but the tumor decreases due to lack of blood supply.

Hepatic artery embolization is an alternative to ablation for people whose tumor is too large (more than 5-6 cm). The procedure is minimally invasive. It is performed on an outpatient basis - the patient can go home the same day. Serious complications are very rare.

Sometimes emboli include chemotherapy drugs - drugs that inhibit tumor growth. This treatment method is called chemoembolization.

Signs of liver cancer (first symptoms)

Nausea, lack of appetite, feeling of early satiety and causeless loss of more than 10% of weight

may be associated with liver cancer, but these symptoms and signs are also common to many other diseases.

The appearance of jaundice and skin itching, light-colored feces, dark urine.

These symptoms are interrelated and occur due to improper functioning of liver cells and/or blockage of the bile ducts. These disorders are caused by an increased amount of bile pigment bilirubin in the blood, from where it penetrates various tissues of the body, including the whites of the eyes and skin. Billirubin not only changes the color of the skin, but also causes irritation, which is accompanied by itching. The pigment is partially excreted in the urine, causing it to darken. At the same time, its absence in the intestines leads to discoloration of stool.

Bloating is another common symptom of liver cancer in women and men, which can occur for two reasons.

Firstly, due to the growth of the tumor, the liver itself enlarges, which causes bloating of the right half of the abdomen. Secondly, fluid may accumulate in the abdominal cavity for one reason or another, as a result of which the patient’s entire abdomen swells, that is, ascites develops. Fluid seeps into the abdominal cavity through the walls of swollen vessels (veins), which in some cases can become so large that they can be seen under the skin. It should be added that ascites often occurs in patients with cirrhosis and is not related to malignancy.

Liver cancer may also have other symptoms (manifestations), including:

• discomfort and/or pain in the right upper abdomen due to liver enlargement;
• a feeling of fullness in the left upper abdomen due to an enlarged spleen;
• so-called “referred” pain in the right shoulder and right half of the back (under the scapula), which are associated with compression of a certain group of nerves;
• weakness, weakness, fatigue, general malaise;
• periodic fever and sweating;
• disruption of the digestive process with alternating constipation and diarrhea, vomiting.

Tumor ablation

The tumor can be destroyed in various ways:

• laser;
• radio wave method;
• liquid nitrogen;
• ethyl alcohol.

The method does not involve surgery. A needle or probe is inserted into the tumor. Doctors apply energy or a substance to the tumor that destroys the cancer.

The ablation is performed under CT guidance so that the doctor can accurately guide the needle. But some patients require an incision, similar to surgery.

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Liver Cancer: Signs and Symptoms Caused by Paraneoplastic Syndrome

In rare cases, in the early stages of the disease, a special type of disorder may develop, manifested by:

• changes in the blood - increased calcium, decreased sugar, increased number of red blood cells, high cholesterol;
• enlarged mammary glands (gynecomastia);
• reduction in testicular size in men.

Despite the fact that with progressive liver cancer the symptoms (manifestations) are quite well expressed, in some cases patients are not aware of the seriousness of the problem.

For example, people who abuse alcoholic beverages associate their deterioration in health with the consequences of alcohol intoxication, patients with chronic hepatitis - with errors in diet, etc.

Symptoms of imminent death

Just before death, the patient exhibits other signs indicating the body’s inability to fight the tumor, namely:

• Unstable body temperature and decreased blood pressure.
• Impaired urination function, which is accompanied by swelling of tissues and limbs, a sharp decrease in the daily norm of discharge.
• The development of venous spots on the legs indicates disruptions in the circulatory system. The appearance of such marks on the feet indicates imminent death.
• Due to a decrease in blood flow to the organs, the limbs become cold and acquire a bluish tint.
• Shortness of breath appears and breathing worsens. Patients experience difficulty coughing and produce characteristic wheezing due to swelling of the lungs.
• The emotional and mental state is disturbed: quiet, slow, unintelligible speech, apathy, severe lethargy.
• If the condition is accompanied by dysfunction of certain areas of the brain, patients often forget, do not recognize their relatives, experience disorientation and hallucinations.
• Mobility is clearly reduced to the point of inability to move independently.
• Complete lack of appetite due to various unpleasant sensations in the digestive system. In some cases, even water can cause painful reactions.
• Drowsiness is more pronounced against the background of the previous days. The development of this condition occurs as a result of dehydration and exhaustion of the body.

In medicine, there are 4 stages of human death:

1. Predagonia is accompanied by a rapid drop in blood pressure, the skin becoming bluish, and deterioration of emotional and physical capabilities.
2. Agony – characterized by a lack of oxygen, which leads to difficulty breathing and stopping it. There is a significant slowdown in blood circulation for no more than 3 hours.
3. Clinical death - all metabolic processes deteriorate to critical levels, which provokes the cessation of many body functions.
4. Biological death - cessation of brain function, death.

All of the listed stages of death are typical for both stage 4 cancer and other cancers.

Symptoms of stage 4 liver cancer

The last stage of the disease is characterized by the addition of signs of tumor metastases affecting other organs and tissues, including:

• pain in the spine and ribs, arms and legs;
• internal bleeding;
• other painful and life-threatening conditions for the patient.

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Expert opinion

Surgery

Surgical resection is the most effective treatment method that can maximize life expectancy. But, unfortunately, such a procedure can be carried out only in 20% of cases (this is explained by the presence of accompanying abnormalities: liver cirrhosis, vascular invasion).

The goal of resection is to eliminate the entire neoplasm with clear contours while preserving as much liver parenchyma as possible (this will avoid the occurrence of liver failure). The ideal situation for partial resection is the presence of a single tumor limited to the liver, without indicators of portal hypertension, and in the absence of spread to the hepatic vasculature. The result of treatment in such cases is a five-year survival rate in almost half of the patients; in 29% of cases there will be no symptoms of the disease.

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Liver carcinomas are divided into types, taking into account the location and degree of tumor development:

• hepatocellular carcinoma of the liver is a primary lesion of the liver of a malignant nature, which is characterized by rapid development - 2-4 months pass from the first symptoms to death;
• fibrolamellar carcinoma is a type of primary liver cancer, when there is pronounced fibrosis of the parenchyma and the development of abnormal cells like oncocytes. This type of tumor is characterized by slower development and a more favorable prognosis for survival;
• hepatocholangiocellular carcinoma is a rare type of tumor in which pathological transformations affect not only liver tissue, but also the bile ducts;
• Liver cholangiocarcinoma is a rare anomaly in which the cancerous process occurs in the bile ducts. Tumor development begins when cancer cells invade the walls of the bile ducts and begin to actively multiply;
• liver adenocarcinoma is a malignant neoplasm that originates from glandular tissue, but usually adenocarcinoma develops in the process of metastasis in the presence of primary cancer in other organs (uterus, intestines, lungs, ovaries);
• liver cystadenocarcinoma - this tumor is formed as a cyst from intra- and extrahepatic bile ducts;
• Neuroendocrine carcinoma is the rarest form of liver carcinoma and develops in the hormone-producing cells of the liver. Occurs in men and women with equal frequency. Characterized by a high degree of malignancy.

Based on the type of macroscopic transformations in the liver, we can distinguish:

• knotty shape. The neoplasm is represented by several nodes that are located in one or both parts of the liver;
• massive shape. The tumor has only one large node, or a node with metastases.
• diffuse form. The tumor consists of numerous small tumor nodes (carcinomatosis).

Based on the characteristics of the clinical course, there is another classification of liver carcinoma. The following forms of carcinoma can be distinguished:

• abscess-like. This type is characterized by rapid breakdown of liver cells. Such neoplasms occur in only 5% of patients;
• cirrhosis-like. This type of carcinoma is the outcome of complicated cirrhosis - alcoholic or viral. The disease has a rapid course and vivid symptoms. This type of disease is diagnosed in a quarter of cases of liver carcinoma;
• cystic. This type of tumor appears as a capsule filled with fluid. It is diagnosed in 5% of patients. At the initial stages of development, there are no symptoms;
• with masked flow. Formed due to the proliferation of tumors located in other organs;
• hepatonecrotic. This type is characterized by the presence of necrotic areas in tumor nodes or in neighboring tissues. Detected in 10% of cases;
• hepatomegalic. This carcinoma grows very quickly and is fatal in less than six months.

According to the degree of differentiation, the following tumors are distinguished:

• highly differentiated;
• moderately differentiated;
• poorly differentiated;
• undifferentiated.

Treatment of carcinoma

Treatment of the pathology is complex: surgery, medication, diet.

The pathology is difficult to treat, since diagnosis in the initial stages is difficult. The patient's treatment regimen is determined based on the stage of the disease, type of tumor and general health.

At the initial stages of the development of the disease, surgical intervention is used. During the excision process, only the affected tissue is removed, while most of the organ is preserved. But resection is effective only for small tumors.

If the tumor has affected half of the organ, a hemihepatectomy is performed - excision of 50% of the organ. The remaining part of the gland is restored over time to its original size. After surgery, a course of radiation therapy is prescribed to destroy remaining tumor cells and prevent relapse.

In addition to the surgical method, there are other methods of treating liver carcinoma:

• Chemotherapy is the treatment of cancer through infusions of chemicals. Chemotherapy is used at all stages of the disease, including the latter to suppress uncontrolled tumor development and prolong life;
• ablation - influence on a tumor using microwaves, alcohol, cold gases. As a result, the carcinoma is destroyed and the progression of the disease slows down;
• radioembolization is a method in which radioisotope nanoparticles are introduced that destroy cancer cells in the hepatic artery;
• embolization is a method during which special substances are injected intravenously to block the blood flow to the tumor. This method is used for large (more than 5 cm) inoperable tumors.

When carcinoma is represented by numerous small nodes, and the functions of the organ are severely impaired, transplantation is used. An organ transplant is performed when there are no metastases in other organs. A completely healthy person can become a donor for a patient, usually a relative.

In addition, the use of immunotherapy for carcinoma shows good effectiveness.

Diet and traditional methods of treatment for carcinoma

In case of oncology, dietary adjustments are mandatory. Patients with a similar diagnosis are advised to reduce the load on the organ as much as possible, consume food in small portions and often. The table shows food products whose consumption is allowed or strictly prohibited.

For liver cancer, it is recommended to eat boiled, steamed, and oven-baked foods. It is better to replace sweets with marshmallows, honey, and jam.

When treating carcinoma, folk remedies can be used as an additional treatment. Tinctures made from propolis or hemlock have proven themselves well.

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Disease prevention

To prevent the disease, the following recommendations must be followed:

• be vaccinated against hepatitis viruses in a timely manner;
• lead a healthy lifestyle: stop drinking alcohol and quit smoking;
• promptly treat liver diseases;
• Healthy food;
• use protective equipment when in contact with chemicals;
• Periodically undergo ultrasound of the abdominal cavity and undergo tests.

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Stages of disease development

The development of carcinoma occurs in stages. Depending on the severity of symptoms and the nature of transformations in tissues, 4 degrees of the disease are determined:

Stage 1 tumor is characterized by a small tumor size. It does not affect blood vessels and does not spread to normal tissues. It is impossible to determine it by palpation.

Stage 2 – the tumor reaches a size of 50 mm, the vascular system is involved in the cancer process, there are no lesions of the lymph nodes yet.

Stage 3 – the tumor grows even more, and multiple foci of abnormal cells can be detected. The vessels are severely affected, there are metastases in other organs (pancreas, gall bladder).

Stage 4 – damage to the lymphatic system occurs. Internal bleeding and mental breakdown may occur due to the spread of metastases to the brain.

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Diagnosis of the disease

To diagnose carcinoma, the following examinations are carried out:

• physical examination of the patient and history taking. Digital examination helps to detect the presence of ascites, obstructive jaundice, hepatomegaly - indirect symptoms of liver carcinoma;
• Ultrasound;
• CT scan with contrast agent;
• MRI;
• angiography;
• a blood test to determine the amount of alpha-fetoprotein can confirm carcinoma in 80% of cases;
• biochemical blood test (level of urobilin, bilirubin, AST and ALT, protein);
• coagulogram;
• blood test for tumor markers, antibodies to hepatitis viruses.
• biopsy.

Scintigraphy is used to differentiate liver carcinoma from other malignant tumors.

Description of orthotopic liver transplantation

For this procedure, patients are selected according to Milan criteria, based on the number and size of tumors. As a rule, transplantation is performed on people with a single lesion with a diameter of up to 5 cm or with 3 lesions, the diameter of which individually does not exceed 3 cm. The mentioned Milan criteria show the degree of survival after surgery. A certain circle of experts call this principle overly rigid. Its alternative is the Barcelona system. In it, cases with 1 formation up to 7 cm, 3 formations up to 5 cm and 5 formations up to 3 cm are considered operable. With this approach, the 5-year survival rate reaches 50%.

Localized treatment methods are based on the size, number and location of the formation, involvement of the portal vein, and the presence of micrometastases. The fact that the tumor is supplied with blood from the hepatic artery has made it possible to develop techniques that help reduce blood flow to the cancer site. In addition, techniques have been developed that allow chemotherapy to be administered locally directly into the tumor. Among the localized methods for eliminating hepatocellular carcinoma, it is worth highlighting:

• transcatheter treatment of the liver artery; • transarterial chemoembolization; • surgical reduction of tumor dimensions; • transarterial radioembolization.

Reasons for appearance

Risk factors that can trigger mutations in normal liver cells are varied. These include:

• presence of bad habits. People who drink large amounts of alcohol and smokers have an increased risk of developing HCC (hepatocellular carcinoma);
• presence of liver cirrhosis;
• viral hepatitis;
• diabetes;
• heredity;
• use of anabolic steroids;
• parasitic infestations. Infection of the liver by parasites and helminthic infestations (schistosomiasis, opisthorchiasis) can lead to mutations of hepatocytes and the development of cholangiocarcinoma;
• work in hazardous industries, prolonged contact with chemicals.

There are other factors that contribute to the development of cancer, but to a lesser extent:

• taking hormonal contraceptives based on estrogen;
• being male;
• history of fatty hepatosis;
• age over 40 years;
• the presence of cardiovascular pathologies;
• cholelithiasis.

It is assumed that Aflatoxin B1, contained in a special genus of Aspergillosis fungi, which are found on wheat, grain, rice (when the storage conditions of cereals are violated - they are stored at high humidity) can have a negative effect on the organ.

Features of systemic therapy for carcinoma

Unfortunately, systemic chemotherapy for liver cancer is ineffective. Due to the often present cirrhosis, this technique can provoke portal hypertension, gastrointestinal bleeding, and platelet sequestration.

Early reports on the use of tamoxifen were very encouraging, but subsequent studies have not confirmed them.

In addition, to this day there are attempts at treatment with doxorubicin, 5-fluorouracil, cisplatin and interferon. People suffering from the most severe forms of liver cancer should be recruited to participate in all kinds of clinical trials. This will increase the chances of ultimate research success.