Liver cancer: symptoms, signs, treatment, prognosis
Carcinoma of the liver are tumors of epithelial origin, originating from parenchymal (hepatocytes) or the epithelium of the intrahepatic bile ducts, which, however, is strongly reflected in the symptoms of cancer of the liver, characterized by a great variety.
The disease is quite rare, every year there are nearly 250-300 thousand cases in the world, but noted that in some countries the tumor is very common. Thus, in the regions of South Africa and of Asia, India, China, the Philippine Islands among the entire cancer pathology cancer of the liver can account for half or more of all tumors. This is due to supply, low quality of life, predisposing to the use of substandard products, the distribution of genetic mutations and infections.
In some bad patterns, liver cancer men are more vulnerable, which he is logged in several times more often than women, and among patients is dominated by persons aged 50-60 years. Partly to blame are the representatives of the stronger sex, prone to bad habits provoke cancer. In addition, more than 90% of tumors of the liver in men are primary cancers, while in women there are only about 40%.
Malignant liver tumors are divided into primary, which is a actually a cancer, growing out of the structures of this body, and secondary – metastatic nodes cancer of other localizations. The liver, due to the peculiarities of blood supply and functional purpose, most often takes the «blow» of the metastatic process. So, more than a third of all known tumors gives hematogenic metastases in the liver when cancer cells from other organs entered the bloodstream and form new foci of growth. In other words, secondary tumors occur in several tens of times more primary liver cancer.
Causes and predisposing factors
Among all causes of liver cancer are such that we cannot change – gender (namely, chromosomes that any operations do not fix it), age, heredity. From this «aid,» as genetic predisposition will not escape, as the additional years of life, so older men should be particularly attentive to lifestyle and health. At the same time, most other risk factors, modifiable, can be subjected to correction and at least try to avoid them.
Liver cancer lead:
- Viral infection and parasitic infestation.
- Liver cirrhosis of different nature.
- Metabolic disorders associated with accumulation in the liver of the excess iron (hemochromatosis).
- Harmful habits such as Smoking and especially alcohol.
- The impact of industrial, domestic and food carcinogens.
Speaking of the viral nature of liver cancer, primarily refers to hepatitis b and C, agents which have a special affinity for hepatocytes, that is, affect mainly the liver, not involving the disease other organs. Scientists have found that these viruses are able to block the genes that suppress the growth and development of cancer cells in the organism (gene-suppressor p53), and thus open the way for cancer. The probability of tumor development in carriers of antigens of hepatitis b virus increases 200 times.
The virus can be detected in 70-90% of patients with primary liver cancer. It should be noted that vaccination against hepatitis b gives good results and is available to all, so you should not overlook such a preventive measure, especially for risk groups (physicians, employees of medical laboratories).
Parasitic infestation can also be considered a risk factor, but the most common opisthorchiasis, schistosomiasis, amoebiasis. Of particular importance in this group of infections belongs to opisthorchiasis. The disease causes the so-called cat Fluke, attributable to flat worms. The pathogen enters the body with insufficiently cooked or even raw river fish and the parasite in the bile ducts, the bladder, causing chronic inflammation, disruption of bile flow and changes of the epithelium of the ducts, so that later you may experience cholangiocellular cancers.
Opisthorchiasis is highly prevalent in some regions of Russia, especially in the basins of the Volga, Kama, Neva, Ob and other rivers. Eating habits associated with the use of slices, quite dangerous in relation to the infecting parasite, so fans of such fish products are at risk. The disease can occur decades with the clinic of cholecystitis, or even without it. Liver cancer is one of those cases when it is better to give up some eating habits than to get into the number of patients of the hospital, therefore a thorough treatment of the fish at high temperatures should be a prerequisite for its use.
About cirrhosis of the liver heard it all, and many know that it can lead to cancer. The cause of the cirrhosis in this case is not decisive, whether chronic hepatitis or alcoholism. Liver cancer is rare, but up to 90% of patients they suffer from cirrhosis of the liver, which although not a carcinoma, but is often found at an advanced stage as the root cause of the tumor. The disease is characterized by proliferation of connective tissue within the hepatic parenchyma with impaired structure of the body, deformation of the slices and the vascular tract, disorders of bile outflow. Heavy sclerotic process, often changing beyond recognition architectonics of the liver, has a very high oncogenic potential. Alcoholic cirrhosis is the main cause of liver cancer in residents of developed countries.
Hemochromatosis is accompanied by the deposition of excess iron in the liver and other organs, causing in response sclerosis, transforming over time in the liver in cirrhosis, and then in a known way to cancer. Cause of hemochromatosis may be not only genetic defects, but frequent blood transfusions, red blood cells, the same alcoholism, States after removal of part of the stomach, etc. Treated hemochromatosis is problematic, so in most cases you can observe the liver injury in cirrhosis.
About the carcinogenic role of bad habits can not speak, because it is a well-known fact, but it is worth mentioning that Smoking and alcohol abuse are often the main causes of cancer. Alcohol not only has a toxic effect on hepatocytes, but long-term use of unreasonable amount of leads to cirrhosis, which, as mentioned above, can cause cancer.
Carcinogens enter the body with food production and even home inevitably undergo various transformations in the liver – the main organ of detoxification. Herbicides, arsenic, aromatic hydrocarbons, nitrosamines, penetrating air, water or food reaches the liver, where he developed their procancerogenic action.
Of particular note is the aflatoxin – one of the most powerful carcinogens and very toxic waste product of the fungus Aspergillus flavus, a favorite place of growth which is peanuts, grains and legumes, cocoa, rice. Liver cancer caused by this fungus is very common in African countries, where food often have to use poor-quality products in the absence of alternatives.
Athletes who are fond of synthetic steroid hormones in pursuit of muscle mass should know that these drugs can cause liver cancer. Hormonal contraceptives also have a similar effect with prolonged use, but modern drugs with low doses of the hormone are almost devoid of this property.
A bright spot among the above-described may be the fact that drinking coffee prevents cancer of the liver, which can not but rejoice «coffee people», but in an attempt to protect themselves thus against cancer, we should not forget about other effects of this delicious drink – increased blood pressure, tachycardia, etc.
Speaking of the secondary, metastatic cancer of the liver, it should be noted that the structure of such tumor nodes corresponds to a primary carcinoma elsewhere in the body, from which cancerous cells and «profit» in the liver. Usually there are multiple such metastases, similar in appearance and histological structure. The source of the metastatic cancer can become any organ, but a special place is bowel cancer. This fact is easy to explain: the venous blood from the intestine goes via the portal vein to the liver for clearance of products of metabolism, and with it fall back and the tumor cells deposited in a well-developed microvascular network and give rise to metastases.
In half of cases bowel cancer becomes the cause of early hematogenous metastases in the liver. Features of blood supply of the outflow of bile and pancreatic juice also predispose to hepatic metastases in malignant tumors of the pancreas, stomach, esophagus.
In some cases of liver cancer process may be the consequence of the tumor from another organ. In particular, from the close of the stomach, duodenum or colon, gallbladder. Under these carcinomas there is a clear interrelation between the anatomical and histological structure between the individual fragments of the tumor, which allows you to merge, for example, cancer of the stomach and liver in one disease.
Types and stages of liver cancer
Liver tumors are divided into types depending on their structure, purity and origin.
The histological classification of malignant epithelial tumors involves the allocation of such varieties as:
Most (80%) of primary hepatocellular carcinoma is liver cancer originating from the cells of the parenchyma – hepatocytes. Hepatocellular carcinoma is almost always combined with cirrhosis of the liver.
Another variety, occurring in 20-30% of patients, is cholangiocellular cancer, the source of which is the epithelium of the bile duct. This variant of the tumor is less associated with liver cirrhosis, and often occurs on the background of chronic inflammation in the biliary tract (cholangitis), including as a result of parasitic infestation.
Other varieties of cancer, among which and mixed epithelial-mesenchymal tumors, are recorded much less frequently described above.
Depending on the type of growth it is customary to distinguish nodular and diffuse forms of cancer. Most frequently the tumor grows in the form of nodes, the number and size of which can vary. There is still no consensus as to the primary if there are several nodes cancer, or as one of them main and the other metastatic screenings. The nodular type of growth prevails in the case of hepatocellular cancer, causes a significant increase in the size of the liver and is combined in most cases with cirrhosis. The diffuse form is accompanied by the appearance of numerous small neoplastic foci in cirrhotically changed liver, the size of which substantially do not change.
Like any other malignant tumor, liver cancer can have different degrees of differentiation, from high to moderate and low, which determines its malignancy and prognosis.
The stage of the disease is determined by the size, number of tumor lesions, metastases and complications, and is determined by comprehensively taking into account parameters according to the TNM system, well known to oncologists.
Only patients with the first stage, when the liver is detected no more than three nodes measuring up to three inches, have a chance to recover. In other cases, the prognosis is quite serious, and stage 4, terminal, treatment is symptomatic.
Liver cancer metastasizes to the lymph nodes of the gate body, mediastinal, celiac, and even neck. Hematogenous dissemination may occur to the bones and lungs. Often there is tumor invasion in neighboring organs and tissues – stomach, diaphragm, adrenal glands. Metastasis liver cancer can retain the ability to form bile.
Symptoms of liver tumors
First signs of liver cancer for quite a while may be absent, and appeared before nonspecific symptoms that do not cause anxiety in patients who carry them to the already familiar manifestations of chronic hepatitis or cirrhosis started. This leads to the fact that often the tumor is diagnosed at advanced stage.
The first symptoms of the disease are confined to a:
- Malaise, weakness, reduced performance, apathy.
- Pain in the right hypochondrium.
- Nausea, vomiting, loss of appetite.
- Weight loss.
After an average of three months from the date of deterioration of health of the patient comes to the doctor, showing, in addition to the above, complaints about the presence of tumor masses in the abdomen, which the patient often finds himself, jaundice, edema, fever. In addition, there is a tendency to hemorrhage, significant liver enlargement (hepatomegaly) and severe dyspepsia.
Hepatomegaly is the most important symptom of a cancer, wherein the organ is greatly increased in size, becoming a stony density, often with a rough surface. To test this, the liver is not difficult for the doctor of any specialty. Glassonby stretching the capsule that covers the liver on all sides, leading to an increase in pain that becomes constant, aching or dull and localized in the right upper quadrant or epigastric pain.
Symptoms such as jaundice and ascites (fluid accumulation in the abdominal cavity) due to the expansion of tumor tissue with compression of the bile duct, portal vein, and a decrease in the mass of functioning parenchyma, capable of detoxification. If the cancer developed on the background of cirrhosis, the patient could already be preceding jaundice, ascites, varicose veins of the anterior abdominal wall, rectum, esophagus and other signs of liver damage. At the same time, the growth of tumors in cirrhosis is accompanied by more rapid deterioration, and increase of all symptoms of liver failure.
Depending on the prevalence of certain symptoms in clinical Oncology there are two kinds of liver cancer: hepatomegalia, jaundice, simulating hepatitis, etc.
In the last stage the patient’s condition becomes severe, progressing hepatic insufficiency, pronounced intoxication symptoms tumor metabolic products, as well as possible signs of dysfunction of other organs of the gastrointestinal tract. Metastasis to bone can cause pain, and damage to the lungs – pneumonia. Such patients will require continuous symptomatic therapy aimed at alleviating painful and painful symptoms.
Detection of liver cancer in the initial stages fraught with considerable difficulties, because the authority are not subject to direct examination, to palpate the tumor is small in size, it is not possible, and the first signs may be masked by other diseases. The examination of the patient, a detailed clarification of complaints, symptoms, palpation of the abdomen gives the amount of information that allows the doctor to suspect something was wrong and to refer the patient for medical examinations.
Diagnosis of liver cancer consists of the event:
In the General analysis of blood of patients with cancer of the liver revealed increased erythrocyte sedimentation rate, increase in the number of leukocytes, anemia, and in biochemical research will be elevated bilirubin and transaminases (ALT, AST), indicating the defeat of hepatocytes.
One of the most important and informative laboratory tests believe determine the level of alpha-fetoprotein in the blood. Increasing its can be found in 70-90% of patients with liver cancer.
Ultrasound is very accessible, inexpensive to implement and allows to identify foci of tumor growth, to examine lymph nodes and adjacent organs of the abdominal cavity. With the help of ultrasound can suspect the malignant nature of the lesion, and secondary metastatic process.
To Refine the localization of the tumor, the state of blood flow in it, the presence of secondary changes used CT, MRI, selective clickography and radioisotope scanning of the liver.
The most reliable information about the tumor obtained via biopsies using a fine needle under ultrasound or by laparoscopy, when there is the opportunity to take pieces of tissue from visually abnormal areas of the liver.
How to overcome cancer?
Treatment of liver cancer – not an easy task, but the positive effect can be achieved only in a small proportion of patients with small tumors limited to one lobe. Complicates the process of combating disease not only by the fact that patients come to the oncologist already at an advanced stage, but features of the structure of the body. Rich blood supply, the lack of clear boundaries between the segments of the liver, and often the multiplicity of tumor sites is often done by carrying out radical surgical treatment impossible, therefore, patients in most cases are doomed. Evolving rapidly and aggressively, liver cancer can lead to death within months of diagnosis.
The main treatment remains surgery, which is technically possible and feasible for small tumors, a single lobe of the liver. This intervention is very complex and can be carried out in specialized clinics, staffed by highly skilled specialists, oncologists and has the appropriate equipment. During the operation it is necessary to follow meticulous hemostasis, and also to adhere to the principles ablestik, removing tumor tissue from healthy liver parenchyma.
In the presence of cirrhosis prior to surgery may not be possible even with a small amount of liver, because the deformation of the body and pronounced sclerosis predispose not only to liver failure, but also to a massive hemorrhage at the time of surgery and after it.
Liver transplantation can save lives, but technically, the operation is very complicated, the search for a donor may take a long time, and the indication is cancer not later than 2 stages, so transplant is rarely used.
In some cases, the primary cancer is of small dimensions can be applied cryoablation (using liquid nitrogen), radiofrequency ablation, and embolization of vessels feeding the tumor.
Chemotherapy has no independent value, since malignant liver tumors insensitive to the effects of cytostatics. In some cases, however, have resorted to the introduction of drugs into the umbilical vein or hepatic artery, but with adjuvant intent after the operation.
Radiation therapy is not used in cancer of the liver, but sometimes it is referred to reduce pain.
In General, treatment options for liver cancer are very limited, although the search for new ways of dealing with it continues. A large proportion of patients with an established diagnosis are incurable, and medicine can only alleviate their suffering. Symptomatic therapy includes the administration of anesthetic drugs, correction of metabolic disorders and maintaining the functions of other vital organs.
Many people wonder whether to choose a liver cancer treatment in Israel than in their own country. In General, approaches to therapy do not differ from those in other countries, but the possibility of the use of modern equipment, highly effective drugs, participation in clinical trials for patients in Israel is broader, then the result will be better. It is just a matter of financial possibilities to be treated in an Israeli hospital, because all the procedure is quite expensive.
Diet for liver cancer
Healthy people do not always think about the composition of your diet, nutrition, ignoring the principles of right living. Frequent snacking, fast food, foods with preservatives, dyes, flavors have become part of our life. At the same time, the presence of serious disease of any of the organs of the digestive system force us to reconsider eating habits. Often patients are already accustomed to a particular diet, a hard time giving up your favorite treats, but the need for the diet for liver cancer due to her participation in the process of digestion, as well as the presence of dyspeptic disorders most patients.
Nutrition for liver cancer should not be «heavy», causing even greater aggravation of digestive disorders, so you should give preference to vegetables, fruits, lean meats and fish, steamed or boiled. Should completely refrain from alcohol, coffee, spicy pepper and other spices, rich broths, margarine, carbonated beverages. Given the significant limitations to please the patient can still be marshmallows, marmalade or honey.
Diet patients with liver cancer is designed to provide all the necessary nutrients and calories with a significant limitation of the list of allowed foods, but in each case it will be corrected by the doctor depending on the severity of certain symptoms. So, the loss of fluid with vomiting must be obtained adequate volume, while in the presence of ascites, edema, should refrain from excess water.
Fans to resort to folk remedies of treatment of malignant tumors, it should again be recalled that liver cancer is a very severe and often incurable disease that dooms to death even with the involvement of all possible modern methods of treatment. Can we expect in this case at least improvements in the use of herbs, baking soda, or even a conspiracy of the psychic? Probably not, it is better to consult an oncologist who is qualified to help relieve suffering.
Prognosis and prevention
Perhaps, malignant tumors of the liver can be considered the case when the cancer verdict.
The chance for a cure are patients in the first stage of the disease, and after surgery in case of resectable cancer life expectancy on average is three years. Five-year survival is possible to predict only one-fifth of patients.
When the diagnosis in the later stages of the cancer patients live a few months, they will have to spend in hospital in pain and other painful symptoms and requiring ongoing supportive care.
The prognosis for liver cancer is very serious and often adverse, therefore, vulnerable groups need to do everything to prevent its development. Preventive measures are:
- Vaccination against hepatitis B.
- The exception to unreasonable and frequent transfusions of blood and blood products that may contain hepatitis viruses and uncontrolled iron supplementation.
- Observance of sanitary and anti-epidemic regime in medical institutions, especially surgical patients.
- Use alcohol in moderation or total abstinence from it.
- The observance of safety rules when working in hazardous industries.
If you suspect a liver tumor, the deterioration of patients with hepatitis or cirrhosis, should not hesitate to see a doctor until the disease has reached an incurable stage.