Liver cancer (liver cancer) is the liverMalignant tumor, can be divided intoPrimaryandsecondaryTwo categories.PrimaryMalignant tumor of liverEpithelium derived from the liver orMesenchymal tissueThe former is called primary liver cancer, which is a malignant tumor with high incidence and great harm;The latter is calledsarcoma, andPrimary liver cancerIt is relatively rare.SecondaryMetastatic liver cancerIt refers to the malignant tumor originating from multiple organs of the whole body invading the liver.It is commonly seen in stomach, biliary tract, pancreas, colorectal, ovary, uterus, lungbreastLiver metastasis of malignant tumors of other organs.
The etiology and exact molecular mechanism of primary liver cancer are not completely clear. It is believed that the pathogenesis of primary liver cancer is a complex process with multiple factors and steps, which is affected by both environmental and dietary factors.epidemiologyAnd experimentresearch data indicate,hepatitis B virus(HBV) andHepatitis C virus(HCV) infectionAflatoxin, drinking water pollution, alcohol, liver cirrhosissex hormone, nitrosaminestrace elementAll are related to the incidence of liver cancer.Secondary liver cancer(Metastatic liver cancer) can be transmitted through different ways, such asLymphThe disease is caused by metastasis or direct invasion into the liver.
(2) Physical signsEarly liver cancer often has no obvious positive signs or is only similarcirrhosisPhysical signs.Liver enlargement, jaundiceascitesAnd other signs.In addition, patients with cirrhosis often haveLiver palms、Spider nevus, MalebreastEnlargement, edema of lower limbs, etc.When extrahepatic metastasis occurs, the corresponding signs of the metastatic sites may appear.
(3) ComplicationsThe common ones are upper gastrointestinal bleeding, liver cancer rupture and bleeding, liver and kidney failure, etc.
Secondary liver cancer
(1) Clinical manifestations of primary tumorsIt is mainly seen in patients without a history of liver disease. Liver metastasis is still in the early stage without corresponding symptoms, while the primary tumor symptoms are obviously in the middle and late stages.Secondary liver cancer in such patients is often found in the examination and follow-up of primary treatment.
(2) Clinical manifestations of secondary liver cancerMost patients complained of flatulence, discomfort or dull pain in the upper abdomen or liver region. With the development of the disease, the patient developed fatigue, poor appetite, emaciation orfeverEtc.During physical examinationEpigastriumEnlarged liver can be felt, or hard and tender nodules can be seen in late patientsanemia, jaundice and ascites, etc.The clinical manifestation of such patients is similar to that of primary liver cancer, but the development is relatively slow and the degree is relatively mild. Most of them are suspicious of metastasis during various liver examinations, and primary tumors are found during further examinations or surgical exploration.Some patients cannot be found after multiple examinationsPrimary carcinomaStove.
(3) Clinical manifestations of both primary and secondary liver cancerMainly seen in primary tumor and liverMetastatic cancerAll haveNon early stage, in addition to the symptoms and signs of the liver similar to the primary liver cancer, the patient also has clinical manifestations caused by the primary tumor, such as nodulesrectal cancerLiver metastasis can be accompanied by bowel habitsfecal property Changes and blood in stool.
(1) Liver cancerSerum markersDetection ① The determination of serum alpha fetoprotein (AFP) has relative specificity for the diagnosis of this disease.radioimmunoassayDetermination of continuous serum AFP ≥ 400 μ g/L can eliminate pregnancy and activityhepatopathyThe diagnosis of liver cancer can be considered.About 30% of liver cancer patients are clinically AFP negative.Simultaneous AFP detectionHeteroplasm, which can significantly increase the positive rate. ②bloodenzymologyDetection of γ - glutamyltranspeptidase and other tumor markers in serum of patients with liver cancerIsoenzyme、Abnormal prothrombin、alkaline phosphatase、lactate dehydrogenaseIsozymes can be higher than normal.But it lacks specificity.
② CT examinationWith high resolution, the diagnostic coincidence rate of liver cancer can reach more than 90%, and micro cancer lesions with a diameter of about 1.0 cm can be detected.
③ MRI examinationThe diagnostic value is similar to that of CT in benign and malignant liverSpace occupying lesion, especially withHemangiomaIts differentiation is better than CT.
④ Selective celiac or hepatic arteriographyFor tumors with abundant blood vessels, the lower resolution limit is about 1cm, and for tumors with less than 2.0cmSmall hepatocellular carcinomaThe positive rate was 90%.
⑤ Needle aspiration cytology of liver punctureFine needle puncture guided by B-mode ultrasound is helpful to improve the positive rate.
2. Secondary liver cancer
Most of the tumor markers in patients with secondary liver cancer are within the normal range, but a few come from the stomachesophagusPancreatic and ovarianMetastatic carcinoma of liverAFP may rise.Those with symptoms are mostly accompanied by ALPGGTrise.Carcinoembryonic antigenElevated CEA is helpful in the diagnosis of liver metastases,colorectal cancer liver metastases The positive rate of CEA was as high as 60%~70%.selectivityHepatic angiographyThe lesion with a diameter of 1cm can be found.Selective celiac or hepatic arteriography mostly showed the tumor with few vessels;CT showed mixed unevennessIsodensityOr low-density space occupying, typical of "cow eye" sign;MRI often shows liver metastasessignal intensity It is even, with clear edges and multiple lesions, and a few have "target" sign or "bright ring" sign.
diagnosis
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According to the cause of disease, clinical manifestations and examination results, a clear diagnosis should be made for different situations.
treatment
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Treatment of liver cancer includes surgeryChemoradiotherapy, interventionTargeted drugs、ImmunotherapyAnd other means.Individualization according to different stages of liver cancercombined treatmentIs the key to improve the curative effect;Treatment methods include surgeryhepatic arteryLigation, hepatic arterychemotherapyEmbolization, radio frequency, freezing, laser, microwave, chemotherapy andRadiotherapyEtc.BiotherapyChinese medicine is also widely used to treat liver cancer.
Surgery is the first choice and the most effective method for the treatment of liver cancer.The surgical methods include radical hepatectomy, palliative hepatectomy, etc.
For unresectable liver cancer, intraoperative ligation of hepatic artery, chemoembolization of hepatic artery, radio frequency, freezing, laser, microwave and other treatments can be used according to the specific situation, which has a certain effect.Primary liver cancer is also OKLiver transplantationOne of the indications of.
throughExploratory laparotomyIf it is found that the tumor cannot be removed, or as a follow-up treatment for palliative resection of the tumor, hepatic artery and/orportal veinPump placement (subcutaneous embeddingFilling device）Regional chemoembolization;Radiotherapy is also available for patients who are estimated to be unresectableinterventional therapy, viaFemoral arteryConduct selective cannulation to hepatic artery and injectEmbolic agent(often used asIodized oil）AndAnticancer drugChemoembolization may give some patients the opportunity of surgical resection.
Treatment based on syndrome differentiationAttack and supplementIt is often used in combination with other therapies.To improve the bodyDisease resistance, improve the general condition and symptoms, relieve chemotherapy and radiotherapyAdverse reactions。
