Liver disease Q&A Blog

My father this year on January 23 was found to be of primary liver cancer. Symptoms are: yellow body. February 14 to do the intervention treatment, so involved in the treatment of 1 week after the hospital recuperating at home. However, the home of this period, it is clear appetite there is a sense of mass, with the same time, after back problems, stomach pains. Tai Lening has to rely on pain. I would like to know is that such a condition belonging to the deterioration of the situation it? If the next step will be what kind of symptoms?

Answer:

Liver cancer at both primary and secondary, secondary liver cancer due to other organs of the tumor through blood, lymph or directly into the liver caused by the invasion.
Primary liver cancer can be divided into the liver cell, bile duct cells and mixed in three types, for the vast majority of liver cell. Primary liver cancer in China as one of the common malignant tumor. Mortality rate in malignant tumors in the third, second only to gastric cancer and esophageal cancer. Epidemiological investigation of liver cancer mortality vary geographically. According to the World Health Organization statistics, liver cancer mortality rates in the world out fifth. Our survey per 100,000 population to 14.58 incidence of 46 to Qidong, Jiangsu and Guangxi Fusui the highest incidence.
It is worth noting that around the world the incidence of primary liver cancer are on the increase, about 250,000 people die of the disease, of which about 40% took place in China, which may be related to hepatitis C virus infection. In recent years, China on the prevention and treatment of liver cancer research has made significant progress. Hepatocellular carcinoma and small sub-clinical liver cancer found that an increasing number of Shanghai Medical University, Zhongshan Hospital, a small liver cancer after surgery to remove the 5-year survival rate reached 69.4 percent. In a world leader. Sub-clinical liver cancer this concept reflects not only the theoretical understanding of hepatocellular carcinoma of the new changes have also facilitated the treatment of major progress. This disease can occur at any age to 40 for the 49-year-old, male to female ratio was 5:1 ~ 3.
The etiology and pathogenesis
Primary liver cancer incidence and cause of the principle has not yet been determined. More than that in a number of factors, recent studies focus on hepatitis B, hepatitis C virus, aflatoxin and other chemical carcinogens.
First, hepatitis clinic, about one-third of patients with primary liver cancer with chronic hepatitis history. National survey found a high incidence of primary liver cancer has a high incidence of hepatitis. Liver cancer epidemiology survey found that a high incidence of HBsAg-positive population is relatively low for the high areas, and liver cancer in patients with HBsAg-positive rate was significantly higher than in healthy people. Pathology found that liver cirrhosis for more nodular cirrhosis. And the latter is closely related to hepatitis. In recent years, sites such as clothes staining method shows that liver cancer cells in the existence of HBsAg, also confirmed the HBV (hepatitis B virus) can be integrated into the host DNA of liver cells, also set up to produce HBsAg of human liver cancer cell lines. Facts have shown that more than hepatitis B and liver cancer among a certain degree of cause and effect. In recent years, research in the past the so-called non-A non-hepatitis B, hepatitis C name is, a threat to humanity than the more serious hepatitis B, cirrhosis and liver cancer more closely.
Second, primary liver cirrhosis merger of the high incidence of liver cirrhosis, according to national statistics about 50-90%, liver cirrhosis and liver cancer combined for 30-50%. Liver cirrhosis associated with larger and more nodular. This is a multi-cirrhosis caused by hepatitis C after (post-necrosis) cirrhosis. HCC may change in the process of regeneration took place, that is, through the liver cell damage - proliferation - dysplasia due to cancer. Europe and the United States often occur in the alcoholic liver cirrhosis, based on Bile is generally believed that congestion and cirrhosis and primary liver cancer incidence has nothing to do.
Third, aflatoxin aflatoxin in rats, ducks, guinea pigs, and other animals have a strong role in cancer. Animal experiments proved that the aflatoxin B1 liver cancer is the most carcinogenic. Epidemiological investigation found a high incidence of liver cancer in some areas, grain and oil, food (such as corn, wheat, soybean, peanut, etc.) by Aflatoxin B1 pollution is often more serious in areas with low rare. Aflatoxins are indications that these may be some areas of liver cancer-prone, but so far no human liver cancer caused by direct evidence. It has been reported recently, the epidemiological investigation of aflatoxin has nothing to do with liver cancer, yet to be studied further.
Fourth, other cancer-causing chemical factors that animal experiments have proved that a number of chemicals such as nitrosamine and the type of azo benzene in many animals can cause liver cancer. High incidence of liver cancer in some soil and water, was found containing nitrates and nitrites material higher. The nitrite in the stomach acid can be generated under the conditions of nitrosamines, these chemical carcinogens and liver cancer and research is worth noting.

Fifth, the Chinese branch of the parasitic infection Metorchis small parasitic intrahepatic bile duct, bile duct epithelial cells stimulated proliferation, and some cancer can occur and become bile duct cancer cells, as seen by the slice in the bile duct epithelial cells gradually develop into cancer at all stages of , So that such parasitic infection in the liver is the physical or chemical stimulation generated. However, the vast majority of bile duct cancer cells do not have liver fluke infection, so there may be other reasons. Schistosomiasis cirrhosis of the liver cells and no obvious shrinkage mostly hyperplasia, so rarely cause liver cancer.
Six other risk factors
(A) of the genetic factors that liver cancer can occur in some cases the family together, live together and more than blood Department, and many scholars believe that family gathering system may be caused by viral hepatitis as a result of the mother and son caused by vertical transmission.
(B) a high incidence of trace elements from soil, water, food, human hair and blood were found to detect trace elements copper, zinc and higher, low-key. Trace elements copper, zinc, liver cancer and the relationship is worth noting.
(C) of malnutrition and lack of nutrition and nutrition during the 90 tumors on human health is a major topic of attention from all circles of society. Its role in tumor promotion stage, to speed up or slow down - cancer. High fat and salt, smoked foods and cancer incidence is most closely related to, and are advised to eat more vegetables, fruits and cereals. Animal experiments confirmed that high-fat diet, hypoproteinemia, a lack of methionine and choline, which can cause liver necrosis, fatty change in liver cirrhosis and liver cancer. If the wealth to feed protein, B vitamins and methionine, the occurrence of liver cancer delayed, or even no.
Invasion and metastasis
(A) the transfer of intrahepatic liver cancer in the liver of the first shift, it is easy to violation and branching and portal vein tumor thrombus to form, after falling in the liver caused by multiple metastases. Heavenly Stems and Earthly Branches as a portal vein tumor thrombus obstruction can be caused or aggravated the existing portal hypertension.
(B) outside the ① liver metastasis to the transfer of the highest rates of lung, liver as a result of vein tumor thrombus in the inferior vena cava extended by up to right heart artery in the lung metastases to form. The transfer of blood can cause chest, adrenal, kidney and bone, and other parts of the transfer. ② lymph node metastasis, local hilar lymph nodes to the most common, can also be caused by the transfer of pancreas, spleen, peri-aortic lymph node on the collarbone. ③ cultivation, rare, even in the peritoneal Ke Zhongzhi, diaphragm, chest, etc.. Cause bloody ascites, pleural effusion. Women in Ovary leading to higher Aikuai.
Clinical
First, the natural course of liver cancer a new concept of onset of the disease hidden, but once symptoms appear, it has developed very rapidly in the past that their natural course around February to June, the “Wang cancer.” That is their natural course of about 24 months, in recent years by the AFP survey, the early detection of cases may have no clinical symptoms and signs, known as sub-clinical liver cancer. According to the development of liver cancer can be divided into: ① the early sub-clinical, pathological changes from the beginning to make a sub-clinical liver cancer diagnosis before the patients with signs and symptoms, clinical difficult to find, with an average of about 10 months. ② from the establishment of sub-clinical diagnosis of liver cancer to appear before the sub-clinical symptoms, patients are still asymptomatic and signs, about 3-5 cm tumor, diagnosis is still difficult, is a multi-AFP survey found that the average period of 8 months Or so. ③ the event of clinical liver cancer, has been to the medium-term, at this time, his condition has developed very rapidly in the near future appear to jaundice, ascites, lung metastases as well as extensive cachexia and the transfer of advanced performance, advanced a total of about six months. To the development of advanced liver cancer when the tumor has a diameter of 10 centimeters or so, it is difficult to cure.
Second, late in the clinical
(A) of the liver pain right upper quadrant pain the most common symptoms of this disease important, for continuity of pain or intermittent, mostly pure pain, or pain, with the development of the disease and unbearable pain intensified. District liver disease and pain is closely related to the site, located in the right lobe of liver disease for the performance of the season right rib pain, is located in the left lobe of liver for the performance of the area under the Xiphoid pain. If the tumor diaphragm, the pain can be emission or right back to the right shoulder; right after the growth of the tumor can cause pain on the right side of the waist. Pain due to tumor growth so that the tension caused by liver capsule. Sudden severe abdominal pain and peritoneal irritation sign for subcapsular liver cancer nodules bleeding, or abdominal Pokui cause internal bleeding and abdominal peritoneum caused by stimulation.
(B) enlargement of the liver was carried out hepatomegaly, the quality of hard, uneven surface, ranging from the size of the nodule or mass, and blunt the edge of neat, palpation often have varying degrees of tenderness, liver prominent right Lei Gong Xiphoid or under, the corresponding site can be seen full of local uplift, such as liver cancer at the side of the diaphragm, the main limitation of diaphragmatic elevation and the lower edge of the liver may swell, the liver is located close to the surface of the lower edge of the Most likely to hit Nodules cancer, patients sometimes can be found and their treatment.
(C) of the liver due to the noise of vascular blood vessel rich and tortuous, Zhou Ranbian small artery or oppression Aikuai hepatic artery and the abdominal aorta, about half of the patients in the corresponding part of hair-like blood vessels hear noise, the diagnostic value of signs, rather, However, early diagnosis is largely meaningless.
(D) of the portal hypertension associated with more signs of liver cirrhosis, it is often the performance of portal hypertension, large spleen can be as a result of the portal vein or splenic vein thrombosis in shape, or liver or spleen oppression portal vein caused. Late for the performance of ascites, hepatic portal vein tumor thrombus could accelerate the growth of ascites, ascites general for leaking fluid, ascites blood cancer for more than Pokui due to the abdominal cavity, can also be caused as a result of peritoneal metastasis.
(E) jaundice often late, because of more cancer of the lymph nodes or oppression caused by bile duct caused by biliary obstruction. Recently, hepatocellular carcinoma can be found in violation of obstructive jaundice due to biliary duct and bleeding. Jaundice can also be a result of liver cell damage caused
F) performance in patients with malignant tumors of the body often progressive weight loss, fatigue, loss of appetite, bloating, diarrhea, malnutrition and cachexia, and so on. (Fever quite common, persistent low heat for, in general about 37.5-38 ℃, or irregular or intermittent and persistent high fever. May be the performance of liver abscess, but not before the fever accompanied by shivering, the application of antibiotic therapy Null and void. TNF-and heat absorption, oppression or violation of bile duct cancer due to cholangitis, as a result of reduced resistance to infection complicated by the other.)
(G) part of the syndrome in patients with cancer showed ① hypoglycemia. There are many reasons for hypoglycemia, liver cells to ectopic secretion of insulin-like material, glycogen storage of too many tumors, inhibiting insulin-production, insulin secretion or β cells by stimulating factor to lower blood sugar. ② vera. The reason may be for erythropoietin-stimulating hormone-induced increase, about 10% of patients in this levy. ③ hypercalcemia, the occurrence of liver cancer may be related to the organization of parathyroid hormone Ectopic secretion, liver cancer associated with hypercalcemia and bone metastases at the time of high blood calcium, phosphorus and the latter with a high clinical Often the signs of bone metastases can help to identify, liver disease associated with high blood calcium, can be high blood calcium crisis, such as drowsiness, psychosis, coma, and so often misdiagnosed as hepatic encephalopathy, or brain metastases, ④ other: the liver can occur porphyria; abnormal fibrinogen hyperlipidemia; thrombocythemia; hyperlipidemia, and so on.
(H) metastasis symptoms occur, such as lung, bone, brain, chest transfer can produce symptoms.
Complications
First, upper gastrointestinal bleeding accounts for about 15% of the cause of death due to liver cancer often have cirrhosis, portal hypertension, and the portal vein, liver and portal vein tumor thrombus and further increase the high-pressure, Guchang caused by the lower esophageal or gastric varices paragraph-break Bleeding. If bile hepatocellular carcinoma can lead to violations of the biliary tract bleeding, but also for performance and hematemesis category. Some patients may be due to intestinal mucosa erosion, ulcer, combined with coagulation dysfunction and extensive bleeding, bleeding and shock can lead to liver in a coma.

Second, in a coma liver (hepatic encephalopathy) account for about one-third of the cause of death, often for liver cancer is not the end of the period of performance, gastrointestinal bleeding, a large number of diuretics, electrolyte disturbance and secondary infection such as the liver often can be induced coma .
Third, liver nodules bleeding for about 10% of patients with liver cancer nodules as a result of the breakdown of death for liver cancer the most urgent and serious complications. Late liquefaction necrosis of the liver can be spontaneous rupture, but also as a result of external forces and break down the way it should be gentle when palpation, the force must not touch pressure, cancer nodules can be confined to the liver capsule rupture, there is sharp pain, the rapid increase in liver , In the local soft mass reach, if Pokui then into the abdominal cavity caused by acute abdominal pain and peritoneal irritation. A small amount of bleeding for the performance of the bloody ascites, massive bleeding can lead to shock or even death quickly. Fourth, secondary infection in patients with primary liver cancer because of long-term bed rest and consumption, weakening resistance, particularly in the WBC after chemotherapy or radiotherapy to reduce easy when complicated by a variety of infections such as pneumonia, intestinal infections, fungal infections and septicemia, and so on
Treatment

China attaches great importance to the prevention and treatment of liver cancer, AFP survey for the three to create favorable conditions for the early, early surgical resection of the opportunity to increase, together with the application of new technologies, as well as traditional Chinese medicine, so that the effect has been greatly improved. Sub-clinical liver cancer and liver cancer after a small 5-year survival rate of 70% of liver cancer in the past to change negative attitudes of palliative care, to take an early complete, active, comprehensive treatment.

First, surgery

(A) surgery is the best way to the treatment of liver cancer. Small liver cancer or liver resection partial row, we expect to fully heal. And a small number of patients relapse after surgery can once again. In addition to the surgery can be used outside: ① Nd-YAG laser (Nd YAG-Laser) cut the advantage for good performance to stop bleeding, may be keeping more of a normal liver, liver function and postoperative inflammatory response to a minor, simple and safe, no Serious complications; ② frozen with liquid nitrogen treatment, so that the tumor in the cases ultra-low temperature have solidified necrosis.
(B) of the liver transplant much progress has been made

Second, the involvement of super-selective percutaneous treatment of hepatic artery imaging, at the same time injecting drugs and chemicals, such as gelatin sponge embolization materials, surgical ligation can be achieved with the same effect of chemotherapy, and can be repeated for patients with advanced To be shrinking tumors, surgical resection of the opportunities available.

Third, radiation therapy for this disease is not sensitive to radiation, and neighboring organs are affected by radiation damage, it is not satisfied with the effect that in recent years due to improved methods of diagnosis. Cobalt 60 irradiation using local, liver function better able to tolerate more than 4.000rad doses, significantly enhance the effect, at the same time the combined chemotherapy treatment and Chinese medicine better, after surgery, radiation with the energy of the update, radiotherapy Will continue to enhance the effect.

Fourth, the use of Chinese medicine treatment of liver Fu Bao Relieving Blood promoting blood circulation, Ruanjian Sanjie, such as the rule is Qingrejiedu. Can mobilize the immune function, improve symptoms, reduce the chemotherapy and radiation toxicity and improve the quality of life of patients to prevent further deterioration of the condition

Prevention
To carry out patriotic public health campaign, eating sanitation, good food custody, to mold poisoning, the protection of water resources, prevent pollution, prevention and active hepatitis and cirrhosis, and so is the main measures to be taken.

Liver cancer cancer mortality rates, liver cancer symptoms, primary liver cancer, secondary liver cancer