Staging of primary liver cancer

The onset is often insidious. Liver cancer is often discovered accidentally during follow-up visits for liver disease or physical examinations using AFP and B-type ultrasound. At this time, the patient has no symptoms and physical examinations lack signs of the tumor itself. This stage is called subclinical liver cancer. Once symptoms appear and patients seek medical treatment, the course of the disease has mostly entered the middle and late stages. The clinical manifestations of liver cancer at different stages are significantly different.

(I) Symptoms of liver cancer Liver pain, fatigue, poor appetite and weight loss are the most characteristic clinical symptoms.

1. Pain in the liver area: the most common, intermittent, continuous, dull or distending pain, caused by the rapid growth of the cancer, which tightens the liver capsule. The tumor invades the diaphragm, and the pain may radiate to the right shoulder or right back. The tumor growing to the right back may cause right waist pain. The sudden onset of severe abdominal pain and peritoneal irritation signs indicates that the cancer nodule is bleeding under the capsule or rupturing into the abdominal cavity.

2. Gastrointestinal symptoms: decreased appetite, indigestion, nausea, vomiting and diarrhea, etc., are easily overlooked due to their lack of sex specificity.

3. Fatigue, weight loss, and general weakness. In the late stage, a few patients may develop cachexia.

4. Fever: Generally low-grade fever, occasionally reaching above 39 degrees Celsius, presenting as continuous or afternoon low-grade fever or remittent high fever. Fever is related to the absorption of necrotic products of the tumor. Compression or invasion of the bile duct by the tumor may lead to biliary infection.

5. Symptoms of metastatic lesions: There are corresponding symptoms at the site of tumor metastasis, which sometimes become the initial symptoms of liver cancer. For example, metastasis to the lungs can cause coughing and hemoptysis, and pleural metastasis can cause chest pain and bloody pleural effusion. Cancer embolism to the pulmonary artery or branches can cause pulmonary infarction, and severe dyspnea and chest pain may occur suddenly. Cancer embolism blocking the inferior vena cava may cause severe edema of the lower limbs and even a drop in blood pressure; blocking the hepatic vein may cause Budd-Chiari syndrome and edema of the lower limbs. Metastasis to the bones may cause local pain or pathological fractures. Metastasis to the spine or compression of the spinal nerves may cause local pain and paraplegia. Intracranial metastasis may cause corresponding localization symptoms and signs, and intracranial hypertension may also lead to brain herniation and sudden death.