Diagnosis methods of liver cancer

In Western countries, secondary liver cancer is much more common than primary liver cancer, and gastric cancer is the most common, followed by lung, pancreatic, colon and breast cancer, etc., so it is important to distinguish them. Secondary liver cancer generally develops relatively slowly, and most of them have clinical manifestations of primary diseases, and the alpha-fetoprotein test is negative.

(I) Secondary liver cancer

Many tumors may metastasize to the liver. In Western countries, secondary liver cancer is much more common than primary liver cancer. Secondary liver cancer is most common, followed by lung, pancreas, colon and breast cancer, etc., and should be carefully differentiated. Secondary liver cancer generally develops relatively slowly, and most have clinical manifestations of primary cancer, and the alpha-fetoprotein test is negative. The key to differentiating it from primary liver cancer is to identify the primary cancer focus.

(ii) Active liver disease and cirrhosis

Acute and chronic active liver disease

It is often difficult to differentiate between primary liver cancer and cirrhosis. If a patient with cirrhosis has pain in the liver area, an enlarged liver, increased alpha-fetoprotein (even if the increase is in low concentrations), etc., the possibility of cancer is very high, and B-ultrasound examination and hepatic angiography should be performed in time to confirm the diagnosis.

3. Liver abscess

Liver abscesses have inflammatory symptoms such as fever and increased white blood cell count. The chest wall at the site of the abscess often has localized edema, tenderness, and right upper abdominal muscle tension. Multiple ultrasound examinations can reveal fluid-level segments or fluid-dark areas of the abscess, but fluid-level segments may also appear in liver cancer fluid necrosis, so they should be distinguished. If necessary, fine needle puncture can be performed at the tender point. During enhanced CT examination, liver abscesses may show peripheral enhancement characteristics.

(IV) Hepatic cavernous hemangioma

Hepatic cavernous hemangioma is a benign space-occupying lesion in the liver, which is often discovered accidentally due to physical examination, B-ultrasound examination or radionuclide imaging examination. This disease is common in my country. Differential diagnosis mainly relies on alpha-fetoprotein determination, B-ultrasound examination and hepatic angiography. Hepatic angiography of hepatic cavernous hemangioma has the following main characteristics: ① The thickness of the hepatic blood vessels is normal, and there may be vascular displacement when the tumor is large; ② There is no arteriovenous communication; ③ The portal vein is normal and there is no cancer thrombus; ④ The blood pool shadow continues to the venous phase and becomes a dense shadow with high concentration. The distribution of the blood pool outlines the size and shape of the cavernous hemangioma as its characteristic manifestation.

5. Hepatic echinococcosis

Patients with hepatic echinococcosis (liver echinococcosis) have progressive liver enlargement, hard texture and nodular feeling; in the late stage, most of the liver is destroyed, and the clinical manifestations are very similar to primary liver cancer. However, this disease generally has a long course, with a history of 2 to 3 years or longer, and progresses slowly. It can be distinguished from liver cancer by various tests such as living in an endemic area, positive skin test for hepatic echinococcosis fluid, and negative alpha-fetoprotein.

6. Extrahepatic tumors adjacent to the liver

Retroperitoneal soft tissue sarcomas, as well as tumors from the kidney, adrenal gland, pancreas, colon, etc., can also present as masses in the right upper abdomen. Ultrasound examination helps to distinguish the location and nature of the mass. The alpha-fetoprotein test is usually negative. When differentiation is difficult, laparotomy is required for diagnosis.