Clinical manifestations of primary liver cancer

Primary liver cancer is insidious, with no typical symptoms in the early stages. Most patients who seek medical treatment are in the middle or late stages, which further highlights the importance of early diagnosis and treatment. The main symptoms of patients in the middle or late stages include pain in the liver, gastrointestinal symptoms, fatigue and weight loss, fever, and bleeding tendency. There are also physical signs such as liver enlargement, abdominal mass, jaundice, ascites, etc.

(I) Pain in the right upper abdomen

When they see a doctor, more than half of the patients have pain in the liver area, which is often persistent or dull. This is mostly caused by the gradual growth of liver cancer and the traction of the capsule. If it occurs in the left lobe of the liver, the upper and middle abdomen will be distended and painful at an early stage, invading the diaphragm and involving right shoulder pain. When the cancerous nodules on the surface of the liver rupture, it can suddenly cause severe pain, which then spreads to the whole abdomen, and symptoms and signs of peritonitis appear.

(II) Gastrointestinal symptoms

Poor appetite, nausea, abdominal distension and diarrhea are common symptoms. Poor appetite is often caused by liver damage, tumors compressing the gastrointestinal tract, etc.

(III) Bleeding tendency

Common bleeding tendency includes nose bleeding, gum bleeding, subcutaneous ecchymosis, etc. As liver cancer gradually increases in size, the number of functional liver cells gradually decreases, leading to liver decompensation, or combined with cirrhosis, coagulation disorder, or advanced tumor complicated by disseminated intravascular coagulation (DIC).

(IV) Jaundice and fever

Jaundice is usually a symptom of advanced liver cancer. It can also be caused by biliary cancer thrombus. In advanced patients, tumors can compress the liver and bile ducts, or it can be caused by hepatocellular jaundice. Fever is usually caused by tumor necrosis, combined infection, and tumor metabolites. People without infection usually have fever but no chills. Cancer fever is usually below 38.5°C and rarely reaches above 39°C.

(V) Enlarged liver

Signs such as a right upper abdominal mass, with or without nodules, jaundice, ascites, splenomegaly, and cirrhosis are often late manifestations of liver cancer. Upward displacement of the upper border of the liver, subcostal hepatomegaly, and a subxiphoid mass are often important signs.