What are the symptoms of primary liver cancer? Can B-ultrasound detect liver cancer?

Liver cancer is divided into two types: primary liver cancer and secondary liver cancer. Secondary liver cancer is caused by the metastasis of cancer cells of primary liver cancer. The onset of primary liver cancer is often hidden. Liver cancer is often discovered accidentally during follow-up of liver disease or physical examination using AFp and B-type ultrasound. At this time, the patient has no symptoms and lacks physical signs of the tumor itself during physical examination. This stage is called subclinical liver cancer. Once symptoms appear, the patient who comes to the doctor has mostly entered the middle and late stages of the disease. The clinical manifestations of liver cancer at different stages are significantly different.

Symptoms of Liver Cancer

1. Pain in the liver area: The most common type is intermittent, persistent dull pain or distending pain. This is caused by the rapid growth of the cancer, which tightens the liver capsule. The tumor invades the diaphragm. The pain may radiate to the right shoulder or right back. A tumor growing to the right back may cause right waist pain. 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 are easily overlooked due to their lack of specificity.

3. Fatigue, weight loss, general weakness, and cachexia in late stage patients

4. Fever: Generally, it is a low-grade fever that can reach above 39°C and is continuous or occurs in the afternoon. It can also be a remittent high-grade fever. Fever is related to the absorption of necrotic products of the tumor. Tumors compress or invade the bile duct and may cause biliary infection.

5. Symptoms of metastasis: There are corresponding symptoms at the place where the tumor metastasizes, which sometimes become the initial symptoms of liver cancer. For example, metastasis to the lungs may cause coughing and hemoptysis. Pleural metastasis may cause chest pain and bloody pleural effusion. Cancer embolism to the pulmonary artery or branches may cause pulmonary infarction, which may cause sudden severe dyspnea and chest pain. 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. Intracranial hypertension may also lead to brain herniation and sudden death.

6 Other systemic symptoms: Endocrine or metabolic syndromes caused by abnormal metabolism of the tumor itself or various effects of cancer tissue on the body are called paraneoplastic syndromes. Sometimes they may precede the symptoms of liver cancer itself. Common symptoms include:

⑴ Spontaneous hypoglycemia: 10-30% of patients may experience it because liver cells can ectopically secrete insulin or insulin-like substances; or the tumor inhibits insulinase or secretes a pancreatic β-cell stimulating factor or there is excessive glycogen storage; it can also be caused by excessive glucose consumption by liver cancer tissue. Severe cases of this disease can cause coma, shock and death. Correct judgment and timely symptomatic treatment can save the patient from death.

⑵ Polycythemia: 2-10% of patients may experience polycythemia vera, which may be caused by increased circulating erythropoietin.

⑶ Other rare diseases include hyperlipidemia, hypercalcemia, carcinoid syndrome, early and gonadotropin-secreting syndrome, cutaneous porphyria and dysfibrinogenemia, which may be related to abnormal protein synthesis, ectopic endocrine secretion and porphyrin metabolism disorders in liver cancer tissue.

Primary liver cancer is one of the most common malignant tumors in my country. Commonly used imaging examination methods in clinical practice include B-type ultrasound, CT, magnetic resonance imaging, selective celiac artery or hepatic artery angiography, radionuclide liver scanning and X-ray examination.

1. Ultrasound examination

B-mode ultrasound is a non-invasive examination method with a diagnostic accuracy rate of about 90% for primary liver cancer, and can be used as a screening tool for high-risk populations.

2. CT examination

CT has a high resolution, and the diagnostic accuracy rate for primary liver cancer is higher than 90%. Dynamic enhanced scanning can improve the resolution and help differentiate it from hemangioma. Combining CT dynamic scanning with arterial angiography can improve the detection rate of tiny cancer foci.

3. Magnetic resonance imaging

The advantage of magnetic resonance imaging (MRI) examination is that it can reconstruct images of the hepatic vein, portal vein, inferior vena cava, and bile duct, and can show tumor thrombi in some ductal lumens.

4. Selective celiac artery or hepatic artery angiography

Selective celiac artery or hepatic artery angiography is an invasive examination method, which is mostly used to examine tiny cancer lesions that are difficult to detect. The detection rate for cancer lesions <2 cm can reach 90%.

5. Radionuclide liver scan

Radionuclide liver scanning is usually performed with 198gold, 99mtechnetium, 131iodine rose bengal, 113mindium, etc., which is helpful in the diagnosis of large liver cancer.

6. X-ray examination

X-ray films may show enlarged liver shadows. If the primary liver cancer occurs in the right lobe of the liver, the right diaphragm may be seen to be elevated or locally bulging. If the liver cancer is located in the left lobe of the liver or is huge, the stomach or transverse colon may be pushed.

What should patients with primary liver cancer pay attention to in their diet?

1. Daily diet should be regular, quantitative, and small and frequent meals to reduce the burden on the gastrointestinal tract.

2 Eat more foods containing vitamins A, C, and E, and eat more green vegetables and fruits.

3 Eat foods that have anti-cancer effects regularly, such as kale, cabbage, carrots, rapeseed, vegetable oil, fish, etc.

4. Stick to low-fat, high-protein and easily digestible foods, such as lean meat, eggs, yogurt, fresh fruit juice and fresh vegetable juice.

5. Eat fresh food and avoid eating moldy or spoiled food.

6. To keep bowel movements smooth, constipation patients should eat foods rich in fiber and drink some honey every day.

7 The main foods should include: milk, eggs, soy milk, lotus root powder, fruit juice, vegetable juice, lean meat paste, liver paste, etc.