What are the commonly used liver cancer diagnosis methods? A complete list of liver cancer diagnosis and examination methods

Primary liver cancer is highly malignant, aggressive, fast-progressing, easy to metastasize, and has a poor prognosis. It is known as the "king of cancers" and is one of the most common malignant tumors in the world, especially in Asia. There are about 750,000 new cases of liver cancer each year, ranking sixth in the incidence of malignant tumors. It mainly occurs in the Pacific coast of Asia and southeastern Africa. There are about 700,000 deaths from liver cancer each year, ranking third in the death rate from malignant tumors, and 80% of them occur in developing countries. my country is a country with a high incidence of liver cancer, with about 400,000 deaths from liver cancer each year, accounting for more than 50% of the total deaths from liver cancer worldwide. The national cause of death monitoring data in 2011 showed that the mortality rate of liver cancer was 23.94/100,000, accounting for 17.5% of the deaths from malignant tumors, ranking second in the death rate from malignant tumors, which seriously endangers the health of the people.

One-third of liver cancer patients can be cured if diagnosed and treated early

The World Health Organization (WHO) clearly points out that among all cancers, about 1/3 of cancers can be prevented through the application of modern medical knowledge and medical technology; about 1/3 of cancers can be cured through early detection, early diagnosis and early treatment; and another 1/3 of cancers can prolong the patient's survival time and alleviate suffering through proper treatment.

Patients with early liver cancer may not have obvious symptoms and signs. Only a few patients experience symptoms such as loss of appetite, upper abdominal distension or fatigue in the short term. When symptoms and signs clearly appear, the disease is mostly in the middle and late stages, and the best treatment period and treatment effect have been lost. The 5-year survival rate of patients who cannot be diagnosed and treated early is usually no more than 10%. Cancer screening and early diagnosis and treatment have been recognized as one of the most effective ways to prevent and control cancer. Many studies have shown that regular screening of high-risk subjects for liver cancer can detect early liver cancer cases, increase the early diagnosis rate, and give patients more chances of cure, thereby prolonging patient survival and improving patient quality of life.

What are the commonly used methods for diagnosing liver cancer?

1. Determination of alpha-fetoprotein (AFp): In the early stage of liver cancer or in the subclinical stage, liver cells secrete a substance called alpha-fetoprotein into the blood. Determining the level of alpha-fetoprotein in the blood is the most sensitive and specific early diagnosis method for liver cancer. However, about 30% of liver cancer patients in my country are AFp-negative, and using AFp alone will miss these patients.

2. Liver function test: The activity of serum transaminase in patients with liver cancer may be increased or normal. Combined with AFp test, it helps to distinguish between liver cancer and common liver disease.

3. Other enzyme tests: Some liver cancer cases may not show elevated AFp. Therefore, other blood enzyme tests should be selected according to the specific situation, such as γ-glutamyl transpeptidase (γ-GT, GGT), decarboxyl prothrombin (DCp), α-L-fucosidase (AFU), serum carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 50 (CA50), etc., for diagnosis and differentiation.

4. Real-time ultrasound imaging (commonly known as B-ultrasound examination): B-ultrasound examination is the most commonly used positioning method. If a "space-occupying" lesion is found that occupies a certain space, liver cancer should be considered first. The accuracy rate of diagnosing liver cancer can reach about 95%, and small liver cancers of 1-2 cm can be detected. It is especially suitable for the diagnosis of AFp-positive or -negative liver cancer.

5. Computed tomography (CT examination for short): CT examination is a routine item for the localization diagnosis of liver cancer. The CT images of liver cancer often show focal areas of reduced density with relatively clear boundaries, or multiple shadows with blurred edges or varying sizes. The positive rate is over 90%.

6. Magnetic resonance imaging (MRI): MRI uses magnetic fields to calibrate the spatial position of the human body surface. Different images can be obtained according to different pulse cycle repetition times and echo delay times. MRI can perform three-dimensional imaging through cross-section, coronal and sagittal planes, and is superior to B-ultrasound and CT examinations in detecting some unique signs of liver cancer, such as fatty degeneration, capsule, peritumoral edema and vascular infiltration.

7. Liver puncture biopsy: Under the guidance of ultrasound or CT, a fine needle is used to puncture nodules in the liver area to aspirate cancerous tissue and examine cancer cells.

The technical plan for early diagnosis and treatment of liver cancer should be "adapted to local conditions"

The technical scheme for early diagnosis and treatment of liver cancer should be determined according to the specific conditions such as local economic conditions and medical conditions. At present, the ideal liver cancer screening scheme is to use AFp and B-ultrasound examination for general screening, which can reduce the missed diagnosis rate. However, due to the large differences in economic conditions, medical personnel configuration, professional and technical level and medical equipment in various parts of my country, especially in rural areas where finances are still relatively difficult, there is still a lack of B-ultrasound doctors and the technical level is not high. Directly using AFp and B-ultrasound examination as a preliminary screening method still has certain difficulties in terms of financial resources, material resources and human resources. Therefore, the technical scheme of first screening out high-risk groups and combining AFp and B-ultrasound for further examination in high-risk groups is in line with my country's national conditions. It can improve the detection rate, reduce costs and improve benefits.

At present, there are two initial screening methods for the large-scale early diagnosis and treatment of liver cancer being implemented in my country: 1. Ministry of Health (Rural) Early Diagnosis and Treatment of Liver Cancer Project: 1. Screening objects: male residents aged 35-64 and female residents aged 45-64 in high-incidence areas. 2. Screening method: Use serum hepatitis B surface antigen (HBsAg) for initial screening, and HBsAg-positive cases are further examined by AFp and B-ultrasound. 2. Ministry of Health (City) Early Diagnosis and Treatment of Liver Cancer Project: 1. Screening objects: residents aged 40-69 in high-incidence areas. 2. Screening method: Use the high-risk population assessment system (including dietary habits, psychology and emotions, past history, family history of tumors, etc.) for initial screening, and cases with positive initial screening are further examined by AFp and B-ultrasound.

Screening interval: Currently, most scholars believe that the interval for liver cancer screening is 6 months; if the screening interval is too short, such as once every 3 months, it will cause excessive psychological burden on the examinee and increase the screening cost.

Comprehensive efforts from multiple parties to promote early diagnosis and treatment of liver cancer

With the development of the times, cancer prevention and treatment must also update concepts and adjust strategies. We must place more emphasis on government leadership, prevention, departmental cooperation, social participation, downward shifting of the focus, and forward shifting of the checkpoints. We must shift from expert behavior to government behavior, from scientific research and clinical treatment to prevention, from high-level to grassroots, and from the health department to the whole society, so as to further promote the early diagnosis and treatment of liver cancer in my country. Among them, government leadership is the prerequisite for early diagnosis and treatment, multi-departmental collaboration is the working mechanism for early diagnosis and treatment, participation of the whole society is the key to early diagnosis and treatment, scientific solutions are the foundation of early diagnosis and treatment, talent development is the guarantee of the quality of early diagnosis and treatment, and people-oriented is the key to sustainable development of work.