How to differentiate primary liver cancer? The diagnosis of primary liver cancer mainly depends on these 6 points

Differential diagnosis of primary liver cancer: Primary liver cancer often needs to be differentiated from secondary liver cancer, cirrhosis, active liver disease, liver abscess, etc.

1. Secondary liver cancer originates from the gastrointestinal tract, respiratory tract, urogenital tract, breast, etc. and often metastasizes to the liver. Compared with primary liver cancer, this type of secondary liver cancer progresses more slowly and has milder symptoms. AFp detection is generally negative except for a few cases of primary cancer in the digestive tract. A few secondary liver cancers are difficult to distinguish from the primary ones. The key to diagnosis lies in pathological examination and finding evidence of extrahepatic primary cancer.

2. Primary liver cancer often occurs on the basis of liver cirrhosis, and it is often difficult to distinguish between the two. If a case of liver cirrhosis has obvious enlarged liver, large hard nodules, or liver atrophy and deformation and imaging examinations also find space-occupying lesions, then the possibility of liver cancer is very high. Repeated testing of AFp or AFp heterogeneity and close follow-up of the condition can eventually make a correct diagnosis.

3. Liver abscesses generally have obvious clinical manifestations of inflammation, such as fever. The surface of the enlarged liver is smooth and free of nodules, and tenderness is obvious. The pleural wall adjacent to the abscess is often edematous, the right upper abdominal muscles are tense, and the white blood cell count is elevated. Ultrasound examination can detect liquid dark areas in the liver. However, when the pus is thick and liquid dark areas have not yet formed, diagnosis is quite difficult. Ultrasound examinations should be repeated, and diagnostic punctures should be performed under ultrasound guidance when necessary. Anti-infective drugs can also be used for experimental treatment.

4. Extrahepatic tumors adjacent to the liver. Retroperitoneal soft tissue tumors, tumors from the kidney, adrenal gland, pancreas, colon, etc. can also present as abdominal masses in the upper abdomen, causing confusion. Ultrasound examination helps to distinguish the location and nature of the mass. AFp test should be negative. When differentiation is difficult, laparotomy is required for diagnosis.

5. Non-cancerous space-occupying lesions of the liver, such as focal nodular hyperplasia such as hepatic hemangioma, polycystic liver, echinococcosis, and benign space-occupying lesions of the liver such as inflammatory pseudotumor, can be diagnosed with the help of CT, MRI, and color Doppler ultrasound examinations, and sometimes laparotomy is required for confirmation.

6. Active liver disease (acute hepatitis, chronic hepatitis) When liver disease is active, serum AFp often increases in the short term, indicating the possibility of liver cancer. Regular follow-up should be performed to measure serum AFp and ALT or to jointly check AFp isomers and other liver cancer markers and analyze them. For example: ① If ALT continues to increase to several times the normal level, and the dynamic curves of AFp and ALT are parallel or increase synchronously, then the possibility of active liver disease is high; ② If the two curves are separated, AFp increases while ALT is normal or decreases from high, primary liver cancer should be considered.