What are the general manifestations of liver cancer? Clinical signs and symptoms of liver cancer

Liver cancer is a common malignant tumor in clinical practice. In recent years, the incidence of liver cancer has become younger, which may be largely related to people's bad living habits. The middle and late stages of liver cancer are more difficult to treat, so timely treatment in the early stages is particularly important. Here we mainly introduce the clinical signs and symptoms of liver cancer to facilitate early detection and early treatment.

Early symptoms:

It takes about 2 years for liver cancer to develop from the first cancer cell in the liver to the patient's subjective symptoms. During this period, the patient may not have any symptoms or signs. Only a few patients may experience anorexia, upper abdominal distension, abdominal pain, fatigue, loss of appetite, etc. Some patients may experience mild liver enlargement, jaundice and skin itching. However, in general, these symptoms are difficult to be taken seriously. Therefore, in clinical practice, many liver cancer patients are often in the middle or late stage of their disease when they are discovered.

Symptoms in the middle and late stages:

Typical symptoms and signs of liver cancer generally appear in the middle and late stages, mainly including liver pain, fatigue, weight loss, jaundice, ascites, etc.

1. Pain in the liver area: The most common type is intermittent or persistent dull pain or bloating. The rapid growth of the tumor will tighten the liver capsule and invade the diaphragm, causing pain. The pain may radiate to the right shoulder or right back. A tumor growing toward the right back may cause right waist pain. Sudden onset of severe abdominal pain and peritoneal irritation signs indicates subcapsular bleeding of the cancerous nodule or rupture into the abdominal cavity.

2. Gastrointestinal symptoms: loss of appetite, indigestion, nausea, vomiting and diarrhea are easily overlooked due to their lack of specificity.

3. Fatigue, weight loss, general weakness, and a few patients in the late stage may develop cachexia.

4. Fever: Generally low-grade fever, occasionally reaching above 39°C, with persistent fever, low-grade fever in the afternoon, or high fever of the remittent type. Fever is related to the absorption of necrotic products of the tumor. Compression or invasion of the bile duct by the tumor may lead to biliary infection.

5. Symptoms of metastatic lesions: There are corresponding symptoms at the place where the tumor metastasizes, which sometimes become the first symptoms of liver cancer. For example, metastasis to the lungs can cause coughing and hemoptysis; pleural metastasis can cause chest pain and bloody pleural effusion; cancer thrombus blocking the pulmonary artery or branches can cause pulmonary infarction, causing patients to have severe breathing difficulties and chest pain; cancer thrombus blocking the inferior vena cava can cause severe edema of the lower limbs and even a drop in blood pressure; blocking the hepatic vein can cause Budd-Chiari syndrome and lower limb edema; metastasis to the bones can cause local pain or pathological fractures; metastasis to the spine or compression of the spinal nerves can cause local pain and paraplegia; intracranial metastasis can cause corresponding localization symptoms and signs, such as intracranial hypertension. Intracranial hypertension can cause brain herniation and cause death of patients.

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, which sometimes appear before the symptoms of liver cancer itself. Common ones include: ⑴ Spontaneous hypoglycemia: 10-30% of patients may experience this disease due to the ectopic secretion of insulin or insulin-like substances by liver cells, the inhibition of insulinase secretion by tumors or the secretion of a pancreatic β-cell stimulating factor, excessive glycogen storage, and excessive glucose consumption by liver cancer tissue. In severe cases, coma, shock, and subsequent death may occur. If doctors can correctly judge and promptly provide symptomatic treatment to patients, their deaths can be effectively avoided.

⑵ Polycythemia: It may occur in 2% to 10% of patients. This symptom may be caused by the increase of erythropoietin in the circulation system.

⑶ Other rare symptoms include hyperlipidemia, hypercalcemia, carcinoid syndrome, early sexual onset and gonadotropin secretion syndrome, cutaneous porphyria and dysfibrinogenemia, etc. The initiation of these symptoms may be related to the abnormal protein synthesis, ectopic endocrine secretion of liver cancer tissue and the disorder of porphyrin metabolism in the liver.

7. Paraneoplastic syndrome: Since tumor metabolism itself is a metabolic abnormality, it will affect the normal metabolism of the body, thus leading to endocrine or metabolic abnormalities. The syndrome related to this is called paraneoplastic syndrome. Hypoglycemia and polycythemia are more common in this syndrome, while others such as hyperlipidemia, hypercalcemia, precocious puberty, gonadotropin secretion syndrome, carcinoid syndrome, etc. are relatively rare.

8. Signs of liver cancer - jaundice. Jaundice is a common sign of advanced liver cancer. Diffuse liver cancer and cholangiocarcinoma are most likely to cause jaundice. Jaundice is mostly caused by compression of the bile duct or invasion of the bile duct by cancer, which causes bile duct obstruction. It can also be caused by compression of the bile duct by enlarged lymph nodes metastasized from the liver hilum. In a few cases, liver cancer tissue grows into the bile duct and blocks it, which in turn causes obstructive jaundice.

Liver cancer may invade the bile duct in the following ways: the tumor directly infiltrates the intrahepatic bile duct; cancer cells invade the veins or lymphatic vessels and retrogradely invade the bile duct; tumor cells invade the bile duct along the gaps between nerve endings. After the tumor cells enter the intrahepatic bile duct, they continue to grow and block the common bile duct, or the detached mass enters the extrahepatic bile duct and causes blockage. When the tumor blocks one side of the bile duct and causes jaundice, the patient may experience itchy skin, intermittent clay-colored stools, and decreased appetite. A small number of patients may experience right upper abdominal colic, chills, fever, and jaundice. Very few patients may develop severe cholangitis. It is not uncommon for patients with liver cancer to have obstructive jaundice, but there is nothing special about their clinical manifestations, so the misdiagnosis rate is high in clinical practice (up to 75%). When patients with chronic liver disease develop obstructive jaundice, the possibility of liver cancer should be considered. Jaundice in some patients may also be caused by damaged liver function. This type of jaundice can be relieved to a certain extent after liver protection treatment. However, jaundice caused by cancer is not effective through conventional liver protection treatment or jaundice-relieving treatment.

Liver cancer is common in my country, with more than 100,000 people dying from it every year. This is enough to attract our attention. It is recommended to have a physical examination once or twice a year to help detect any adverse malignant changes early. The clinical signs and symptoms of liver cancer introduced here are hopefully helpful in recognizing the disease.