What aspects of liver cancer examination should be done? Complete liver cancer examination methods

The incidence of primary liver cancer ranks fifth among malignant tumors. Due to its high malignancy and short survival period of patients, it is highly valued by the medical community.

At present, although the clinic attaches great importance to the regular monitoring of patients with liver diseases such as hepatitis and cirrhosis, we should also note that there are many cases where patients with benign intrahepatic space-occupying lesions are misdiagnosed as primary liver cancer. Some patients are also wrongly treated with interventional treatment, chemotherapy, liver resection, liver transplantation, etc. due to misdiagnosis. This not only causes serious damage to the physical and mental health of patients, but also causes them to suffer significant economic losses.

So, what examinations should liver cancer patients undergo?

1. Detection of tumor markers: Tumor markers are substances produced and released by cancer cells, existing in tumor cells or in the patient's body fluids, such as alpha-fetoprotein (AFp) (for liver cancer, alpha-fetoprotein is still the most specific marker and the main indicator for diagnosing liver cancer), r-GT2, Ap, AFU, etc.

2. Ultrasound imaging: It has been widely used in the screening of liver cancer and is conducive to early diagnosis.

3. Computerized tomography (CT): Among various imaging examinations, CT can best reflect the pathological morphology of the liver, such as the size, shape, location, number of lesions, and the presence or absence of hemorrhage and necrosis within the lesions. The invasiveness of the lesions can be understood from the edge of the lesions, and the invasion of the portal vein can be understood from the cancer thrombus and invasion of the portal vein. CT is considered to be the preferred non-invasive diagnostic method to supplement ultrasound imaging to estimate the scope of the lesion. CT is currently the best method for diagnosing small liver cancer and micro liver cancer.

4. Magnetic resonance imaging (MRI): It can clearly show the internal structural characteristics of hepatocellular carcinoma and is valuable in showing sub-tumors and tumor thrombi.

5. X-ray hepatic angiography: often used to diagnose small hepatocellular carcinoma.

6. Radionuclide liver imaging

7. Liver tissue biopsy or cytology examination: In recent years, biopsy or fine needle aspiration under the guidance of real-time ultrasound or CT for histological or cytological examination is an effective method for confirming small hepatocellular carcinoma with a diameter of less than 2 cm.

Liver function tests for liver cancer patients

It helps to understand the severity of liver damage and choose a reasonable treatment plan; it assists in the diagnosis and differential diagnosis of liver cancer; it is used to predict whether the cancer will recur after surgical resection, as well as to judge the prognosis. Liver function tests commonly used in clinical practice mainly include bilirubin metabolism, protein metabolism, enzyme metabolism and dye excretion tests. Specific items include serum bilirubin, albumin/globulin, protein electrophoresis, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GT), prothrombin time, etc.

1. Bilirubin: Elevated serum bilirubin often indicates active liver disease, obstructive jaundice or advanced stage of the disease. Patients with total bilirubin>30μmol/L should not undergo surgery; patients with total bilirubin>20μmol/L should be cautious when undergoing large liver cancer resection.

2. The absolute value of albumin reflects the total number of effective hepatocytes, which is clearly exposed when the liver is chronically and severely damaged. The normal value of albumin is 35-55g/L. If it is less than 30g/L, it is not suitable for major surgical resection. The normal white/globulin ratio is 1.5-2.5. An inverted white/globulin ratio reflects liver decompensation and difficulty in enduring major surgery.

3. Alanine aminotransferase (ALT) Abnormal ALT often reflects damage to liver parenchymal cells or massive necrosis of the tumor. ALT levels in tumor patients are significantly elevated, and the surgical mortality rate is also significantly increased.

4. γ-glutamate transpeptidase (γ-GT) When liver cancer is huge and there are extensive tumor thrombi in the portal vein, and liver function is abnormal, γ-GT is significantly elevated, which has a great impact on surgery or prognosis.

5. Prothrombin time (pT) A significant prolongation of pT indicates severe liver damage and a poor prognosis. Surgery is not recommended when pT is 50% lower than the normal value.

Which groups of people should undergo regular checkups? This depends on the cause of liver cancer.

1. Patients with liver cirrhosis are at high risk of liver cancer

Globally, about 70% of primary liver cancer occurs on the basis of cirrhosis. Studies have found that about 9.9%-16.6% (the highest reported rate is 51.1%) of patients with cirrhosis will eventually develop primary liver cancer.

2. Viral hepatitis is closely related to liver cancer

So far, the hepatitis viruses that have a clear relationship with primary liver cancer include hepatitis B, C and D. In my country, hepatitis B virus is most closely related to liver cancer, and the hepatitis B virus infection rate in liver cancer patients is about 90%.

3. Living environment and lifestyle are closely related to liver cancer

People in areas with a high incidence of liver cancer (such as Qidong, Jiangsu and Fusui, Guangxi) should undergo regular targeted examinations, preferably once a year, due to the influence of environmental factors (such as drinking mainly stagnant water or surface water, or soil lacking selenium, high in copper, high in zinc, or high in molybdenum, or eating foods high in nitrite).

4. Age is an important factor

The high-risk age for liver cancer is around 40-60 years old (even lower in high-risk areas), and the male-to-female ratio is about 5.9 to 1. In addition, people with a family history of liver cancer should also be highly vigilant and undergo regular examinations.