5 clinical symptoms of liver cancer The most commonly used liver cancer examination method by doctors

Common cancer diseases include stomach cancer, intestinal cancer and other physical diseases. In addition to these, we also need to pay attention to a terrible disease - liver cancer. Do you know how to check for liver cancer?

In recent years, the incidence of various malignant tumors has shown an upward trend, and everyone has generally strengthened their awareness of health. Regular physical examinations once a year are essential. However, once a physical examination finds shadows on the liver or liver nodules, does it mean that you have liver cancer? It's stressful! You can't eat well and sleep well. Here I will analyze which examination methods can help doctors diagnose liver malignant tumors at an early stage.

How to check for liver cancer

1. Ask about medical history:

In fact, many people overlook this point. Detailed medical history is very important for the diagnosis of any disease. Perhaps one sentence can remind the doctor. The liver cancer I am talking about here refers to primary liver cancer. Liver cancer is highly prevalent in specific populations, mainly including chronic hepatitis B (HBV)/hepatitis C (HCV) virus infection, long-term heavy drinking (especially alcoholic cirrhosis), smoking, severe fatty liver, family history of liver cancer, etc. Such people are at high risk of liver cancer and should have a full body check-up at least once every six months, including tumor screening.

2. Blood biochemical examination:

It is mainly used to evaluate liver function, especially when combined with cirrhosis. Doctors can judge the liver's reserve function through indicators such as bilirubin (TBIL), albumin (ALB), and abnormal coagulation function (pTA). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which are commonly referred to as liver function, are actually inflammatory indicators that reflect damage to liver cells. In addition, increased alkaline phosphatase (ALp), lactate dehydrogenase (LDH), and glucagon-transferase (GGT) are related to cholestasis, but may also be related to liver tumors.

3. Tumor marker examination:

1) Alpha-fetoprotein (AFp): It is the main tumor marker for diagnosing liver cancer. If AFp is greater than 400ng/mL, after excluding pregnancy and gonadal embryonic tumors, one should be highly alert to the occurrence of liver cancer and need to be diagnosed as soon as possible with imaging examinations; if AFp is only slightly elevated, it is generally recommended to have regular follow-up examinations; once AFp increases rapidly and progressively in a short period of time (2-3 months), one should go to the hospital for further examination as soon as possible. However, it is particularly important to note that even if AFp is not high, it cannot completely rule out the possibility of liver cancer.

2) Carbohydrate antigen 19-9 (CA19-9): The positive rate is higher in pancreatic cancer, gallbladder and bile duct cancer, and may also be elevated in some liver cancers, especially in intrahepatic cholangiocarcinoma.

3) Carcinoembryonic antigen (CEA): Elevated CEA is mainly seen in digestive tract malignancies such as colorectal cancer and gastric cancer. However, considering that colorectal cancer is prone to liver metastasis (with a probability of about 50%), if elevated CEA is found and there are shadows in the liver during physical examination, it is necessary to be alert to the greater possibility of metastatic liver cancer.

4. Imaging examination:

1) Abdominal ultrasound: Ultrasound examination is a non-invasive examination that has no adverse effects on human tissues and can be repeated many times. The cost is relatively low and the detection rate of liver lesions is relatively high. It is the preferred examination method for screening liver cancer in high-risk groups. In addition, ultrasound angiography can further improve the accuracy of diagnosis. Ultrasound-guided puncture biopsy can directly obtain histological diagnosis. Ultrasound during surgery can also help our surgeons find tiny lesions and conduct targeted treatment. Ultrasound is also used for regular follow-up after liver cancer treatment. However, ultrasound has limitations for smaller lesions, or lesions located near the top of the diaphragm or behind the ribs, and it is not easy to find lesions.

2) Enhanced CT examination: Enhanced CT is undoubtedly one of the most important examination methods for diagnosing liver cancer and distinguishing from other liver lesions, but I would like to remind you that you must do enhanced CT, that is, inject contrast agent into the vein before doing the examination. Otherwise, CT without contrast agent enhancement is sometimes even worse than ultrasound examination. I believe that many people will worry about contrast agent allergy or drug toxicity when doing enhanced CT. I can tell you here with confidence that under normal circumstances, the probability of contrast agent causing allergy is very low. Only people with severe allergies and combined renal impairment are contraindicated. Therefore, enhanced CT examination should be used as a routine examination for diagnosing liver cancer. In addition, through image analysis software, surgeons can also reconstruct various ducts (blood vessels, bile ducts) in the liver, simulate surgical resection before surgery, design surgical plans, and calculate the volume of pre-resection and remaining liver, which greatly improves surgical safety.

3) MRI examination: MRI has gradually surpassed enhanced CT examination in the diagnosis of liver space-occupying lesions, especially in the diagnosis of fatty liver, liver cirrhosis combined with liver cancer, atypical liver nodules, and smaller liver cancer lesions. In our hospital, enhanced MRI has been used as a routine examination method for liver cancer. MRI has higher tissue resolution, and enhanced scanning can more clearly understand the blood supply of the tumor. The disadvantage of MRI examination is that the examination time is longer than CT, there is noise, and it is not suitable for the presence of metal objects in the body.

4) Selective angiography (DSA): This is an invasive examination. First, the femoral artery at the base of the thigh is punctured, and then a very thin tube is inserted through the femoral artery, the abdominal aorta, and all the way to the hepatic artery. Some contrast agents are injected to show the tumor and blood vessels. In the past, DSA played a decisive role in the diagnosis of unclear liver lesions, but with the advancement of CT and MR enhanced scanning, the value of DSA is no longer diagnosis, but to treat liver cancer lesions through transarterial chemotherapy and embolization (TACE), which is usually called interventional therapy. Vascular embolic agents and anti-tumor drugs are directly injected into the tumor blood vessels through the hepatic artery, with fewer side effects.

5) pET-CT: pET-CT is not as sensitive to liver cancer itself as the previous tests, but it is very sensitive to metastatic cancer. It is generally suitable for comprehensive assessment of extrahepatic metastatic lesions such as lymph node metastasis, bone metastasis, and lung metastasis when liver cancer has been confirmed or recurred. However, it is expensive and is generally not used as a routine examination method, let alone recommended as a health examination item. pET-CT also causes relatively large radiation damage to the human body.

5. Pathological examination:

When all imaging data cannot help doctors make a diagnosis, or when the nature of liver lesions needs to be clarified before starting treatment, pathological examination is still the gold standard for diagnosing malignant tumors. Surgeons can use ultrasound to guide percutaneous fine needle biopsy, or take biopsies under direct vision or ultrasound guidance under laparoscopy to take a small amount of tumor tissue for pathological examination, which is an invasive examination. Although pathological examination is the gold standard, there is a possibility that too little tissue can be punctured to make a diagnosis, or that the tumor is not punctured, resulting in a negative pathological examination result.

Symptoms of Liver Cancer

1. Weight loss and fatigue

This symptom often occurs in the middle and late stages of liver cancer. It may be that tumor metabolites cause changes in the body's biochemical metabolism, reduce food intake, and in severe cases, cachexia

2. Fever

The fever caused by liver cancer is generally around 37.5'C~38℃, occasionally reaching above 39℃, with irregular fever pattern, often without chills. Fever is more common in the afternoon, and sometimes remittent high fever can also be seen. Fever can be caused by tumor necrosis or its metabolites.

3. Digestive tract symptoms

Common symptoms include decreased appetite, upper abdominal fullness after meals, or even nausea, vomiting or diarrhea.

4. Pain

This is a common symptom in patients with liver cancer. The pain is generally located in the liver area. The liver pain in patients with mid-to-late stage liver cancer is generally located in the right rib or under the xiphoid process. The nature of the pain is mostly persistent dull pain, or stabbing pain. A small number of patients may have special manifestations of pain. Patients with liver cancer may also have referred pain in other parts of the body. The pain area of ​​some patients is located in the upper and middle abdomen, which is mostly caused by left lobe liver cancer, but sometimes it is misdiagnosed as stomach disease and delayed treatment. Some patients may experience right shoulder pain.

Clinically, it is more common in tumors near the diaphragm in the right lobe. Because it affects the diaphragm, it causes referred pain in the right shoulder, which is easily misdiagnosed as frozen shoulder. When liver cancer metastasizes to other parts, symptoms of metastatic lesions will appear. Metastasis to the lungs may cause chest pain; metastasis to the bones may cause bone pain, etc. Therefore, when liver cancer patients experience chest pain or bone pain, it should be considered that it is caused by liver cancer metastasis.

Clinically, a small number of patients may experience sudden severe pain in the liver area, which is mostly caused by rupture and bleeding of cancerous nodules located on the surface of the liver. If the patient is also accompanied by dizziness, blurred vision, palpitations, and low blood pressure, it mostly indicates that the cancerous nodule has ruptured and is complicated by severe internal bleeding. If this happens, emergency rescue should be carried out in time.

5. Other symptoms

People with hepatitis, cirrhosis or infiltrative tumor growth that causes liver decompensation may have a tendency to bleed, such as nosebleeds, gum and subcutaneous ecchymoses, etc.; they may also have hypoproteinemia, leading to edema, ascites, abdominal distension, etc. (Reference website: 39 Health Network)