Liver Cancer - Causes, Symptoms and Treatment .MF .
liver cancer - a malignant liver tumor that develops from its structure under the influence of a variety of reasons, causing disruption of the body and, if left untreated, leads to death of the patient.The proportion of liver cancer in the total mass of cancer patients is gradually increasing in the first place this is due to the rising incidence of chronic forms of viral hepatitis.Not everyone hepatitis becomes chronic, usually the proportion of cases is about 5 to 15%, but among them the most part - it is virus carriers who do not have clinical signs of disease.
Causes of liver cancer
A direct connection between the development of liver cancer with chronic hepatitis B, especially B, C and D, as well as asymptomatic carriage of the virus.Cancer develops gradually over a period of at least 20 years or more after infection with hepatitis after step process is cirrhosis.Several times the men get sick more often.Much faster cancer occurs at a combination of several forms of hepatitis (B and C, C and D,
Another cause of liver cancer is chronic alcoholic hepatitis and its outcome - alcoholic cirrhosis.
in recent times has been found between the development of liver cancer to metabolic products of certain fungi (Aspergillus) - aflatoxin.Fungi affect rice, wheat, nuts, as well as contained in the meat of domestic animals, eating contaminated food.Aflatoxin strong poison.The risk of developing liver cancer increased more than 7 times by eating contaminated food.Most often, the fungus is found in Africa and China.
The origin of these liver tumors as cholangiocarcinoma, the leading role belongs to parasites - flat worms trematodes.A person infected with helminths Eating poorly processed fish.Often the disease is found in the coastal areas of the Russian Federation, Kazakhstan, China, Thailand.The parasite is located directly in the bile ducts of the sick person, constantly feeding the bile, the liver blood, releasing waste products, irritants and causing inflammation of the bile ducts.Over time this leads to the development of tumors of the bile ducts.
Liver cancer is of two types:
- cholangiocarcinoma - of the bile ducts;
- hepatocellular carcinoma - directly from the liver cells (hepatocytes, from the Latin "gepar" - liver).
In addition, the liver can be affected by secondary tumors (metastases).Metastases - a primary screenings of other organ tumors (for example breast, colon, lung, ORL - organs, prostate, etc.) having the structure of the original tumor and capable of growing, disrupting the function of the liver.In some cases, metastases can reach huge sizes (10 cm) and lead to the death of patients by poisoning food tumor life and work of the liver (liver failure).In most cases metastases arise from colorectal cancer, which is associated with the specific outflow of blood from that body: whole blood from the abdominal primarily to the liver as a natural filter, since this body is very small and highly developed vascular network of the tumor cellsdeposited in it from the bloodstream and begin to grow, forming a colony - metastasis.The liver can metastasize malignancy of any organ.
liver cancer, liver cancer specific symptoms do not have, so they are often confused with other, non-specific diseases of the body (cholelithiasis, cholecystitis, cholangitis), or exacerbation of chronic process (eg, hepatitis B), these patients are treated for a long time and,often detect the disease is a late stage.Clinical changes appear only when the tumor reaches a significant size or presses on nearby structures.The first signs may not pay attention to the patients: causeless weakness, fatigue, weight loss, loss of appetite, changes in stool: the tendency to diarrhea, as well as a nagging pain in the right upper quadrant.Pain may be associated with tumor growth, as a consequence - stretching of the liver capsule in which there is a lot of nerve endings, as well as with the increase in size of the body when multiple lesions or accession inflammation.
With the progression of the disease is a disturbance of hepatic function: recycling of bile and allocate it to the intestine, which leads to a change in color of the skin - jaundice, until the bright yellow color, mucous membranes (oral, whites of the eyes), joining the permanent pruritus, dry skinand mucous membranes, occurrence of defecation disorders.May include the rises in body temperature of small (37.5 C) to high numbers (39 C), which acquire a permanent character.Visual inspection of such patients can detect an increase in the lower edge of the liver, his bulging from under the costal arc, painful, and in some cases, the tumor itself, which has the form of a large, dense, hilly and stationary part.
Both photographs show the remote tumor liver nodes (on a cut)
To identify are liver tumors leading a number of studies:
1) ultrasound of the abdominal cavity - it can be suspected malignant nature of the tumor, determine its size,structure and the presence of metastases in nearby lymph nodes.
2) The next step after the ultrasound is spiral computed tomography of the abdomen with contrast or nuclear magnetic resonance imaging (MRI).It gives an idea of the exact size of the tumor, the possibilities of its surgical removal, presence of metastases, as well as fairly reliably confirms the nature of the malignancy.
Computed tomography of the liver-tumor sites are indicated by arrows
Computer picture of liver metastasis in the right lobe
3) Next, as a rule, made a puncture of the tumor: under local anesthesia thick needle is performed skin puncture andunder ultrasound needle is inserted into the tumor, taken a small piece of tissue for histological examination.This is done in order to confirm the malignant nature of the tumor and to determine accurately its form.
4) Perform other general clinical research: complete blood count, urinalysis, blood from a vein.The latter is the most important: giving a presentation on liver function and its reserves: the level of bilirubin, specific enzymes (AST, ALT), proteins, and other indicators.Knowing it is necessary to plan the operation, the operation to take the patient to the very high levels of the past can not be - a high risk of complications.
5) In the case of liver cancer can give some clue so-called tumor markers-specific proteins that are produced by the tumor in large quantities, measuring their levels can confirm or deny this or that swelling of the body.Specific liver alfafetoprotein- is a protein found in blood during early childhood, it is absent in adults and significantly elevated in liver cancer.
treatment of liver cancer liver cancer treated only by surgery: as with any cancer, the hope for a cure can only complete tumor removal.Operations performed on the liver in large surgical clinics, they are quite difficult and traumatic.In malignant tumors as well as metastases often performed liver resections: tumor removal of diseased liver lobe, i.e., in some cases - half of the body.The liver has the ability to quickly restore their original size, and within half a year the mass of the remaining share is close to the original.
liver View after removing
tumor nodules If unable to remove the body of the solution to the problem could be a liver transplant.
Other treatments of tumors, such as chemotherapy or radiation therapy, is almost not used as a liver cancer is not sensitive to almost all of the known anticancer drugs, as well as to radiation.Drug therapy is possible only in a very small group of patients (absence of cirrhosis, low levels of bilirubin), although survival is not significantly affected.Recently, some promise of drug therapy of hepatocellular carcinoma associated with the appearance of the drug Nexavar (sorafenib), initially registered for the treatment of metastatic renal cell carcinoma, and in September 2008 - and for the treatment of HCC.
If the tumor can not be removed: it is very large and is situated close to major vessels or their set, and they occupy both lobes of the liver, is used restorative treatment designed to alleviate the patient's condition and prolong its life in the best possible conditions: nutrition, introductionintravenous nutrient, vitamin, analgesic, and so on.
The major research centers used the introduction of chemotherapy directly into the large vessels near a tumor, this is done in order to reduce the swelling in size as much as possible sparing the whole body, that is, the impact on the tumor itself.In some cases, this leads to a prolongation of life of patients.
Without treatment, liver cancer very quickly leads to the death of patients.
As a subsidiary, restorative treatment, if you wish, you can use a variety of drugs vitamins and herbal teas (chamomile, yarrow, sea buckthorn), which have a local anti-inflammatory and wound-healing effect.Do not use cholagogue preparations, they are forced to strain an already sick liver.It is strictly forbidden during the treatment to use folk remedies, such as tincture of mushroom, hemlock, celandine and other poisonous substances!All of them have a pronounced toxic effect and poison the body's defenses that undermined oncological disease, further aggravating the patient's condition.
Possible complications of liver cancer can be:
- fester and decay of the tumor (fever, abdominal pain, weakness, refusal to eat, signs on US suppuration);
- bleeding from the tumor, in some cases leading to death of the patients;
- prevents the outflow of bile as a result of the overlap of large tumors of the bile ducts and, as a consequence, the development of jaundice food poisoning organism destruction of bile acids;
- obstruction to outflow of blood from the abdominal organs due to compression of the tumor of the large vessels of the abdomen and, as a consequence, an accumulation of fluid in the abdomen - ascites.
Forecasts and survival in liver cancer.
incidence of liver cancer is 0.7% of all cancers.The high incidence in Africa, where more than 50% of the population are infected with the hepatitis C virus and B, including liver cancer is about 50% tumor pathology.2 times more common in men, the average age of cases - 50 years.Most affected the right lobe of the liver in 5-13% of cases of liver damage is bilateral.
Liver cancer ranks 5th on the frequency of occurrence in men and 8 women place among all tumor pathology.In Russia, the incidence is 4,7 to 5 persons per 100 thousand population and is gradually reduced.The immediate cause of the development of tumors pecheni- virus infection of hepatitis C and B, they are found in 80% of patients.
Approximately 60-90% of cancer occurs amid cirrhosis, cancer that develops in 5% of patients with cirrhosis.Approximately 1/3 of the patients with liver cancer is subject to the operation.
liver cancer may be a primary (about 25%) or metastatic (about 75%).Among the latter, the most common - metastasized colon cancer (50%).Among these patients, the operation should only be not more than 10%.The number of patients with metastasis of other tumors to the liver (breast, stomach, lung, etc.) are subject to surgical treatment, even less - no more than 5%.
on the prognosis of liver tumors is influenced by such factors as the number and size of tumor nodules, the presence of intra-organ metastases (in the liver itself), the volume of operations, the characteristics of the tumor itself (the presence of the capsule, the increase in liver blood vessels), a history of viral hepatitis, the extent of collateralcirrhosis or no.For example: it is proved that the survival is inversely proportional to the volume of the operation: the small minimally invasive interventions, the results are much better than when you remove half the liver.Depending on the number of liver tumor nodules in the results can be different: for a single tumor site survives about 40- 52%, with two nodes - 31- 38%, 12-18% over three survived for 5 years patients.When HCC recurrence within 5 years may be up to 70% of patients.
But even with a favorable outcome of surgery for liver cancer survival rate is less than 40%.
Prevention of liver cancer
Prevention of liver cancer is in compliance with the principles of a healthy way of life: giving up alcohol, preventive vaccination against hepatitis B. Hepatitis infection - compliance with all the requirements of the attending physician, sparing regimen and diet, as well as the use of special drugs,designed to destroy the virus, ie the creation of maximal conditions to ensure recovery of the patient.Patients who still carry the virus and hepatitis have periodic flare-must constantly monitor liver function regularly for tests, perform the ultrasound examination and, if necessary, and a CT scan of the abdomen.
Consultation of the oncologist on liver cancer:
1. Cirrhosis of the liver - it's cancer?
No cirrhosis - a chronic disease, which is the outcome of the current long-term inflammation in the body (viral or alcoholic nature).Patients with cirrhosis may live for many years, they are at risk of developing liver cancer.
2. Are liver transplantation in cancer?
Yes, in some cases, even when the patient is suffering from viral hepatitis.The condition for this is: to find a suitable donor, the impossibility of performing a liver resection (removal of part of it) and good general condition of the patient, the absence of metastases.
3. In what terms developing liver cancer in patients with chronic viral hepatitis?
usually long periods - more than 20 years, but a combination of several viruses in the same patient, such as C and D, the cancer may develop much faster - within five years or more.
Surgeon oncologist Barinov Natalia