Some patients also show some complications of liver cirrhosis, such as melena and hematemesis. Jaundice and so on. A few patients go to the hospital because of the symptoms caused by metastasis, and most of these symptoms are not special. The following mainly introduces some common symptoms of liver cancer.
1. Liver pain
The first symptom of most patients with advanced liver cancer is pain in the liver area, and the incidence rate is above 50%.
. The pain in the liver area is generally located under the right rib or xiphoid process, and the pain is intermittent or persistent dull pain. Dull pain or tingling, the patient may feel discomfort in the right upper abdomen some time before the pain. The pain can be relieved by itself in a short time. The main cause of pain is the rapid enlargement of tumor, which compresses the liver capsule and produces traction pain. It can also be caused by tumor necrosis stimulating the liver capsule.
A few patients spontaneously or suddenly have severe pain in the liver area after liver puncture, which is mostly caused by rupture and bleeding of cancer nodules on the surface of the liver. If there is blood pressure drop and shock at the same time, there is bloody liquid at the puncture site of abdominal cavity, which indicates that the cancer node is ruptured and bleeding seriously. In this case, emergency rescue is needed. Without the above-mentioned accompanying symptoms, the pain is limited, indicating that the bleeding is located under the liver capsule. The pain will be different according to the location where the tumor grows. Tumors located in the left lobe often cause pain in the upper and middle abdomen. The tumor is located in the right lobe, and the pain is in the right quarter rib; When the tumor involves the diaphragm, the pain radiates to the right shoulder or back, which is easily mistaken for shoulder arthritis; When the tumor is located in the posterior segment of the right lobe, it can sometimes cause low back pain; Patients with tumors located in deep liver parenchyma generally do not feel pain.
2. Symptoms of digestive tract
Loss of appetite after meals and fullness in the upper abdomen. Heating, dyspepsia and nausea are common digestive tract symptoms of liver cancer, among which loss of appetite and abdominal distension are the most common. Diarrhea is also a common digestive tract symptom of liver cancer, which has been reported at home and abroad. The incidence rate is high and it is easy to be mistaken for chronic enteritis. Portal hypertension and intestinal dysfunction caused by tumor thrombus in portal vein or hepatic vein can cause abdominal distension, increase stool frequency, and ascites can also cause abdominal distension. Gastrointestinal dysfunction can also lead to indigestion, warm gas, nausea and other symptoms.
3. fever
A considerable number of patients with liver cancer will sweat and have fever. Fever is mostly moderate to low fever, and a few patients may have high fever, which is above 39℃ and is generally not accompanied by chills. The fever of liver cancer is mostly cancerous fever, which is caused by the release of pyrogen into the blood circulation after tumor tissue necrosis. Cancer patients are prone to infection and fever because of their low resistance, which is sometimes difficult to distinguish from cancerous fever of liver cancer. It is necessary to combine the blood picture to observe whether the antibacterial treatment is effective.
4. emaciation and fatigue
Patients with liver cancer often feel more tired than patients with other tumors, which is similar to patients with chronic hepatitis. The cause of fatigue is unknown, which may be due to digestive dysfunction and nutrient absorption disorder, or liver cells are damaged, liver function declines, so that metabolic disorder and some toxins cannot be inactivated in time, or liver cancer tissue necrosis releases toxic substances. Emaciation is also a common symptom in patients with liver cancer, which is due to impaired liver function. Digestion and absorption function decreased. With the development of the disease, the degree of emaciation can be aggravated, and cachexia appears in severe cases.
5. Bleeding tendency
Patients with liver cancer often have bleeding tendency such as gingival bleeding and subcutaneous ecchymosis, which are mainly caused by impaired liver function and abnormal coagulation function, especially patients with liver cancer complicated with cirrhosis. Gastrointestinal bleeding is common, mainly esophageal varices caused by portal hypertension. In fact, gastrointestinal bleeding is also the main cause of death in patients with liver cancer.
6. Lower extremity edema
Patients with ascites due to liver cancer often have edema of lower limbs, which can occur in the ankle, and in severe cases, it can spread to the whole lower limbs. Clinically, I have seen some patients with high edema of lower limbs, and the skin of thighs can ooze water. The main reason of edema of lower limbs is that ascites compresses the veins of lower limbs or blocks tumor thrombus and venous reflux. Mild edema can also be caused by low plasma albumin.
7. Acute abdomen
The rupture of cancer nodules usually causes pain in the liver area, and there is obvious tenderness in the liver area during physical examination, which is a symptom of the stimulation of the liver capsule. Some patients have acute abdominal pain with peritoneal irritation after the rupture of cancer nodules, which is easy to be misdiagnosed as acute peritonitis. Abdominal pain caused by rupture of cancer nodules is usually accompanied by blood pressure drop or even shock, which is different from general acute peritonitis.
Preventive measures:
1, active prevention and treatment of viral hepatitis is of great significance to reduce the incidence of liver cancer. The study on the relationship between hepatitis B virus and liver cancer found that ① the marker of shame hepatitis in serum of patients with liver cancer was as high as 90%; ② The probability of HBsag positive patients developing liver cancer in the high incidence area of liver cancer is 6 ~ 50 times higher than that of negative patients; (3) Molecular biology research shows that simple integrated HBV-DNA accounts for 565,438 0.5% of patients with liver cancer in China; . The above shows that hepatitis B virus is closely related to liver cancer and is an important risk factor for liver cancer. In recent years, the relationship between hepatitis C and liver cancer has attracted people's attention. The combined rate of liver cancer and liver cirrhosis was 83.6%, and the combined rate of liver cirrhosis and liver cancer was 49.9%, of which severe liver cirrhosis accounted for 73.3%. Preventive injection of inactivated hepatitis B virus vaccine can not only prevent hepatitis, but also prevent liver cancer to some extent.
2. Preventing grain mildew and improving drinking water quality are also important measures to prevent liver cancer. In areas with high incidence of liver cancer, especially in southern areas where corn is the main grain, the survey believes that the prevalence of liver cancer may be related to the pollution of aflatoxin to food. The incidence of liver cancer in drinking ditch polluted by drinking water in Qidong, Jiangsu Province is 60 ~10165438+million, and that in drinking well water is only 0 ~ 19/65438+ million. The relative risk of drinking ditch water is 3.00. It was found that an algal toxin produced by cyanobacteria in ditch water may be a clue to drinking water pollution and liver cancer.
3. Genetic factors sometimes lead to family clustering in high-risk areas of liver cancer, especially people who live together and are related by blood. It may be related to the vertical transmission of hepatitis virus. Patients with a family history of liver cancer should have regular physical examinations to achieve early detection and early treatment.
4. Other carcinogens or carcinogenic factors that cause liver cancer are still suspected: ① alcoholism; ② nitrosamines; 3 pesticides such as organochlorine; (4) Trace elements: The contents of copper and zinc in water, soil, grain, human hair and blood in the epidemic area of liver cancer are high, but the contents of molybdenum are low; ⑤ Clonorchis sinensis stimulates the proliferation of bile duct epithelial cells and produces cholangiocarcinoma. ⑥ Trace elements, sex hormones, radioactive substances, parasites, alcoholism, smoking and genetic factors. Therefore, we should not drink alcohol, eat less pickled and smoked food, and reduce our exposure to pesticides, various chemicals and radioactive substances.
5. Early detection, early diagnosis and early treatment of liver cancer are called "secondary prevention" when the prevention of liver cancer is not perfect. Since the application of alpha-fetoprotein in the general survey of liver cancer in China in the 1970s, the diagnosis of primary liver cancer has reached the subclinical level, the proportion of early liver cancer has been increasing, and the five-year survival rate has also been significantly improved. Since 1980s, the detection rate of high-risk population (hepatitis history, hbsag positive, over 40 years old) is about 501110,000, which is 34.4 times that of the natural population, among which 1/3 is early liver cancer. Highly sensitive alpha-fetoprotein detection and ultrasound imaging 1 ~ 2 times a year are the basic methods to detect early liver cancer. The combined detection rate of AFP and AFP can reach 97.9%, which not only can make up for the lack of missed detection of AFP negative patients, but also has important value for timely clothing confirmation of low-concentration AFP liver cancer. There is a contradiction between "cost and benefit" in the general survey of liver cancer. Some people think that the early detection of the general survey is essentially the "leading time" for diagnosis and treatment. However, before the prevention of the cause of liver cancer has achieved results, the "lead time" won by the census is of great value to more and more long-term survival patients. It must be emphasized that for the early detection of small liver cancer, surgical resection should be taken as actively as possible to achieve the goal of radical cure. The five-year survival rate of small hepatocellular carcinoma after radical resection is about 70%, but most of them die within two years without surgical treatment. The key to the therapeutic effect of this disease lies in early diagnosis. Take "improving water, preventing mildew and hepatitis" as the main preventive measures.