Liver cancer – the malignant new growths of a liver coming from epitelialny and neepitelialny structures of body. As typical displays of cancer of liver serve weight and pain in the right podreberye, nausea, vomiting, jaundice; in late stages – ascites, fever, a hemorrhagic syndrome, a kakheksiya. Diagnosis of cancer of liver is made by means of ultrasonography of an abdominal cavity, KT, YaMRT, a stsintigrafiya, a punktsionny biopsy of a liver, a diagnostic laparoscopy, definition of onkomarker and biochemical tests. In cancer therapy of a liver surgical methods (a liver resection), radiation therapy, chemotherapy are used.
By origin cancer of a liver can be primary, initially developing from hepatic structures, and secondary (metastatic). Primary malignant new growths develop in a liver at 20-30 times less than secondary, and make no more than 0,2-3% of all cancer tumors. The greatest incidence of primary cancer of a liver is noted in South Africa, Senegal, India, China, on Philippines that it is connected with high prevalence of chronic hepatitis in these countries. Cancer of a liver 4 times more often develops at male population; primary age of sick 50-65 years.
Classification of cancer of liver
Primary cancer of a liver most often grows from hepatocytes – hepatic cells (a gepatotsellyulyarny carcinoma or hepatocellular cancer) or from epitelialny cages of bilious channels (holangiotsellyulyarny cancer or a holangiokartsinom). Less often cancer of a liver the mixed structures (gepato-holangiotsellyulyarny cancer), neepitelialny new growths (gemangioendotelioma), a kartsinosarkoma, a gepatoblastom, etc. meets. Primary cancer of a liver develops in the form of single or multiple formations of whitish color, a dense consistence. Cancer of a liver has tendency to diffusion growth, quickly invazirut vessels, thereby extending on a liver.
Metastatic cancer of a liver makes up to 90% of cases of malignant defeats of body. By origin it is metastatic, i.e. represents a dissemination of primary tumors of other localizations: cancer of a large intestine, pancreatic cancer, cancer of a stomach, lung cancer, breast cancer, prostate cancer, cancer of a uterus or ovaries, kidney cancer etc. Frequent metastasis of various new growths in a liver is connected with features of blood supply of a liver and inflow to it of all blood from an abdominal cavity.
In the international TNM-classification allocate the following stages of primary cancer of liver:
- T0 – primary cancer of a liver is not defined
- T1 – solitary education to 2 cm in the diameter; germination of vessels is absent
- T2 – the solitary education to 2 cm in the diameter sprouting liver vessels, or a tumor more than 2 cm without involvement of vessels
- T3 – the single tumors more than 2 cm in size or multiple small tumors sprouting vessels and limited to one share
- T4 – the multiple centers in both shares of a liver or a single tumor with germination of a hepatic or portal vein or a visceral peritoneum.
- N0 – is absent damage of lymph nodes of a gepatoduodenalny sheaf and gate of a liver
- N1 – are defined metastasises in lymph nodes of a gepatoduodenalny sheaf or gate of a liver
- M0 – the remote metastasises of cancer of liver are not defined
- M1 – come to light liver cancer metastasises in the remote bodies.
Liver cancer reasons
In most cases cancer of a liver is directly associated with presence at patients of chronic viral hepatitis B and C - the gepatotsellyulyarny carcinoma develops at 80% of persons with virus damage of a liver within 20 years. The mechanism of development of cancer of liver is connected with the action of viruses injuring hepatocytes leading to a chronic inflammation of cells of a liver and bilious channels, violation of their work.
Cirrhosis of any etiology, hemochromatosis, alcoholic liver disease, medicinal hepatitis, heart failure, parasitic infections (, , ), cholelithiasis, syphilis, etc. belongs to factors of the increased risk of cancer of liver. Potential carcinogens are B1 aflatoxin developed by mold fungi of an aspergillama, industrial chemicals (nitrosamines, tetrachloride carbon, chlorine-containing pesticides, arsenic, vinyl chloride, etc.), pharmacological medicines (, anabolic steroids).
Liver cancer symptoms
Clinical displays of cancer of liver demonstrate from nonspecific symptoms in this connection the disease quite often is accepted in gastroenterology to ZhKB, cholecystitis, holangit, an exacerbation of hepatitis, etc.
At early stages cancer of a liver is characterized by causeless weakness, fatigue, a loss of appetite and loss of weight, weight in a podreberye and an epigastriya. The dispepsichesky phenomena develop: nausea, vomiting, tendency to locks or diarrhea. Emergence of pains in a liver is connected with growth of a tumor, stretching of the hepatic capsule, secondary inflammatory reaction. The liver soon increases in sizes, gets a bugristost and ligneous density; through a belly wall the tumoral knot is sometimes palpated. Violation of a zhelcheotvedeniye at cancer of a liver is led to development of obturatsionny jaundice, skin itch, coloring by a calla in light color, and urine – in dark.
Further anemia, ascites appears and accrues, there are teleangiektaziya on skin, a hemorrhagic syndrome (repeatedly repeating gastrointestinal and nasal bleedings). In late stages of cancer of liver the constant steady against therapy, fever from oznoba is noted. At a spontaneous or traumatic rupture of a tumor there is bleeding in an abdominal cavity or peritonitis. Metastasis of cancer of liver can be intra organ (in other departments of a liver); regionarny (in lymph nodes of gate of a liver, chrevny, paraortalny lymph nodes) or remote (in other bodies - lungs, a pleura, a peritoneum, a pancreas, kidneys, bones).
Diagnosis of cancer of liver
The initial diagnosis of cancer of liver can be suspected in the analysis of objective data (existence of jaundice, pains and the palpated education in a podreberye, a gepatomegaliya, the deformation of a stomach expressed to hypodermic vascular network, etc.).
As primary method of tool diagnosis of cancer of liver in most cases serves ultrasonography of abdominal organs (liver). OUSE scanning allows to reveal focal damages of a liver, to assume their character (primary, metastatic), to determine the sizes. In some cases ultrasonography is used for carrying out an aim chreskozhny biopsy of a liver and establishment of the morphological diagnosis. Specification of the data received at an ekhografiya is made by means of KT or YaMRT.
For assessment of function of a liver the level of hepatic enzymes, bilirubin, proteins, alkaline phosphatase, a koagulogramm, platelets, etc. indicators is investigated. With high degree of probability to speak about cancer of a liver it is possible at increase in level alpha (AFP) – a specific tumoral marker.
The additional specifying data are obtained when carrying out a static stsintigrafiya of a liver, a selective tseliakografiya, splenoportografiya, PET of a liver, a diagnostic laparoscopy. At suspicion of metastatic cancer of a liver as the major task serves identification of primary center that can demand carrying out an irrigoskopiya, a kolonoskopiya, an ezofagogastroduodenoskopiya, ultrasonography of a small pelvis, ultrasonography of a prostate, a X-ray analysis of lungs, ultrasonography of kidneys, excretory urography.
Cancer therapy of a liver
At primary rezektabelny cancer of a liver the combined treatment including a liver resection (lobectomy, atypical resections of a liver or a gemigepatektomiya) in combination with a chemotherapy course a methotrexate, 5-ftoruratsily is shown. However the resection of a liver manages to be executed not at all patients. Serve as criteria of operability the tumor with a diameter no more than 3 cm which is not sprouting in blood vessels; absence of cirrhosis. The postoperative lethality after a liver resection concerning cancer makes 10%, mainly, of the developed liver failure. In some cases in the specialized centers transplantation of a liver can be undertaken.
Surgical treatment of metastatic cancer of liver is possible only at operability a tumor basis, existence of metastasises in one of shares of a liver and lack of other extra hepatic centers. Chemotherapy by means of cytostatic medicines as an independent method of treatment, it is shown at inoperable cancer of a liver. In this case the best effect is reached at introduction of tsitostatik directly in a hepatic artery. Radiation therapy at cancer of a liver is used infrequently in view of the low efficiency.
As alternative methods of cancer therapy of a liver serve the himioembolization, a radio-frequency termoablyation, chreskozhny introduction to an ethanol tumor, proton therapy.
Forecast and prevention of cancer of liver
After a liver resection concerning primary cancer 5-year survival is small – only 9-20%. At inoperable cancer of a liver from the moment of installation of the diagnosis before death of the patient, as a rule, there pass no more than 4 months. In case of metastatic cancer of a liver the forecast also extremely adverse.
Prevention of cancer of liver includes immunization of a general population against viral hepatitis B, refusal of abuse of alcohol, observance of safety rules during the work with harmful chemical compounds. In the presence of chronic hepatitis it is necessary to adhere to recommendations of the gastroenterologist (hepatologist) and infectiologist, to keep to the sparing mode and a diet, to undergo dispensary control.