Liver tumors – the new growths of malignant and good-quality character proceeding from a parenchyma, bilious channels or vessels of a liver. As the most frequent displays of tumors of baking serve nausea, weight loss, appetite loss, a gepatomegaliya, jaundice, ascites. Diagnosis of tumors of a liver includes performing ultrasonography, a research of hepatic tests, KT, a liver biopsy. Treatment of tumors of a liver surgical also consists in a resection of an affected area of body.
In hepatology it is accepted to distinguish primary benign tumors of a liver, primary and secondary (metastatic) malignant new growths (liver cancer). Knowledge of a look and origin of a tumor of a liver allows to carry out the differentiated treatment. Benign tumors of a liver meet rather seldom. Usually they proceed asymptomatically and come to light incidentally. More often in gastroenterology it is necessary to face primary cancer of a liver or secondary metastatic defeat of body. Metastasises in a liver quite often are found in patients with primary cancer of a stomach, lungs, a thick gut, a breast cancer.
Classification of benign tumors of a liver
Adenomas occur among benign tumors of a liver in clinical practice (gepatoadenoma, adenomas of a bilious channel, biliarny tsistadenoma, ). They come from epitelialny and soyedinitelnotkanny elements of a liver or bilious channels. Gemangioma, limfangioma belong to tumors of a liver of a mesodermal origin. Seldom gamartoma, lipomas, liver fibromas meet. Sometimes rank not parasitic cysts as tumors of a liver.
Adenomas of a liver represent single or multiple round formations of grayish or dark red color of various size. They settle down under the capsule of a liver or in the thickness of a parenchyma. It is considered that development of adenomas of a liver in women can be connected with long use of oral contraception. Some types of benign tumors of a liver (trabekulyarny adenomas, tsistadenoma) are inclined to regeneration in gepatotsellyulyarny cancer.
Vascular educations (angioma) occur among benign tumors of a liver most often. They have a cavernous spongy structure and come from venous network of a liver. Among vascular tumors of a liver distinguish kavernozny gemangioma and kavernoma. There is an opinion that vascular formations of a liver are not true tumors, but congenital vascular anomaly.
The knotty giperplaziya of a liver develops owing to local circulator and biliarny violations in separate zones of a liver. Macroscopically this tumor of a liver can have dark red or pink color, a melkobugristy surface, various size. A consistence of a knotty giperplaziya of a liver dense, the phenomena of local cirrhosis microscopically are found. Regeneration of a knotty giperplaziya in a malignant tumor of a liver is not excluded.
The origin of not parasitic cysts of a liver can be congenital, traumatic, inflammatory.
Symptoms of benign tumors of a liver
The most part of benign tumors of a liver has no accurately expressed clinical symptomatology. Unlike malignant tumors of a liver, good-quality educations grow slowly and is long do not lead to violation of the general health.
Gemangioma of a liver of the big sizes can cause pains and weight in epigastriya, nausea, an eructation air. Danger of a gemangioma of a liver consists in high probability of a rupture of a tumor with development of bleeding in an abdominal cavity and gemobiliya (bleedings to bilious canals), reabrupt tumor legs. Large cysts of a liver cause weight and pressure in a podreberye and an epigastriya. The gap, suppuration, jaundice, hemorrhage in a tumor cavity can be complications of cysts of a liver.
Liver adenomas at achievement of the considerable sizes can cause belly-aches, and also be palpated in the form of opukholevidny education in the right podreberye. In the complicated cases there can be a rupture of adenoma to development of a gemoperitoneum. The knotty giperplaziya of a liver usually has no the expressed symptoms. At a palpation of a liver the gepatomegaliya can be noted. Spontaneous ruptures of this tumor of a liver are observed seldom.
Diagnostics and treatment of benign tumors of a liver
For the purpose of diagnosis of benign tumors of a liver the gepatostsintigrafiya, KT, a gepatoangiografiya, a diagnostic laparoscopy with an aim biopsy of a liver and a morphological research of a bioptat are used ultrasonography of a liver. At adenomas or a knotty giperplaziya carrying out a chreskozhny biopsy of a liver is possible.
In view of probability of a malignization and the complicated course of benign tumors of a liver the main tactics of their treatment – surgical, assuming a liver resection in borders of healthy fabrics. The volume of a resection is defined by localization and the sizes of a tumor of a liver and can include a regional resection (including laparoscopic), a segmentektomiya, lobectomy or a gemigepatektomiya.
Classification and reasons of malignant tumors of a liver
Malignant tumors of a liver can be primary, i.e. directly come from structures of a liver, or secondary, connected with growth of the metastasises brought from other bodies. Secondary tumors of a liver meet by 20 times more often than primary that is connected with a filtration through a liver of the blood going from various bodies and a hematogenic drift of tumor cells.
Primary malignant tumors of a liver – the phenomenon rather rare. Occurs mainly at males 50 years are more senior. By origin allocate the following forms of primary malignant tumors of a liver:
- gepatotsellyulyarny carcinoma (hepatocellular cancer, the gepatoma) proceeding from cages of a hepatic parenchyma
- the holangiokartsinoma proceeding from epitelialny cages of bilious channels
- the angiosarkoma growing from an endoteliya of vessels
- gepatoblastoma – the liver tumor which is found at children
Among the reasons of formation of primary malignant tumors of a liver superiority belongs to chronic viral hepatitises B and C. The probability of development of gepatotsellyulyarny cancer in patients with hepatitis increases by 200 times. Distinguish cirrhosis, parasitic defeats from other factors connected with risk of development of malignant tumors of a liver (, ), hemochromatosis, syphilis, alcoholism, cancerogenic impact of various chemical compounds (tetrachloride carbon, nitrosamines, organic chlorine-containing pesticides), the alimentary reasons (food mycotoxin – an aflatoxin).
Symptoms of malignant tumors of a liver
The indisposition and the general weakness, dyspepsia belong to initial clinical displays of malignant tumors of a liver (deterioration in appetite, nausea, vomiting), weight and the aching pain in a podreberye on the right, subfebrilitt, weight loss.
With increase in the sizes of a tumor the liver acts from under edge of a costal arch, gets a bugristost and ligneous density. In late stages anemia, jaundice, ascites develops; endogenous intoxication, a liver failure accrues. If tumor cells have hormonal activity, then there are endocrine violations (Cushing's syndrome). At a sdavleniye the growing tumor of a liver of the lower hollow vein, hypostases of the lower extremities develop. At an erosion of vessels development of intra belly bleeding is possible; in case of a varicosity of a gullet and a stomach gastrointestinal bleeding can develop.
Diagnostics and treatment of malignant tumors of a liver
Shifts in the biochemical indicators characterizing functioning of body are typical for all malignant tumors of a liver: decrease in albumine, increase in fibrinogen, activity growth , increase in urea, residual nitrogen and creatinine. In this regard at suspicion of a malignant tumor of a liver it is necessary to investigate hepatic tests and a koagulogramma.
For more exact diagnostics resort to carrying out ultrasonic scanning, a computer tomography, MRT of a liver, a liver angiography. For the purpose of histologic verification of education the punktsionny biopsy of a liver or a diagnostic laparoscopy is carried out.
At signs of metastatic damage of a liver establishment of localization of primary tumor is necessary for what performance of a X-ray analysis of a stomach, EGDS, mammography, ultrasonography of mammary glands, kolonoskopiya, irrigoskopiya, a X-ray analysis of lungs etc. can be required.
Full treatment of malignant tumors of a liver is possible only during their radical removal. As a rule, at tumors of a liver the resection of a share of a liver or a gemigepatektomiya is made. At holangiokartsinoma resort to removal of a channel and imposing of soustiya (a gepatikoyeyunoanastomoz, a gepatikoduodenoanastomoz).
At single tumoral knots of a liver performance of their destruction by means of a radio-frequency ablyation, a himioablyation, a krioablyation is possible. A choice method at malignant tumors of a liver is the chemotherapy (system, intra vascular).
The forecast at liver tumors
Uncomplicated benign tumors of a liver in the predictive plan are favorable.
Malignant tumors of a liver are characterized by a rapid current and without treatment lead to death of the patient during 1 year. At operable malignant tumors of a liver life expectancy averages about 3 years; 5-year survival — less than 20%.