Primary liver cancer is rare. Basically, cancer of this organ is secondary, that is, metastatic. Primary liver tumors include cholangio- and hepatocellular carcinoma. Similar types of cancer can develop in both men and women (less often). In childhood, these tumors are almost never found. Young patients may develop liver cancer originating from germinal tissues, called hepatoblastoma. This pathology is rare. Almost all primary liver tumors are considered aggressive. They take the 5th place in terms of mortality in the structure of oncological pathologies. Currently, a search is underway for new means of combating liver cancer. Great advances have been made through the discovery of targeted and immune therapies.
Description of hepatocellular carcinoma
Hepatocellular carcinoma is a tumor originating from liver cells that have undergone atypia. Compared with other primary oncological pathologies of this organ, it is the most common. This tumor is also called hepatocellular carcinoma. According to the frequency of occurrence, hepatocellular carcinoma among men ranks 5th in the world. This tumor occurs more often in developed countries. It is a severe and rapidly progressive oncological disease and often leads to death. The point is not only in the late diagnosis of pathology, but also in its aggressiveness and ability to metastasize to other organs. This is due to the peculiarities of the blood supply to the liver.
All types of cancer are listed in the International Classification of Diseases (ICD). Like other oncological pathologies, hepatocellular carcinoma also has its own special code. ICD-10 is used in all countries of the world. In the classification, the disease has the code C22.0, which means "hepatocellular cancer." Most often, this pathology occurs against the background of chronic pathologies, under the influence of adverse factors.
Causes of liver carcinoma
As you know, the etiology of malignant neoplasms has not yet been studied. However, scientists have long found out exactly what factors provoke the development of a particular tumor. Hepatocellular carcinoma is no exception. The following influences lead to it:
- Long-term carriage of some viruses. It is believed that pathologies such as chronic hepatitis B and C increase the risk of developing liver carcinoma by more than 100 times. In addition, these diseases are often asymptomatic. Therefore, to reduce the risk of developing cancer, you should periodically donate blood for viruses.hepatitis.
- Cirrhosis of the liver of any etiology. The replacement of hepatocytes with connective tissue most often occurs as a result of a chronic viral infection, alcohol and drug use.
- Eating food rich in aflatoxins.
- Genetic predisposition to disease.
- Using hepatotoxic drugs.
If you exclude the listed provoking factors, the risk of developing hepatocellular carcinoma is minimal. Nevertheless, no one is immune from this tumor. Like other cancer pathologies, it can occur as a result of exposure to ionizing radiation, smoking, malnutrition, stress, etc.
Pathogenesis of hepatocellular carcinoma
As a result of a chronic inflammatory process, normal liver cells begin to transform into tumor elements. What exactly causes this is not known exactly. Due to the action of the virus, the liver tissue becomes inflamed, the organ becomes swollen and painful. The permeability of the vessels increases, they become full-blooded. As a result, liver function is impaired. In addition to the fact that the body is destroyed by viral particles, it is also affected by other harmful substances coming from food. All this leads to cellular transformation. The nucleus increases in size, the cytoplasm and other organelles are displaced to the periphery. After that, the cell begins to divide unmotivated. Many nuclei appear, metabolic processes in the hepatocyte are disturbed. begin to be synthesized in the celltumor proteins that spread rapidly through the bloodstream. Thus hepatitis C and hepatocellular carcinoma are interrelated.
It should be remembered that this viral disease almost always leads to the development of cirrhosis of the liver or cancer. In most cases, it is diagnosed already when complications occur. Another name for viral hepatitis C is “gentle killer”. This is due to the complete absence of clinical manifestations of the pathology for many years and the inevitable death as a result of the cessation of the functioning of the liver.
Classification of hepatocellular carcinomas
Hepatocellular carcinoma of the liver is divided into several morphological and clinical forms. In addition, the tumor is classified according to the stage of development and severity. Depending on the macroscopic picture, nodular, massive and diffuse forms of liver cancer are distinguished. Fibrolamellar hepatocellular carcinoma is considered a separate type. According to the clinical picture, 6 forms of hepatocellular carcinoma are distinguished. Among them:
- Hepatomegalic variant.
- Icteric form.
- Feverish variant of liver cancer.
- Ascitic form.
- Acute abdominal variant.
- Metastatic liver cancer.
Most often there is a combination of several clinical options. The stage of hepatocellular carcinoma depends on the size of the tumor and its spread to nearby lymph nodes and other organs.
Hepatocellular carcinoma: symptoms
Symptoms of the disease depend on the clinical form of carcinoma. In most cases, early stage cancer has no symptoms. In addition, diagnosis is difficult due to the fact that the symptoms of the tumor resemble the clinical picture of other liver pathologies (chronic hepatitis, cirrhosis). Late manifestations of cancer include subfebrile temperature, loss of appetite, general weakness, swollen lymph nodes, and weight loss. With the hepatomegalic form of carcinoma, there is a pronounced enlargement of the liver, pain in the right hypochondrium. In a third of patients, an icteric variant of the pathology is observed. He has a poor prognosis. Jaundice develops in the first or second stage of the tumor process.
In addition, patients complain of pain and itching. With a feverish form, there is a constant increase in body temperature, unpleasant, aching sensations in the upper abdomen. Ascites appears in the late stages of cancer, accompanied by general symptoms of tumor intoxication. The acute abdominal form is less common. It is characterized by severe pain syndrome, tension of the abdominal muscles. In the metastatic variant of hepatocellular cancer, signs of damage to other organs predominate. Among them are bones, lungs, intestines.
Morphological forms of liver carcinoma
The following tumor forms are distinguished by morphology:
- Massive hepatocellular carcinoma. It occupies an entire segment or even a lobe of the liver. When cut, it has clearborders. Also, small foci (satellites) may be present inside the tumor node. One of the varieties of massive liver cancer is the cavity form. On incision, a tumor node is found, inside of which there is a brown liquid. The walls of the cavity are thick and smooth.
- Nodular carcinoma of the liver. It is characterized by many tumor foci located over the entire surface of the parenchyma of the organ.
- Diffuse liver carcinoma. Most often develops on the background of cirrhosis. The entire parenchyma consists of elements of connective tissue and atypical cells.
Fibrolamellar carcinoma consists of one or more large nodules. More often it is localized in the left lobe of the liver. The color of the tumor is yellow or green. Another separate form is encapsulated (small) hepatocellular carcinoma. It is characterized by a favorable prognosis and slow growth, the size of the tumor does not exceed 5 cm in diameter.
Diagnosis of hepatocellular carcinoma of the liver
Many tests must be performed before a disease such as hepatocellular carcinoma is diagnosed. Diagnosis of pathology consists of several stages. First, the doctor listens to all the patient's complaints and conducts an examination. Particular attention is paid to the skin (color, presence of scratches, hemorrhages), lymph nodes, palpation of the liver. In cancer, the organ has a bumpy surface, a dense texture, and soreness is noted. This is followed by a series of examinations. Among them:
- UAC, biochemical analysisblood.
- Determination of the level of a special marker - alpha-fetoprotein.
- Ultrasound of the abdominal organs.
- Computed tomography.
- Investigations of the vessels of the liver. These include angio- and portohepatography.
Diagnosis is based on cytological and histological findings. To conduct these studies, a biopsy of the organ is performed.
Hepatocellular carcinoma of the liver: treatment of the disease
The choice of treatment tactics depends on the morphological shape and size of the tumor, as well as the stage of the oncological process. At the initial stages of cancer, surgery, aspiration of nodular formations, and chemotherapy are performed. For diffuse tumors, hepatic artery embolization is performed. This helps to slow down the growth of the neoplasm and limit the process. Hepatocellular carcinoma of the liver is insensitive to radiation treatments. In addition, it rarely responds to chemotherapy, only 15-20% of patients experience a temporary positive effect. One way is liver transplantation. This method is widely used in developed countries. Donor organ transplantation is performed only at the initial stages of cancer. In the presence of distant metastases, symptomatic therapy is considered the only treatment. It includes palliative care (patient care, psychotherapy) and pain management.
Surgical treatment of liver cancer
Surgical intervention is performed in almost all patients who are diagnosed"hepatocellular carcinoma". Treatment includes liver resection within the anatomical zone (segment, lobe, half of the organ). If the node is small, it is enucleated with a special aspirator. Another method of surgical treatment is percutaneous embolization of the liver artery.
The most effective way is transplantation of an organ or part of it. The liver tissue has the ability to regenerate. As a result, a complete cure of the patient is possible.
Drug therapy for hepatocellular carcinoma
In addition to chemotherapeutic drugs, a new pharmacological group of drugs is actively used - protein kinase inhibitors. Their action is to reduce the proliferation of tumor cells. Despite the many side effects, these medicines are quite effective. An example of medicines from this group is Nexavar.
Prognosis for hepatocellular carcinoma
One of the aggressive malignant neoplasms of the gastrointestinal tract is hepatocellular carcinoma of the liver. The prognosis for this tumor is poor in most cases. A high 5-year survival rate is observed only with a small size of the formation after surgical treatment or liver transplantation. Often there is a recurrence of the tumor and rapid metastasis. The cessation of the functioning of the body leads to death.
Prevention of hepatocellular carcinoma
Preventive measures include annual screening for hepatitis viruses, avoidance of drugs and alcohol. It is worth remembering that inflammation of the liver can be obtained as a result of such manipulations as dental and cosmetic procedures, blood transfusion.
