The number of people with pathological formations in the liver continues to increase every year. Benign and malignant tumors of the gland are the main cause of damage to the hepatic structures in general. Doctors find the explanation for the prevalence of such diseases not in the deterioration of the environmental situation, but in the rapid development of diagnostic techniques. Compared to previous decades, these days it is much easier to detect pathology in a timely manner.
Changes in organ structure
Hearing the term "hepatic mass" from a doctor, you should not immediately panic and despair. If we are talking about focal changes in the structure of the gland, it is impossible to exclude diseases of an inflammatory and infectious nature, which are manifested by narrow or wide localization. The liver is affected in hepatitis, cirrhosis, hepatosis and other diseases. Generallyfocal changes of an inflammatory nature respond well to therapy, and in some cases it is possible to completely eliminate them with the help of medications or by surgical intervention.
Having found a formation in the liver on ultrasound, the doctor suspects the presence of a tumor-like pathological process. In this case, organ changes can be:
- single or multiple cavities filled with liquid secretions, blood or other contents;
- foci of overgrown tissues, consisting of benign or atypical (cancerous) cells.
The main sign of any formation in the liver is the replacement of a he althy glandular tissue with a pathological one, which is an undoubted violation of the normal functioning of the body. The appearance of benign or malignant formations is dangerous because, in their presence, the natural process of blood purification slows down, as a result of which toxins accumulate in the body and other diseases develop.
How to recognize the problem
The most common clinical manifestations of tumor-like processes in the liver are the following symptoms:
- sudden and causeless weight loss;
- appearance of baseless nausea, profuse vomiting;
- deterioration or complete loss of appetite;
- visible yellowing of the eye sclera and certain parts of the epidermis;
- enlargement of the liver in size;
- fluid buildup in the abdomen (ascites).
Symptoms of pathology in each person can beindividual, which depends on the type of mass formation in the liver, its size, concomitant diseases, etc. To confirm the presence of a pathological focus, the patient is prescribed appropriate diagnostics, including ultrasound, CT, MRI, biopsy of affected areas and other examination methods.
Main types of hepatic neoplasms
Injuries to an organ can be of several types:
- primary benign tumors;
- primary malignant foci in the gland;
- Secondary liver formations (metastases) caused by the development of a cancerous tumor in another organ.
Having determined the type of neoplasm, the doctor gets the opportunity to prescribe the most appropriate treatment method. Statistics show that benign tumors of the gland are diagnosed extremely rarely, since this disease almost never manifests itself as any symptomatology. At the same time, in most cases it is possible to recognize cancer only at the stage when even the most radical methods of treatment are ineffective.
Benign tumors
The most common types of liver tumors (in the ICD, these pathologies are indicated by code D13.4) are the following types of tumors:
- Cyst. This non-malignant type of formation occurs in patients for various reasons. A cyst in the liver can be congenital, acquired, inflammatory, parasitic. The tumor is a capsule filled with a translucent liquid, sometimes a jelly-like green-brown mass is found. Hepatic cysts can be localized on the surface or inside the gland. Neoplasms come in different sizes: from a few millimeters to 25 cm. If a cyst occurs in each segment, they are diagnosed with polycystic disease.
- Hemangioma. This is a focal formation of the liver. What does it represent? This type of benign tumor is characterized by slow growth. Hemangiomas do not penetrate deep into the parenchyma and do not provoke the formation of metastases. However, despite the benignness of the tumor, if it is present, regular monitoring by a doctor and an ultrasound scan are required. With a sudden increase in the size of the tumor, additional diagnostic procedures are prescribed.
- Lipoma. This is a non-cancerous liver lesion that grows from fat cells. Usually the size of the lipoma does not exceed five centimeters. To confirm the diagnosis, it is necessary to undergo computed tomography or MRI. You can control the growth of education using ultrasound diagnostics.
- Hyperplasia. In this case, the structure of the cells remains the same, but the lobulation of the gland changes. Most often, hyperplasia is congenital and occurs in women. This benign liver lesion is localized predominantly in the right hepatic lobe. Hyperplasia, which has a heterogeneous structure and different echogenicity, is often confused with cancer cells, so if it is suspected, a biopsy may be prescribed. Compared to he althy tissues, hyperplasia is more often an isoechogenic mass in the liver, that is, consisting of the same tissue as itself.organ.
- Hamartoma. This disease mainly occurs at an early age. The neoplasm of the liver is located not inside, but under the capsule.
- Cystadenoma. A focal hepatic tumor is in many ways similar to a cystic formation. A feature of this neoplasm is the presence of several chambers separated from each other by a lined epithelium.
Features of adenomas
As a rule, such tumors occur in the bile ducts. Among the varieties of adenomas, the most common are hepatoadenomas and biliary cystadenomas. Each of these diseases develops from the connective tissue and integumentary lining of the liver.
Due to the different structure, it is impossible to differentiate the pathology using ultrasound. To confirm the good quality of the tumor, a puncture of the organ is performed. In the risk group for the appearance of hepatic adenoma, young women who use hormonal contraceptives. If hepatic adenoma is suspected, steroids are discontinued.
This formation in the liver can be multiple or single, have a gray or dark blood color, have a rounded shape and a different size. The place of its localization is the capsule of the gland. Some adenomas can develop into cancer. Treatment of a malignant tumor gives good chances to a patient who seeks help in the early stages of the disease.
In the International Classification of Diseases (ICD), benign liver formations are not divided into adenomas, hemangiomas, hamartomas, etc. InIn the generally accepted coding, any non-cancerous liver diseases are indicated by the code D13.4, but in medical practice, pathologies of this type have a broader classification. So, for example, vascular tumors with a cavernous spongy structure are classified as a separate group, since they are formed from the venous-vascular network of the gland. This type of adenoma is conditionally divided into:
- cavernomas;
- cavernous hemangiomas.
Most modern hepatologists do not classify vascular tumors as neoplasms, considering them to be congenital anomalies of vascular development. As for biliary and circulatory lesions, they are often referred to as varieties of hyperplasia. These benign tumors have a pink or reddish tint, they are covered with an uneven shell and a dense structure, they can be of various sizes and can degenerate into cancer.
Stages of a non-malignant tumor process
None of the described benign tumors is characterized by severe symptoms. In the initial stages, such diseases do not affect the patient's well-being in any way, since tumors do not in the least interfere with the full functioning of the organ. Usually there are no symptoms of a neoplasm until it affects more than two hepatic lobes.
As a rule, the disease begins with the appearance of small nodules in the left lobe of the liver, while three adjacent segments remain intact. The second stage is characterized by the spread of volumetric lesions. At this stage of the diseasetwo lobes of the liver are affected, and two more adjacent ones remain he althy. To confirm the third stage of a benign tumor, three of the four lobes are affected. If pathological formations are present in all four segments, they speak of the fourth stage.
Characteristic symptoms
As already noted, a liver tumor begins to disturb the patient when it reaches a certain size. Iron itself does not have sensitive receptors, so the most common cause of pain is the pressure of the tumor or the liver itself on other internal organs. In addition to pain, patients may experience heaviness in the epigastric region, suffer from belching and nausea. To indicate that these are focal formations of the liver, there may be heaviness in the right hypochondrium, frequent pulsation of the organ.
Despite its good quality, this disease poses a serious danger to the he alth and life of the patient in case of rupture of the cavity formation, which will provoke intra-abdominal bleeding, chaotic outflow of bile and deformation of the tumor base. In advanced cases, cysts can cause suppuration. At any stage of its development, only nodular hyperplasia can occur latently. On palpation of the right side of the abdomen, the patient has hepatomegaly. Hyperplasia is rarely complicated by bleeding or rupture. But even with a blurred clinical picture and the presence of dubious symptoms, you need to be vigilant and hurry to see a hepatologist.
Diagnosisand basic terms
Without a preliminary examination, it is impossible to make a diagnosis and prescribe treatment. You can verify the presence or absence of a benign tumor in the liver using the following methods of instrumental and laboratory diagnostics:
- Ultrasound of the abdominal organs;
- CT and MRI of the liver;
- laparoscopy and biopsy of gland tissues with subsequent study of the obtained material;
- hepatoangiography.
The liver tissue biopsy procedure is prescribed for suspected hyperplasia or adenoma. The organ is penetrated with a puncture needle inserted through the epidermis and subcutaneous tissues.
After an ultrasound examination, patients often begin to worry when they hear unfamiliar medical terms from the doctor. "Frightening", for example, for many is the concept of hypervascular formation of the liver. You should not worry too much, as this term refers to the presence of typical signs of the disease. Hypervascular formation is a synonym for "hyperechoic focal lesion". That is, in this case we are talking about a pathological formation with increased echo density. Hypervascular tumors are better able to reflect ultrasound waves. Education in the liver on ultrasound will look like a white spot. Hemangiomas and cancerous tumors are hyperechoic.
In turn, a (hypodense) hypoechoic mass in the liver is a fragment of an organ with a lower density. On the monitor, this area will appear as a dark spot. Hypodense formation in the liver is often a cyst or itsvarieties containing liquid in the cavity. The term “anechoic formation” has a similar meaning - this is a site in the structure of an organ that does not reflect ultrasound due to being filled with liquid. In the predominant number of cases, this characteristic is applied to the hepatic cyst. On the ultrasound monitor, the tumor has a rounded shape.
If the term “diffuse liver formations” is found in the doctor’s report, most likely, we are talking about the fact that ultrasound visually shows structural tissue damage resulting from serious functional disorders. Diffuse changes can affect the entire organ or its separate lobe, which is called a diffuse-focal lesion. In any case, this concept is not a diagnosis, but only helps to clarify the clinical picture and choose the correct method of treatment.
How to treat benign growths
An effective way to treat benign liver tumors is surgery. Only removal of the tumor can reduce the risk of its degeneration into a malignant formation. Moreover, during the operation, the surgeon can decide not only to remove the pathological tissue, but also part of the organ itself. In the presence of a hormone-dependent tumor of a small size, a choice is often made in favor of drug therapy. Drugs can stop tumor growth.
Types of liver cancer
Malignant neoplasms of the liver can be of two types:
- primary tumor thatformed from gland tissue;
- secondary tumor is a focus of metastasis that occurs due to a cancerous lesion of another organ.
In medicine, secondary liver cancer is diagnosed much more often than primary liver tumors. The thing is that with the bloodstream, atypical cells spread throughout the body. Since the first blood passes through the liver, it is affected in almost 80% of cases.
Primary malignancies are much rarer. The risk group is predominantly men over 50 years of age. There are several types of liver cancer:
- angiosarcoma, developing from the inner lining of the blood vessels of the gland;
- hepatocellular carcinoma growing directly from liver tissue;
- Hepatoblastoma is a cancer that is diagnosed mainly at an early age;
- cholangiocarcinoma develops from the basal layer of the bile ducts.
Seven out of ten cases of liver cancer are caused by a history of hepatitis B or C. In such patients, the likelihood of developing a malignant tumor increases several times. The second most common cause of oncology is chronic inflammation of the liver against the background of cirrhosis, untreated parasitic infestations (opisthorchiasis, schistosomiasis), syphilis, and alcoholism. Frequent contact of the patient with carcinogenic chemicals can serve as a factor provoking the disease. Treatment of liver cancer is successful only in isolated cases, since the mechanism of development and causesmalignant processes in the liver are still not 100% studied.
How a malignant tumor manifests
The cancerous process in the human body is manifested by "classic" symptoms. With the defeat of the abdominal organs, patients develop nausea, vomiting, high body temperature. It is almost impossible to suspect liver cancer in the initial stages - this oncological disease may not declare itself for several years. When a certain symptom complex appears, indicating the probable course of malignant processes in the liver, it is urgent to be examined for cancer. Characteristic signs of a malignant formation of the liver parenchyma are:
- febrile condition;
- weakness and fatigue even after sleep;
- anemia;
- aching dull pain in the right hypochondrium;
- rapid weight loss.
In turn, anemia manifests itself in many patients with additional symptoms in the form of hypotension, severe fatigue, hand tremors, causeless dizziness, fainting. As the disease progresses and the tumor grows, the liver begins to increase in size. Moreover, the gland becomes more bumpy and dense. In parallel with this, the epidermis of the patient acquires an icteric hue, liver failure develops.
In some cases, cancer patients are diagnosed with intra-abdominal bleeding, up to the development of a state of shock. A complication of liver cancer are also endocrine disorders that occurdue to the release of heme-like substances by cancer cells. With the progression of the tumor against the background of cirrhosis, patients feel severe pain, suffer from constant fever, ascites.
Symptoms of metastatic liver cancer do not differ fundamentally from the signs of primary cancer. The difference lies in the fact that cancer cells enter the gland from other organs and lymph nodes.
A malignant tumor that has grown in size can bulge strongly. Most often, volumetric formations of the left lobe of the liver become noticeable - on this side, closer to the epigastrium, an atypical swelling of the abdomen is observed, and when probing, an area of \u200b\u200bdense structure is detected.
Cancer diagnosis
Unlike benign liver formations, malignant tumors can be diagnosed not only with the help of functional diagnostic methods, but also by taking biochemical blood tests. Some indicators directly indicate the usefulness or abnormalities in the liver. Low levels of albumin, elevated levels of transaminase, fibrogen, creatinine and urea can indirectly indicate liver cancer. With such results of the analysis, the specialist will additionally prescribe a liver test and a coagulogram.
To get a more accurate picture, you need to undergo an ultrasound examination. To date, the most informative type of instrumental diagnostics is magnetic resonance and computed tomography of the liver, angiography. To verify the malignancy of the cells of the neoplasm,most doctors are inclined to the need for a puncture biopsy of the gland tissue for a detailed histological examination.
If cancerous foci are the result of metastasis from a tumor in other organs, it is important to establish the localization of the primary cancer. In this case, the treatment of the liver and the affected organ is carried out simultaneously. To detect a tumor, patients are referred for the following procedures:
- FGDS;
- X-ray of the gastrointestinal tract;
- breast ultrasound and mammography;
- lung fluorography;
- colonoscopy.
Can cancer be cured
Depending on the type, stage of cancer and characteristics of the patient's body, an individual treatment regimen is selected. In the early stages of the disease, surgical methods are considered the most effective. If the tumor is diagnosed at the very beginning of its development, complete removal of the formation with partial resection of the affected hepatic lobe is not ruled out. At the same time, most of the organ is preserved.
In some cases, to save the patient's life, it is required to remove half of the liver. The remaining fragment of the gland for some time works with maximum intensity, performing functions for the entire organ. After a few months, the liver returns to its previous size.
If surgery is not possible for any reason, radiofrequency ablation is used. The essence of this manipulation is to influence the cells of a cancerous tumor withusing radiation waves. The course of radiation therapy is carried out several times to achieve maximum results.
In addition, a number of cytostatics are used to combat malignant liver cells. Significant disadvantages of chemotherapy is the rapid addiction of the body. To prevent this, drugs are delivered directly to the gland through the hepatic artery. Chemical preparations get to all pathological cells of the liver, but at the same time it does not affect other tissues and internal organs. Side effects of chemotherapy include severe nausea, vomiting, bleeding, hair loss, a weakened immune system, and malaise.
