Primary oncological diseases of the liver are rare. Basically, the cancer of this organ is secondary, that is, metastatic. Primary liver tumors include cholangio- and hepatocellular carcinoma. Similar types of cancer can develop both in men and among the female population (less often). In childhood, these tumors practically do not occur. In small patients, liver cancer originating from germinal tissues, hepatoblastoma, can develop. This pathology is rare. Almost all primary liver tumors are considered aggressive. They occupy 5th place in mortality in the structure of oncological pathologies. A search is underway for new ways to fight liver cancer. Great achievements have been achieved thanks to the discovery of targeted and immune therapy.
Description of hepatocellular carcinoma
Hepatocellular carcinoma is a tumor originating from atypical liver cells. Compared with other primary oncological pathologies of this organ, it is most common. This tumor is also called hepatocellular carcinoma. According to the frequency of occurrence, hepatocellular carcinoma among men takes 5th place in the world. This tumor often occurs in developed countries. It refers to severe and rapidly progressive cancer, 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 included in the international classification of diseases (ICD). Like other oncological pathologies, it has its own special code and hepatocellular carcinoma. ICD-10 is used in all countries of the world. In the classification, the disease has a code of C22.0, which means "hepatocellular carcinoma." Most often, this pathology occurs against a background of chronic pathologies, under the influence of adverse factors.
Causes of liver carcinoma
As is known, the etiology of malignant neoplasms has not yet been studied. However, scientists have long found out exactly which factors provoke the development of a particular tumor. Liver cell cancer is no exception. The following effects lead to it:
- Long-term carrier 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 lower the risk of developing cancer, you should periodically donate blood for hepatitis viruses.
- Cirrhosis of the liver of any etiology. Substitution of hepatocytes with connective tissue most often occurs as a result of a chronic viral infection, the intake of alcohol and drugs.
- Eating foods rich in aflotoxins.
- Genetic predisposition to the disease.
- Taking hepatotoxic drugs.
If you exclude these provoking factors, the risk of hepatocellular carcinoma is minimal. Nevertheless, no one is safe 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 leads to this is not exactly known. Due to the action of the virus, the liver tissue becomes inflamed, the organ becomes swollen and painful. The permeability of blood vessels increases, they become full-blooded. As a result, liver function is impaired. In addition to the fact that viral particles destroy the organ, other harmful substances coming from food also act on it. All this leads to cell transformation. The nucleus increases in size, the cytoplasm and other organelles are displaced to the periphery. After this, the cell begins to divide unmotivated. Many nuclei appear, metabolic processes in the hepatocyte are disturbed. In the cell, tumor proteins begin to be synthesized, which quickly spread through the bloodstream. Thus, hepatitis C and hepatocellular carcinoma are interconnected.
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 even if complications occur. Another name for viral hepatitis C is “affectionate killer”. This is due to the complete absence of clinical manifestations of pathology over the years and the inevitable death as a result of the cessation of liver function.
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, nodal, massive and diffuse forms of liver cancer are distinguished. Fibrolamellar hepatocellular carcinoma is considered a separate species. According to the clinical picture, 6 forms of hepatocellular cancer are distinguished. Among them:
- Hepatomegalic variant.
- Icteric form.
- Feverish variant of liver cancer.
- Ascitic form.
- Acute abdominal variant.
- Metastatic form of liver cancer.
Most often, a combination of several clinical options is observed. 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, in the early stages, cancer has no manifestations. In addition, the 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 low-grade fever, loss of appetite, general weakness, swollen lymph nodes, and weight loss. With the hepatomegalic form of carcinoma, a marked increase in the liver, pain in the right hypochondrium are noted. A third of patients have an icteric version of the pathology. He has an unfavorable prognosis. Jaundice develops in the first or second stage of the tumor process.
In addition, patients complain of pain and itching. With a febrile 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. Acute abdominal form is less common. It is characterized by severe pain, muscle tension in the abdominal press. With the metastatic variant of hepatocellular cancer, signs of damage to other organs predominate. Among them are bones, lungs, intestines.
Morphological forms of liver carcinoma
According to morphology, the following tumor forms are distinguished:
- Massive hepatocellular carcinoma. It occupies a whole segment or even a fraction of the liver. When cut, it has clear boundaries. Also, small foci (satellites) may be present inside the tumor node. One of the varieties of massive liver cancer is the abdominal form. A tumor node is found in the section, inside 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 along the entire surface of the organ parenchyma.
- Diffuse carcinoma of the liver. Most often develops against a background of cirrhosis. The entire parenchyma consists of elements of connective tissue and atypical cells.
Fibrolamellar carcinoma consists of one or more large nodes. 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 tumor size does not exceed 5 cm in diameter.
Diagnosis of hepatocellular carcinoma of the liver
Many examinations must be completed before identifying a disease such as hepatocellular carcinoma. Diagnosis of pathology consists of several stages. First, the doctor listens to all patient complaints and conducts an examination. Particular attention is paid to the skin (color, scratching, hemorrhage), lymph nodes, palpation of the liver. In cancer, the organ has a tuberous surface, a dense texture, pain is noted. After this, a series of examinations are performed. Among them:
- KLA, biochemical blood test.
- Determination of the level of a special marker - alpha-fetoprotein.
- Ultrasound of the abdominal cavity.
- CT scan.
- Studies of blood vessels of the liver. These include angio- and portohepatography.
Diagnosis is based on cytological and histological findings. To conduct these studies, an organ biopsy is performed.
Hepatocellular carcinoma of the liver: treatment of the disease
The choice of treatment tactics depends on the morphological form and size of the tumor, as well as the stage of the oncological process. At the initial stages of cancer, surgery is performed, aspiration of nodules, chemotherapy. In diffuse tumors, hepatic artery embolization is performed. This helps to slow the growth of the tumor and limit the process. Hepatocellular carcinoma of the liver is insensitive to radiation treatments. In addition, it is rarely amenable to chemotherapy, only 15-20% of patients have a temporary positive effect. One way is liver transplantation. In developed countries, this method is widespread. A donor organ transplant is performed only in 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 relief.
Surgical treatment of liver cancer
Surgery is performed on almost all patients diagnosed with hepatocellular carcinoma. Treatment includes resection of the liver within the anatomical zone (segment, lobe, half of the organ). If the site is small, it is enucleated with a special aspirator. Another method of surgical treatment is percutaneous embolization of a liver artery.
The most effective way is transplantation of an organ or part thereof. Liver tissue has the ability to regenerate. As a result, a complete cure of the patient is possible.
Drug therapy against hepatocellular carcinoma
In addition to chemotherapeutic drugs, a new pharmacological group of drugs, protein kinase inhibitors, is actively used. Their action is to reduce the proliferation of tumor cells. Despite the many adverse reactions, these medicines are quite effective. An example of drugs from this group is the drug "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 in most cases unfavorable. High 5-year survival is observed only with small education after surgical treatment or liver transplantation. Often there is a relapse of the tumor and rapid metastasis. The cessation of the functioning of the organ leads to death.
Prevention of hepatocellular carcinoma
Preventive measures include annual screening for hepatitis viruses, refusal of drugs and alcohol. It is worth remembering that inflammation of the liver can be obtained as a result of manipulations such as dental and cosmetic procedures, blood transfusion.