Education in the liver: types, diagnosis, symptoms and treatment

The number of people with pathological lesions in the liver continues to increase every year. Benign and malignant tumors of the gland are the main cause of damage to the liver structures in general. Doctors find an 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, it is much easier to detect pathology in a timely manner today.

Changes in organ structure

Hearing from the doctor the term “volumetric formation in the liver”, one 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 by hepatitis, cirrhosis, hepatosis and other diseases. In general, focal inflammatory changes respond well to therapy, and in some cases they can be completely eliminated with the help of medications or by surgical intervention.

Having discovered the formation in the liver by ultrasound, the doctor suspects the presence of a tumor-like pathological process. In this case, changes to the body can be:

• single or multiple cavities filled with liquid secretion, 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 healthy glandular tissue pathological, which is an undoubted violation of the normal functioning of the body. The appearance of benign or malignant formations is dangerous because, if they exist, 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 a problem

The most common clinical manifestations of tumor processes in the liver are the following symptoms:

• sudden and unreasonable weight loss;
• the occurrence of unjustified nausea, profuse vomiting;
• deterioration or complete loss of appetite;
• noticeable yellowing of the eye sclera and certain sections of the epidermis;
• enlargement of the liver in size;
• accumulation of fluid in the abdominal cavity (ascites).

The symptomatology of the pathology in each person can be individual, which depends on the type of volumetric 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 the affected areas and other examination methods.

The main types of hepatic neoplasms

Lesions of the body 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 of another organ.

Having determined the type of neoplasm, the doctor is given the opportunity to prescribe the most appropriate treatment technique. Statistics show that benign tumors of the gland are extremely rarely diagnosed, since this disease almost never manifests itself with any symptoms. At the same time, in most cases, cancer can be recognized only at the stage when even the most radical methods of treatment are ineffective.

Benign tumors

The most common types of liver formations (in the ICD, pathology data are indicated by code D13.4) are the following types of tumors:

• Cyst. This non-cancerous type of formation occurs in patients for various reasons. A cyst in the liver can be congenital, acquired, inflammatory, parasitic. A 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 is found in each segment, polycystosis is diagnosed.
• Hemangioma. This is a focal formation of the liver. What is it like? 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 examination are required. With a sudden increase in tumor size, additional diagnostic procedures are prescribed.
• Lipoma. This is a non-malignant lesion of the liver, which grows from fat cells. Typically, 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 cell structure remains the same, and the lobation of the gland changes. Most often, hyperplasia is congenital and occurs in women. This benign liver damage is localized mainly in the right hepatic lobe. Hyperplasia, which has a heterogeneous structure and various echogenicity, is often confused with cancer cells, therefore, if it is suspected, a biopsy can be prescribed. Compared with healthy tissues, hyperplasia often represents an isoechoic formation in the liver, that is, consisting of the same tissue as the organ itself.
• Hamartoma. This disease mainly occurs at an early age. A neoplasm of the liver is not located inside, but under the capsule.
• Cystadenoma. Focal hepatic tumor is largely similar to cystic formation. A feature of this neoplasm is the presence of several chambers separated from each other by a lined epithelium.

Features of adenomas

Typically, 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 the integument of the liver.

Due to the different structure, it is impossible to differentiate pathology using ultrasound. To confirm the benignity of the tumor, an organ puncture is performed. At risk for the appearance of hepatic adenoma are young women using hormonal contraceptives. If hepatic adenoma is suspected, steroid medications are canceled.

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 a good chance 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. In the generally accepted coding, any non-cancerous liver diseases are indicated by code D13.4, but in medical practice pathologies of this type have a wider classification. So, for example, vascular tumors with a cavernous spongy structure are attributed to 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 attribute vascular tumors to neoplasms, considering them to be congenital abnormalities of vascular development. As for biliary and circulatory lesions, they are more often referred to as varieties of hyperplasia. Such benign tumors have a pink or reddish tint, they are covered with a nonsmooth shell and a dense structure, can be of various sizes and can degenerate into cancer.

Stages of a non-malignant tumor process

None of the benign tumors described has a pronounced symptomatology. At the initial stages, such diseases do not affect the patient’s well-being, since tumors do not interfere with the full-fledged work of the body. Usually, the symptoms of the neoplasm are absent until it affects more than two hepatic lobes.

As a rule, the disease begins with the appearance of small nodular formations 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 disease, two lobes of the liver are affected, and two more adjacent remain healthy. To confirm the third stage of a benign tumor, three out of 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 bother the patient when it reaches a certain size. Iron itself does not have sensitive receptors, so most often the cause of the pain syndrome 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, tormented by 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 the benign nature, such a disease poses a serious danger to the health and life of the patient in the event of a rupture of the cavity formation, which will provoke intra-abdominal bleeding, chaotic outflow of bile and deformation of the base of the tumor. In advanced cases, cysts can cause suppuration. At any stage of its development, only nodular hyperplasia can latently occur. On palpation of the right side of the abdomen, the patient shows hepatomegaly. Hyperplasia is rarely complicated by bleeding or rupture. But even with a blurred clinical picture and the presence of doubtful symptoms, you need to be vigilant and rush to see a hepatologist.

Diagnostics and 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 cavity;
• CT and MRI of the liver ;
• laparoscopy and biopsy of the gland tissue with subsequent study of the resulting material;
• hepatoangiography.

A liver biopsy procedure is prescribed for suspected hyperplasia or adenoma. They penetrate the organ using a puncture needle inserted through the epidermis and subcutaneous tissue.

After an ultrasound scan, patients often begin to worry when they hear unfamiliar medical terms from the doctor. “Intimidating,” for example, for many is the concept of hypervascular formation of the liver. You should not worry too much, as this term denotes 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 pathological formation with increased echo density. Hypervascular tumors are better able to reflect ultrasound waves. Formation in the liver on an ultrasound scan will look like a white spot. Hemangiomas and cancers have hyper echogenicity.

In turn, a (hypo-intensive) hypoechoic formation in the liver is a fragment of an organ with a lower density. On the monitor, this area will look like a dark spot. A cyst or its varieties containing fluid in the cavity often turns out to be a hyperactive formation in the liver. The term “anechogenic formation” has a similar meaning - this is a section in the structure of an organ that does not reflect ultrasound due to its fullness with liquid. In a predominant number of cases, this characteristic is applied to a liver cyst. On the ultrasound monitor, the tumor has a rounded shape.

If the term “diffuse liver formations” is used in the doctor’s opinion, it is most likely that the ultrasound scan shows structural damage to the tissues that has arisen as a result of serious functional disorders. Diffuse changes can affect the entire organ or its individual lobe, which is called diffuse focal lesion. In any case, this concept is not a diagnosis, but only helps to clarify the clinical picture and select the correct treatment method.

How to treat benign tumors

An effective method of treating benign tumors in the liver is surgery. Only the removal of the tumor can reduce the risk of its transformation into a malignant formation. Moreover, during the operation, the surgeon can decide not only on the removal of pathological tissue, but also part of the organ itself. In the presence of a hormone-dependent small tumor, the choice is often made in favor of drug therapy. With the help of drugs, you can stop the growth of the tumor.

Types of Liver Cancer

Malignant neoplasms of the liver can be of two types:

• primary tumor, which is formed from the tissues of the gland;
• secondary tumor - a focus of metastasis, which occurs due to cancerous lesions 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 blood passes primarily through the liver, it is affected in almost 80% of cases.

Primary malignancies are much less common. At risk, mostly men older than 50 years. There are several types of liver cancer:

• angiosarcoma, developing from the inner membranes of the blood vessels of the gland;
• hepatocellular carcinoma, sprouting directly from the liver tissue;
• hepatoblastoma - a cancerous tumor that is diagnosed mainly at an early age;
• cholangiocarcinoma develops from the basal layer of the bile ducts.

In seven out of ten cases, the cause of liver cancer is the presence of 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 cirrhosis, untreated parasitic infestations (opisthorchiasis, schistomiasis), syphilis, and alcoholism. Frequent contact of the patient with carcinogenic chemicals is capable of serving as a factor provoking the disease. Treatment of liver cancer only in isolated cases is successful, since the mechanism of development and the causes of malignant processes in the liver are still not 100% studied.

How does a malignant tumor manifest?

The cancer process in the human body is manifested by "classic" symptoms. With damage to the abdominal organs in patients, nausea, vomiting, high body temperature appear. It is almost impossible to suspect liver cancer in the initial stages - this oncological disease may not make itself known for several years. When a certain symptom complex appears, indicating the likely course of malignant processes in the liver, it is urgent to be examined for cancer. Characteristic signs of malignant formation of the liver parenchyma are:

• fever;
• 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, and fainting. As the disease progresses and the tumor grows, the liver begins to increase in size. Moreover, the iron becomes more tuberous and dense. In parallel with this, the patient's epidermis acquires an icteric hue, and liver failure develops.

In some cases, cancer patients are diagnosed with intra-abdominal bleeding, up to the development of a shock state. Complications of liver cancer are also endocrine disorders resulting from the release of hematopoietic substances by cancer cells. With the progression of the tumor against cirrhosis, patients feel severe pain, suffer from constant fever, ascites.

Symptoms of metastatic oncology of the liver do not differ fundamentally from signs of primary cancer. The difference is that cancer cells enter the gland from other organs and lymph nodes.

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To obtain a more accurate picture, it is necessary to undergo an ultrasound scan. To date, the most informative type of instrumental diagnosis is magnetic resonance imaging and computed tomography of the liver, angiography. To verify the malignancy of the tumor cells, most doctors are inclined to the need for a puncture biopsy of the gland tissue for a detailed histological examination.

If cancer foci are the result of metastasis of a tumor of other organs, it is important to establish the localization of primary cancer. In this case, the treatment of the liver and the affected organ is carried out simultaneously. To identify a tumor, patients are sent for such procedures:

• FGDS;
• X-ray of the digestive tract;
• breast ultrasound and mammography;
• fluorography of the lungs;
• colonoscopy.

Can Oncology be Cured?

An individual treatment regimen is selected depending on the type, stage of cancer and the characteristics of the patient's body. 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, the complete removal of the formation with partial resection of the affected hepatic lobe is not ruled out. In this case, most of the organ is preserved.

In some cases, to save the patient’s life, it is necessary to remove half 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 takes on its previous size.

If surgery is not possible for any reason, the radiofrequency ablation technique is used. The essence of this manipulation is to influence the cells of a cancerous tumor with the help of radiation waves. A course of radiation therapy is carried out several times to achieve maximum results.

In addition, a number of cytostatics are used to combat liver cancer cells. Significant disadvantages of chemotherapy are the quick addiction of the body. To prevent this, drugs are delivered directly to the gland through the hepatic artery. Chemicals get to all pathological cells of the liver, but it does not affect other tissues and internal organs. Among the side effects of chemotherapy, it is worth noting severe nausea, vomiting, bleeding, hair loss, weakening of the immune system and malaise.