Hepatocellular carcinoma of the liver: diagnosis, symptoms and treatment

Primary oncological diseases of the liver are rare. In general, the 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 practically do not occur. In small patients , liver cancer, derived from embryonic tissues, can develop - hepatoblastoma. This pathology is rare. Virtually all primary liver tumors are considered to be aggressive. They occupy the fifth place in mortality in the structure of oncological pathologies. Currently, a search is being made for new means of combating liver cancer. Great achievements are achieved through the discovery of targeted and immune therapy.

Description of hepatocellular carcinoma

Hepatocellular carcinoma is a tumor originating from the hepatic cells that have undergone atypia. In comparison with other primary oncological pathologies of this organ, it is most common. This tumor is also called hepatic cell carcinoma. The frequency of occurrence of hepatocellular carcinoma among men ranks 5 th in the world. This tumor often occurs in developed countries. It refers to severe and rapidly progressing oncological diseases and often leads to death. It's not just the late diagnosis of pathology, but also its aggressiveness and the 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, it has its own special code and hepatocellular carcinoma. ICD-10 is used in all countries of the world. In classification, the disease has code C22.0, which means "liver-cell carcinoma." Most often, this pathology occurs against a background of chronic pathologies, under the influence of unfavorable factors.

Causes of carcinoma of the liver

As is known, the etiology of malignant neoplasms has not yet been studied. However, scientists have long found out which factors trigger the development of a particular tumor. Not an exception and liver-cell carcinoma. The following effects are brought to him:

1. Long-term carrier of some viruses. It is believed that such pathologies as chronic hepatitis B and C, increase the risk of liver carcinoma more than 100 times. In addition, these diseases often occur asymptomatically. Therefore, to reduce the risk of developing cancer, you should periodically give blood for hepatitis viruses.
2. Cirrhosis of the liver of any etiology. Substitution of hepatocytes for connective tissue most often occurs as a result of chronic viral infection, alcohol and drug use.
3. Eating foods rich in aflotoxins.
4. Genetic predisposition to the disease.
5. Reception of hepatotoxic drugs.

If we exclude the above provoking factors, the risk of developing hepatocellular carcinoma is minimal. Nevertheless, no one is immune from this tumor. Like other cancer pathologies, it can arise 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 cells. What exactly leads to this is not known. Due to the action of the virus, liver tissue becomes inflamed, the body becomes edematous and painful. The permeability of the vessels increases, they become full-blooded. As a result, the liver function is impaired. In addition to the fact that the body destroys viral particles, it is affected by other harmful substances coming from food. All this leads to cell transformation. The nucleus increases in size, the cytoplasm and other organelles are shifted toward the periphery. After this, the cell starts to share unmotivated. Many nuclei appear, metabolic processes in the hepatocyte are violated. In the cell, tumor proteins begin to be synthesized, which rapidly spread 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 in the event of complications. Another name for viral hepatitis C is "a gentle killer." This is due to the complete absence of clinical manifestations of pathology over the years and the imminent deaths resulting from 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 by the stage of development and severity. Depending on the macroscopic picture, the nodular, massive and diffuse forms of liver cancer are isolated. A separate species is considered fibrolamellar hepatocellular carcinoma. According to the clinical picture, 6 forms of hepatocellular carcinoma are isolated. Among them:

1. Hepatomegalic variant.
2. The icteric form.
3. A feverish version of liver cancer.
4. Ascetic form.
5. Acute abdominal variant.
6. Metastatic form of liver cancer.

Most often there is a combination of several clinical options. The stage of liver-cell cancer depends on the size of the tumor and its prevalence on the nearby lymph nodes and other organs.

Hepatocellular carcinoma: symptoms

Symptoms of the disease depend on the clinical form of the carcinoma. In most cases, in the early stages of cancer does not have any manifestations. In addition, diagnosis is difficult due to the fact that the symptoms of the tumor resemble a clinical picture of other liver pathologies (chronic hepatitis, cirrhosis). The late manifestations of cancer include subfebrile temperature, loss of appetite, general weakness, lymphadenopathy, weight loss. With hepatomegalic form of carcinoma, a marked increase in the liver, pain in the right subcostal area is noted. A third of patients have a jaundiced variant of the pathology course. He has an unfavorable prognosis. Jaundice develops in the first or second stage of the tumor process.

In addition, patients complain of pain and itchy skin. With a febrile form, there is a constant increase in body temperature, unpleasant, aching sensations in the upper half of the abdomen. Ascites appear in advanced stages of cancer, accompanied by common symptoms of tumor intoxication. Less common acute abdominal form. It is characterized by a pronounced pain syndrome, tension of abdominal muscles. In the metastatic variant of hepatocellular carcinoma, signs of defeat of other organs predominate. Among them - bones, lungs, intestines.

Morphological forms of carcinoma of the liver

According to the morphology, the following tumor forms are distinguished:

1. Massive hepatocellular carcinoma. It takes up a whole segment or even a fraction of the liver. At a cut has clear boundaries. Small foci (satellites) can also be present inside the tumor node. One form of massive liver cancer is the cavity form. On the cut, a tumor node is found, inside of which there is a brown liquid. The walls of the cavity are thick and smooth.
2. Nodular carcinoma of the liver. It is characterized by a multitude of tumor foci located along the entire surface of the parenchyma of the organ.
3. Diffuse carcinoma of the liver. Most often develops against cirrhosis. The entire parenchyma consists of elements of connective tissue and atypical cells.

Fibrolamellar carcinoma consists of one or more large nodes. Most often it is located in the left lobe of the liver. The color of the tumor is yellow or green. Another single form is considered to be encapsulated (small) liver-cell 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

It is necessary to perform a variety of examinations before identifying a disease such as hepatocellular carcinoma. 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, the presence of clefts, hemorrhages), lymph nodes, palpation of the liver. With cancer, the organ has a tuberous surface, a dense consistency, and soreness is noted. After this, a number of surveys are performed. Among them:

1. UAC, biochemical blood test.
2. Determination of the level of a special marker - alpha-fetoprotein.
3. Ultrasound of the abdominal cavity organs.
4. CT scan.
5. Research of blood vessels of the liver. These include angio-and portogepatografiyu.

Diagnosis is made on the basis of a cytological and histological conclusion. To conduct these studies, a biopsy of the organ is performed.

Hepatocellular carcinoma of the liver: treatment of the disease

The choice of therapeutic 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, surgical intervention, aspiration of nodal formations, chemotherapy is performed. In diffuse tumors, embolization of the hepatic artery is performed. This helps slow the growth of the tumor and limit the process. Hepatocellular carcinoma of the liver is insensitive to radiation methods of treatment. In addition, it rarely succumbs to chemotherapy, only 15-20% of patients have a temporary positive effect. One way is liver transplantation. In developed countries, this method is widely used. Transplantation of the donor organ is carried out only at the initial stages of cancer. In the presence of distant metastases, the only treatment is symptomatic therapy. It includes palliative care (patient care, psychotherapy) and anesthesia.

Surgical treatment of liver cancer

Surgical intervention is carried out almost all patients who are 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 the liver artery.

The most effective way is organ transplantation or part of it. Liver tissue has the ability to regenerate. As a result, the patient can be completely cured.

Medication for hepatocellular carcinoma

In addition to chemotherapeutic drugs, a new pharmacological group of medicines is actively used - protein kinase inhibitors. Their action is to reduce the proliferation of tumor cells. Despite many adverse reactions, these medications are quite effective. An example of drugs 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 in most cases unfavorable. High 5-year survival is observed only with a small size of education after surgical treatment or liver transplantation. Often there is a relapse of the tumor and rapid metastasis. The termination of the functioning of the organ leads to a lethal outcome.

Prevention of hepatocellular carcinoma

To preventive measures include an annual examination for hepatitis viruses, the denial of drugs and alcohol. It is worth remembering that the inflammation of the liver can be obtained due to such manipulations as dental and cosmetic procedures, blood transfusion.