Among the various forms of liver cancer the first place is occupied by hepatocellular carcinoma( HCC).
This type of malignant lesion of liver tissue leads to a rapid transition of one stage of the disease in the following, which explains the aggressiveness of the cancer and high mortality.
What is this disease?
Hepatocellular carcinoma leads to hepatocyte damage, which causes inflammation and subsequent tissue change. A distinctive feature of these malignant neoplasms can be called congestion of bile in them.
The defeat of the liver in HCC can be diffuse, nodular, the tumor is often multi-focal. Usually the cancer of this form is diagnosed already at the stage of metastasis - the patient is diagnosed with metastases in the lungs, bones, and lymph nodes.
If the transmission of the virus is from the mother to her child, it is possible to suggest the possible development of hepatocellular carcinoma in the first 10 years of life. Liver cancer of this species in most cases is diagnosed in patients with alcoholic cirrhosis.
Prevalence of
The number of patients with HCC continues to increase steadily and more and more of them become young adults.
Associate this, especially with the increase in infection with viral hepatitis.
Hepatocellular carcinoma according to recent studies is detected in more than 80% of cases of primary cancer.
This disease, according to the incidence rate, stands on the 8th place worldwide, and on death rate on the third place.
Annually more than 600 thousand people die from this kind of cancer. The average life expectancy from the time of diagnosis to death in Europe is about 4 months, in Asian countries about two months.
Types of
Macroscopically hepatocellular carcinoma is divided into several forms, this is:
- Massive form. This can be either a single large node or an entity that has a metastasis around its periphery.
- Nodal. In the parenchyma of the organ, several tumor nodes are detected, having almost the same size and localized in one or both in both lobes. Around the main formations there may be many small nodes, in the center of each neoplasm a site of necrosis is found. Individual nodes during their growth can merge with each other, occupying most of the liver.
- Diffuse form is rare. Cancer cells spread throughout the body, leading to infiltration or the formation of small nodules.
The histological structure of the fcc is divided into:
- Trabecular type. Cancer cells form trabeculae, separated by sinusoidal vessels.
- Pseudogertic type. In the liver, ferruginous structures are seen that have the shape of tubules, in their lumens there may be bile and cavities with fibrous exudate
- . Compact type of fcc - the trabeculae are so tightly attached to one another that the sinusoids become practically indistinguishable.
- Sclerotic type almost completely corresponds to trabecular, but has an abundant fibrous stroma.
Causes of
Hepatocellular carcinoma develops in most cases already against the background of existing chronic liver diseases. In turn, these pathologies occur against the background of viral hepatitis B and C, alcoholic cirrhosis.
Allocate the dependence of the disease on the characteristics of nutrition. If the human diet is predominantly unbalanced, there is insufficient protein intake, then the risk of malignant liver damage increases substantially.
A carcinogenic effect on hepatocytes is provided by aflatoxin contained in products with disturbed storage conditions. Aflatoxin is more often found on peanuts, corn, cereals.
As precancerous diseases such liver pathologies as adenomatous hyperplasia, the formation of dysplastic nodes are considered.
Allocate a group of provoking factors, these are:
- Parasitic lesions of the liver - opisthorchiasis, schistosomiasis.
- Fatty degeneration of the liver with obesity.
- Hemochromatosis.
- Perennial smoking.
- Excessive passion for alcoholic beverages.
- Use of steroids for muscle mass gain.
- Work on harmful industries associated with contact with solvents, polychlorinated biphenyls, aflatoxins of food.
HCC are more susceptible to men. In 80% of cases the disease develops against the background of cirrhosis, and smoking with a simultaneous long-term use of alcohol, the risk of cancer in the liver increases several times.
Symptoms of hepatocellular carcinoma of the liver
The development of hepatocellular carcinoma leads to a rapid deterioration in overall health, there is increasing weakness and there is a symptom such as weight loss.
In the initial stages of the disease, it can manifest only minor discomfort in the upper abdomen, later it starts to worry the constant pain on the right under the ribs.
The progression of the disease and tumor growth leads to a stretching of the liver capsule, which intensifies the pain. In HCC, the liver grows very quickly, the lower edge of the organ can be near the navel. When palpating the liver, you can feel the formation on it, which is mobile, but is welded to the organ.
In late stages of primary cancer, the patient most often develop ascites, there are signs of jaundice, possibly internal bleeding. Both in the early and late stages of liver damage is characterized by dyspeptic phenomena - flatulence, nausea, constipation or diarrhea, there is a persistent decrease in appetite, and aversion to certain types of food.
The formation of a tumor only strengthens these symptoms - in people suffering from viral hepatitis or cirrhosis, in a short time the overall well-being worsens, there is severe pain, progressive liver growth, signs of jaundice and dropsy.
Hepatocellular carcinoma can develop with different clinical manifestations.
There are several variants of the course of pathology.
- The hepatomegalic variant is manifested by a marked increase and compaction of the liver in size. When the organ is palpated, its tuberosity is determined. Patients complain of pain, irradiating in the lower back, rising body temperature, you can notice the yellowish color of the mucous membranes and sclera.
- Cirrhosis-like variant of the course of the disease is characterized by a slow development, a pronounced compaction and no increase in the organ. The pain is tolerable, arising periodically, most patients show signs of dropsy.
- The cystic variant with its course and symptoms is similar to the hepatomegal cancer variant, but only the tumor is formed much more slowly.
- A hepatonecrotic type of disease occurs if the tumor nodes are necrotic. With such a course of the disease, the symptoms of intoxication are clearly manifested, the body temperature rises to high figures, significant hepatomegaly is revealed, and patients complain of severe pain.
- Obturation type of fcc is exposed, when the compression of the main bile duct is detected, this causes early development of icterus, the neoplasm increases gradually.
Approximately 10% of cases of HCC does not manifest initially characteristic symptoms. The development of the clinical picture occurs when distant secondary foci appear, and jaundice and ascites begin to appear already in the terminal stage.
Neuroendocrine form
This type of disease begins to develop due to uncontrolled division of neuroendocrine cells.
These cells are located throughout the body, so the disease can affect any organ.
Characteristic features of neuroendocrine carcinoma of the liver should be indicated by the slow and asymptomatic growth of the neoplasm.
This is precisely what prevents the detection of cancer of this species in the initial stages.
General signs of pathology include cachexia, nephropathy, enteropathy.
Fibrolamellar form of
This subtype of pathology is today considered to be attributed to individual malignant diseases. Fibrolamellar carcinoma of the liver is most often detected in young people, as well as in children from five years of age.
In the initial stages of the disease, pain appears and there is a slight compaction under the ribs on the right. Neoplasm grows slowly, metastases appear at the last stage. Such features of the course of fibromellar carcinoma in most cases with surgical intervention allow us to give a comforting prognosis.
Diagnostics
Obligatory examination methods for suspected hepatocellular carcinogenesis are ultrasound of the liver, its computed tomography and a biopsy of the tissue taken for analysis. Assign and blood tests - conduct a general and biochemical analysis, determine oncomarkers.
Treatment of
In the treatment of hepatocellular carcinoma, complex therapy is mainly used - the patient is given an operation and a course of chemotherapy. During surgery, the segment or liver portion is removed, if complete organ removal is required, transplantation is performed.
In small tumors, it is possible to administer ethanol, which has a destructive effect. Another method of treating fcc is embolization of the artery, which disrupts the nutrition of the tumor and leads to its death.
The method of treatment is selected, only based on the size of education, the presence of metastases, the patient's well-being.
Prognosis and prevention of hepatocellular liver cancer
Hepatocellular carcinoma is considered a disease with high mortality. The prognosis improves if the disease is detected at the initial stage, the recovery and the absence of relapses also depends on the pathology variant.
Videoconference on orthotopic liver transplantation in hepatocellular carcinoma: