How does a liver tumor develop?
Long-term inflammation and liver cell death trigger ongoing tissue repair. With each cycle of division, genetic damage accumulates, and cicatricial restructuring in cirrhosis creates regeneration nodes. Some of these nodes gradually change their structure and turn into tumor nodes. Separate from hepatocellular carcinoma, cholangiocarcinoma growing from the bile ducts and metastases of other tumors to the liver are distinguished - the latter are even more common than primary cancer, but are treated differently.
- Hepatocellular carcinoma is the most common primary tumor
- Cholangiocarcinoma - from the bile ducts
- Metastases to the liver from the intestines, stomach, breast
- Precursors - nodes of regeneration and dysplasia in cirrhosis
- Rare forms in children - hepatoblastoma
Causes and risk factors
The basis of the risk is chronic liver damage. Viral hepatitis B and C maintain inflammation for years, and against their background, tumors can develop even without significant cirrhosis, especially with hepatitis B. Alcohol and metabolic fatty liver disease, associated with excess weight and diabetes, are now coming to the fore. Additional contributors include aflatoxins, mold toxins in improperly stored nuts and grains, and hereditary hemochromatosis.
- Liver cirrhosis of any nature
- Chronic hepatitis B and C
- Systematic alcohol consumption
- Fatty liver disease, obesity, type 2 diabetes
- Aflatoxins in moldy foods
- Hemochromatosis and other hereditary liver diseases
- Male gender and age over 50 years
Symptoms
At an early stage, the tumor gives no complaints and is detected only during routine ultrasound. Later, heaviness and dull pain in the right hypochondrium, weakness, loss of appetite and weight loss appear. In a person with cirrhosis, the alarming signal is a sudden deterioration: an increase in jaundice, rapid accumulation of fluid in the abdomen, resistance to previous treatment. Sometimes the tumor first manifests itself with sharp pain and a drop in pressure due to a ruptured node - this is an emergency situation that requires calling 103.
- Heaviness and pain in the right hypochondrium
- Weakness, fatigue, loss of appetite
- Weight loss
- Jaundice and itchy skin
- Enlarged abdomen, swelling of the legs
- Increase in temperature for no apparent reason
Diagnostics and screening
For people with cirrhosis and chronic hepatitis B, liver ultrasound is recommended every 6 months, often along with an alpha-fetoprotein test. When a node is detected, MSCT or MRI with contrast is performed in several phases: hepatocellular carcinoma has a characteristic contrast behavior, which in many cases makes it possible to make a diagnosis without a biopsy. A biopsy is performed if the picture is unclear. Be sure to evaluate liver function, coagulation and markers of viral hepatitis.
- Ultrasound of the liver every 6 months in risk groups
- Alpha fetoprotein blood
- MSCT of the abdominal cavity with contrast
- MRI of the liver with contrast
- Biopsy of a node with ambiguous data
- Markers of hepatitis B and C, liver tests, coagulogram
Treatment and prevention
The choice of method depends on the size and number of nodes, the preservation of liver function and general condition. If there is a single small tumor and good liver function, resection or radiofrequency ablation is performed, and in some cases liver transplantation is considered. In case of multiple nodes without distant spread, chemoembolization of the vessels feeding the tumor is used. At the advanced stage, targeted and immune drugs are used. Prevention is real: vaccination against hepatitis B, treatment for hepatitis C, avoiding alcohol and controlling weight.
- Surgical resection of a portion of the liver
- Radiofrequency or microwave ablation
- Liver transplantation according to indications
- Transarterial chemoembolization
- Targeted and immunotherapy
- Hepatitis B vaccination, antiviral treatment
- Alcohol cessation, weight loss, diabetes control
