August 15, 2023
The onset of liver cancer is often concealed, and it is often discovered by chance through the use of alpha fetoprotein (AFP) and B-mode ultrasound during liver disease follow-up or physical examination. At this time, the patient has no symptoms, and the physical examination also lacks the signs of the tumor itself. This stage is called subclinical liver cancer. Once symptoms appear, most patients who seek medical attention have already entered the middle to late stages of the disease. The clinical manifestations of liver cancer vary significantly in different stages.
(1) The symptoms of liver cancer include liver pain, fatigue, poor appetite, and weight loss, which are the most characteristic clinical symptoms.
① Liver pain: The most common, intermittent and persistent, dull or distended pain, caused by the rapid growth of cancer and the tightening of the liver capsule. The tumor invades the diaphragm, and the pain can radiate to the right shoulder or back. Tumors that grow to the right can cause pain in the right back. Sudden occurrence of severe abdominal pain and peritoneal stimulation signs indicates subcapsular bleeding or rupture into the abdominal cavity of the cancer nodule.
② Gastrointestinal symptoms include decreased appetite, indigestion, nausea, vomiting, and diarrhea, which are easily overlooked due to a lack of specificity.
③ Fatigue, emaciation, general weakness, and a few patients in the late stage may present with cachexia.
④ Fever: Generally low fever, occasionally reaching over 39C, presenting as persistent or afternoon low fever or relaxation type high fever. Fever is related to the absorption of cancer necrosis products. Cancer compression or invasion of the bile duct can lead to biliary tract infection.
⑤ Symptoms of metastatic foci: There are corresponding symptoms at the site of tumor metastasis, sometimes becoming the initial symptom of liver cancer. If transferred to the lungs, it can cause coughing and hemoptysis, while pleural metastasis can cause chest pain and bloody pleural effusion. Embolization of pulmonary arteries with cancer thrombi can cause pulmonary infarction, which can suddenly cause severe breathing difficulties and chest pain. Cancer thrombus obstructs the inferior vena cava, which can lead to severe edema of the lower limbs and even a decrease in blood pressure; Obstruction of hepatic veins can lead to Budd Chiari syndrome and lower limb edema. Metastasis to the bone can cause local pain or pathological fractures. Transferring to the spine or compressing spinal nerves can cause local pain and paraplegia. Intracranial metastasis can present corresponding localized symptoms and signs, and intracranial hypertension can also lead to sudden death due to cerebral hernia.
⑥ Other systemic symptoms: Endocrine or metabolic symptoms caused by abnormal metabolism of cancer itself or various effects of cancer tissue on the body are called concomitant cancer syndrome, which sometimes precedes the symptoms of liver cancer itself. Common symptoms include: 10% to 30% of patients may experience spontaneous hypoglycemia; 2% to 10% of patients may develop polycythemia, etc.
(2) Physical signs
① Progressive liver enlargement is one of the most common characteristic signs. The liver has a hard texture, irregular surface and edges, often presenting as nodules. Cancer of the right lobe of the liver on the diaphragmatic surface can significantly elevate the right diaphragm.
② About one-third of patients with splenomegaly have splenomegaly, which is often caused by cirrhosis.
③ Ascites are a common manifestation of advanced liver cancer, with about half being bloody and often not relieved by diuretics.
④ Jaundice can cause hepatocellular jaundice when the cancer infiltrates extensively; Obstructive jaundice can occur when the intrahepatic bile duct or hilar lymph nodes are invaded and compress the bile duct. Sometimes, tumor necrosis tissue and blood clots fall off into the bile duct, causing obstruction of the bile duct and leading to obstructive jaundice.
