Hepatocellular carcinoma: symptoms

Symptoms of hepatocellular carcinoma are rather polymorphic. The course of the disease can be asymptomatic; while in patients only signs of cirrhosis are revealed. A tumor can be diagnosed accidentally. However, the clinical manifestations can be so vivid, and liver failure - so pronounced that the clinical picture resembles that of a liver abscess. The spectrum of manifestations fits between these two extreme clinical forms of the disease.

Age. Hepatocellular carcinoma can develop at any age. Among the Chinese and Bantu people, people under 40 years of age are often ill. In countries with a temperate climate, the age of patients with hepatocellular carcinoma is usually older than 40 years.

Floor. Men get sick 4-6 times more often than women.

Concomitant cirrhosis. It is necessary to diagnose cirrhosis in a timely manner. Hepatocellular carcinoma can be suspected in a patient with cirrhosis with worsening of the condition or the appearance of pain in the right hypochondrium, as well as the appearance of a palpable tumor originating from the liver. Hepatocellular carcinoma should be excluded even in cases when there is no improvement with adequate treatment of ascites, bleeding from esophageal varices or precoma in a patient with cirrhosis of the liver.

Rapid deterioration in a patient with hemochromatosis or chronic liver disease with serum HBsAg or anti-HCV antibodies indicates a possible development of hepatocellular carcinoma.

Patients complain of weakness and a feeling of discomfort and pressure in the upper abdomen. There is a decrease in body weight. The temperature rarely exceeds 38 ° C.

Pain is often observed in patients with hepatocellular carcinoma, but only in rare cases it is intense.

Usually it is a dull constant pain in the epigastric region, right hypochondrium or back. Intensive pain indicates perihepate or lesion of the diaphragm.

Disturbance of the function of the gastrointestinal tract with hepatocellular carcinoma is often observed. It is manifested by a lack of appetite, flatulence and constipation. The first symptom of the disease can be diarrhea, which is caused by cholestasis or the production of a tumor of active substances, such as prostaglandins.

Shortness of breath is a late symptom caused by a large tumor that presses against the diaphragm or sprouts into it, or metastases into the lungs.

Jaundice is rarely intense and, as a rule, does not depend on the size of the tumor. In rare cases, the tumor can have the appearance of a polyp on the leg, be located inside the bile duct and cause mechanical jaundice. The tumor can germinate into the common bile duct. In this case, in the lumen of the duct, tumor masses can be detected, and the immediate cause of death can be hemobiology.

Sometimes, as a result of necrosis of the central part of the tumor, fever and leukocytosis appear; while the clinical picture resembles that of a liver abscess.

The liver increases in size not only in the direction downward, into the abdominal cavity, but also in the direction of the thoracic cavity. In the right hypochondrium it is possible to palpate the dense tumor-forming formation with an uneven surface emanating from the liver. When the left lobe is affected, the tumor is palpated in the epigastric region. Sometimes several tumor nodes are palpable. Soreness can be so severe that it makes it difficult for palpation.

Over the tumor as a result of perihepatitis, friction noise can sometimes be heard. Arterial noise over the tumor is a consequence of the expansion of the arterial network, which supplies the tumor with blood. In the absence of acute alcoholic hepatitis, this noise indicates hepatocellular carcinoma.

Ascites are found in about half of the patients. The ascetic fluid contains a lot of protein. Malignant cells can be detected, but interpretation of them in the peritoneal fluid is difficult. Possible increase in LDH activity and carcinoembryonic antigen level in ascites fluid. It can be stained with blood. Rupture of the tumor leads to hemoperitoneum. The latter can develop gradually or be manifested by a picture of an acute abdomen with severe pain syndrome. The prognosis in such patients is very poor.

Thrombosis of the portal vein aggravates ascites. Occlusion of the hepatic veins may develop . Possible tumor germination in the right atrium and venous plexus of the esophagus.

Bleeding from varicose-dilated esophagus veins is a frequent and, as a rule, a fatal complication. The inability to stop bleeding from varicose veins in a patient with cirrhosis of the liver is often due to hepatocellular carcinoma that sprouts into the portal vein.

Clinical manifestations of metastases

Metastasis can be detected in the lymph nodes, especially the right supraclavicular nodes, which can then be palpated. Metastasis to the lungs can be accompanied by the appearance of pleural effusion. Massive embolism of the pulmonary artery causes dyspnea and pulmonary hypertension. Possible development of severe arteriopulmonary bypass. Bony metastases are usually found in the ribs and spine. Metastatic brain damage is manifested by brain tumor symptoms.

Systemic manifestations of hepatocellular carcinoma

Expressed endocrine disorders in hepatoblastoma in children are more common than in hepatocellular carcinoma in adults.

Possible painful gynecomastia, associated with increased secretion of estrogens.

The cause of hypercalcemia is sometimes pseudo-hyperparathyroidism. The tumor may contain a substance resembling parathyroid hormone (PTH); while the serum PTH level is elevated. Embolization of the hepatic artery can be effective.

Hypoglycemia occurs in 30% of patients. It can be caused by an extremely rapid growth of the tumor, usually undifferentiated, which is accompanied by an increase in the need for glucose. Occasionally, hypoglycemia develops in patients with a slowly progressing tumor. In this case, the activity in the tumor of G-6-phase and phosphorylase is reduced or absent, while the content of glycogen in the tumor and adjacent tissue is increased. This indicates that hypoglycemia is caused by the acquired disturbance of glycogen metabolism with its increased accumulation. In such patients it is extremely difficult to normalize blood glucose level even when eating foods with a high carbohydrate content.

In patients with severe recurrent hypoglycemia, the content of insulin-like growth factor with a high molecular weight (IPFR-II) in tumor tissue is 10-20 times higher than its content in normal liver. This can also contribute to the development of hypoglycemia.

Hyperlipidemia is rarely seen in patients with hepatocellular carcinoma, but approximately one-third of patients on a low-cholesterol diet have increased serum cholesterol. In one patient, hyperlipidemia and hypercholesterolemia were caused by the formation of abnormal beta-lipoprotein.

Hyperthyroidism may be due to inadequate production of thyroid-stimulating hormone.

Pseudoporphyria with a significant increase in the concentration of porphybilinogen in urine and serum is the result of porphyrin tumor production.

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