How terrible is liver cancer, known as the "king of cancer"?

The liver is the largest organ in the body and is divided into two lobes, the right lobe accounts for about 3/5 of the liver and weighs about 1.2 kg. A normal liver can regenerate and even if 2/3 of the liver is removed, the body can still maintain normal function and the remaining liver will regenerate, allowing the liver to grow back to its original size. The main function of the liver is to detoxify and metabolize.

The liver's main function is to detoxify and metabolize, and almost all the nutrients needed by the body are synthesized by the liver. There is no nerve inside the liver, so there is no warning when a lesion occurs, and there is no pain until the liver envelope is enlarged.

Classification of liver cancer

Hepatocellular carcinoma is a malignant tumor that occurs in the liver and can be classified as

(1) Cancer caused by cells in the liver is called "primary liver cancer". Primary hepatocellular carcinoma is classified according to the site of complication: (1) "hepatocellular carcinoma", which occurs in the liver cells in the liver lobe; and (2) "cholangiocellular carcinoma", which occurs in the epithelial cells of the bile ducts. Nearly 90% of primary liver cancers are hepatocellular carcinomas, so the term "hepatocellular carcinoma" is generally used as a generic term for hepatocellular carcinoma.

(2) When cancer cells outside the liver spread to the liver through blood or other channels, it is called "metastatic liver cancer" or "secondary liver cancer".

According to the World Health Organization (WHO), hepatocellular carcinoma is the 5th most common cancer in the world and is common in tropical regions and developing countries. For example, the incidence of hepatocellular carcinoma is high in coastal China, including Hong Kong, Guangxi, and Taiwan, and the incidence in Vietnam is also quite high; in Hong Kong, China, hepatocellular carcinoma is the 4th most common cancer, and the death rate is the 3rd highest; there are more than 1700 new cases each year, and the incidence is higher in men than in women. The prevalent age of liver cancer is between 50 and 60 years old, and the main causes of chronic liver disease, cirrhosis, and liver cancer are hepatitis B and C, which account for about 80%; and 70% to 90% of hepatitis B patients are more likely to develop cirrhosis and increase the probability of liver cancer than hepatitis C patients. Non-alcoholic steatohepatitis (NASH) is also becoming more common and is now the leading cause of liver cancer in some parts of Europe and the United States.

Because the symptoms of liver cancer are not obvious, it is often not detected until the middle and late stages of the disease. Therefore, only a relatively small number of people will learn of cancer in its early stages and be cured by surgical resection or local cautery.

Causes of Liver Cancer

The common causes of liver cancer can be classified as follows

(1) Hepatitis B and C viruses: After long-term and repeated inflammation, the liver will regenerate and form nodules after being destroyed and leading to fibrosis, which will turn into cirrhosis. After long-term infection, the virus can be embedded in the nucleus of liver cells, causing degeneration of the cells, and the mutated cells will gradually lose control and become liver cancer. Therefore, people with chronic hepatitis B or C virus infection have a higher incidence of liver cancer than the general population and should be followed up and treated regularly.

(2) Cirrhosis: Cirrhosis caused by any cause such as alcohol or chemicals that cause chronic damage to the liver has the chance to become liver cancer.

(3) Long-term alcohol abuse: Alcohol is metabolized into acetaldehyde, which damages DNA and increases the probability of cirrhosis. The risk of cirrhosis is also increased if there is double damage to the liver caused by hepatitis B or C.

(4) Hepatotoxic substances: corn, rice, and other cereals or peanuts, which are prone to mold production due to humid climates and high temperatures, can induce liver cancer.

(5) Hemochromatosis: Because of the accumulation of excessive iron in the body, it can lead to liver fibrosis and indirectly increase the risk of hepatocellular carcinoma; however, it is less common.

(6) Other factors: such as toxins in the environment, chemical environmental pollution, pesticide residues, metabolic defects, congenital deficiencies, and overdose of drugs may cause liver damage and should not be ignored.

What are the symptoms of liver cancer?

Like other cancers, liver cancer does not easily show symptoms in the early stage and can only be detected early by regular screening tests for high-risk groups. However, if the following symptoms appear

(1) Persistent lack of appetite

(1) Persistent lack of appetite/feeling full after eating a small amount of food, which may be caused by a liver tumor compressing the stomach or rapid deterioration of liver function.

(2) Unexplained weight loss: A significant weight loss of more than 5% of the original body weight within 3 months should be noted.

(3) Swelling and discomfort in the right upper abdomen: There are no nerves inside the liver, only the peritoneum on the surface of the liver. When there is stuffiness, vague pain, or swelling in the right upper abdomen, it is because the swelling of the liver stimulates the nerves, which may also spread to the back or cause pain in the right shoulder.

(4) Yellowish color of the skin and the whites of the eyes: This is the bilirubin produced by the body when breaking down blood cells. When the liver is sick and cannot eliminate bilirubin into the bile, it will cause jaundice; if liver cancer cells invade the bile ducts and cause obstruction, the bile cannot be discharged smoothly, which will also cause jaundice; if you find that the amount of water you normally drink does not change, but the color of urine is dark and the color of stool becomes lighter, it may also be a symptom of jaundice.

(5) Irregular spots: When liver function degenerates to a significant degree, it can lead to the appearance of spider-shaped hemangiomas on the skin, also known as spider nevi.

(6) Arthralgia: Pain that resembles arthritis. For example, autoimmune hepatitis, in which the immune system mistakenly attacks liver cells causing liver damage, can also lead to inflammation of joints, more common in women.

(7) Lower limb edema: When the liver is unable to make enough albumin, lower limb edema is likely to occur.

Developing symptoms

Many patients die not necessarily because of cancer itself but as a result of complications from cirrhosis or the process of liver cancer treatment, which is another major cause of death in patients with liver cancer. The common complications are as follows.

(1) Ascites. Ascites are the accumulation of excessive fluid in the abdominal cavity. Normally, there is a small amount of fluid in the abdominal cavity, about 100 ml, and it can be called ascites when the amount of fluid exceeds 200 ml. The production of ascites is associated with an imbalance in the exchange of body fluids inside and outside the blood vessels in the abdominal cavity.

(2) Jaundice. A clinical manifestation of yellowing of the sclera, skin, and mucous membranes caused by an increase in the concentration of plasma bilirubin when there is an impairment in bilirubin metabolism. Bilirubin comes from the body's aging red blood cells, and its production, metabolism, and excretion are closely related to the liver, and any disorder in one of the links may lead to an increase in the concentration of bilirubin in the blood and cause jaundice.

(3) Upper gastrointestinal bleeding. Upper gastrointestinal bleeding is one of the most common serious complications of hepatocellular carcinoma, and the causes are as follows.

(1) Esophageal or gastric varices: Esophageal or gastric varices are the most important cause of upper gastrointestinal bleeding in hepatocellular carcinoma. The main reason is that about 80% of liver cancer patients are usually accompanied by cirrhosis, which will lead to increased portal vein pressure and varies in esophageal and gastric fundic veins, which will rupture when the pressure reaches a limit and cause upper gastrointestinal bleeding, and serious bleeding will lead to death.

② Gastrointestinal mucosa erosion, and portal hypertension also often cause gastrointestinal stasis, arterial edema erosion, causing bleeding.

③ Coagulation mechanism disorder. The normal liver synthesizes a variety of coagulation factors. When a large amount of tissue is destroyed, its manufacturing function is reduced, resulting in insufficient coagulation factors and impaired coagulation mechanisms. In addition, portal hypertension due to cirrhosis can cause hyperfunction of the spleen and increase platelet destruction, which can also impair the clotting mechanism. In addition, cancer cells occasionally cause diffuse intravascular coagulation, which can also lead to clotting disorders.

(4) Ruptured hepatocellular carcinoma bleeds. When liver cancer grows rapidly, it will cause insufficient blood supply, resulting in tissue necrosis and tumor rupture, and bleeding; patients usually present to the clinic with acute upper abdominal pain, which starts with upper abdominal pain, often accompanied by a pale face, dizziness, cold sweat, nausea, vomiting, and other symptoms. As the disease progresses, the pain may gradually spread to the whole abdomen. Because this condition often occurs in the middle and late stages of cancer, most patients have a poor prognosis.

(5) Infection: Due to impaired liver function and low resistance, pulmonary and intestinal infections, spontaneous peritonitis and even severe sepsis are likely to occur.

(6) Hepatic encephalopathy. Hepatic encephalopathy is also known as the hepatic coma. Cirrhosis or cancerous tissue can severely damage the liver parenchyma and also create a short circuit between the portal system and the systemic circulatory system, which in turn reduces the detoxification function of the liver and leads to hepatic coma. Upper gastrointestinal bleeding, infection, hypokalemia, surgery, improper process of ascites extraction and discharge or heavy use of diuretics and drugs are common causes of hepatic encephalopathy, accounting for about 35% of deaths.

How to prevent liver cancer?

(1) Avoid hepatitis B and C infections: ① Avoid unnecessary injections and blood transfusions.

(2) Avoid using other people's toothbrushes and razors, and avoid tattooing with unsterilized instruments, eyebrow tattooing, ear piercing, and abnormal sexual behavior. ③ Those who are confirmed to be infected with hepatitis B or C virus should not donate blood to avoid infecting others. ④ If the blood test determines that the person is not infected with hepatitis B and has no immunity, he/she should be vaccinated against hepatitis B as soon as possible. ⑤ Blood tests should be performed when pregnant. If the pregnant woman is a highly infectious (e antigen positive) hepatitis B carrier, the newborn must receive one dose of hepatitis B immunoglobulin within 24 hours of birth, followed by three doses of hepatitis B vaccine on time. Other newborns should receive one dose of the hepatitis B vaccine each at 3-5 days, 1 month, and 6 months of age after birth.

(2) Actively treat hepatitis B and C. There are good drugs available for both types of hepatitis. According to research, reducing the amount of virus in the blood can reduce the incidence of liver cancer. Patients with hepatocellular carcinoma should regularly track liver indexes ALT and AST and consult their physicians about the suitability of antiviral drugs. Patients with hepatitis virus antigen carriers, cirrhosis, or a family history of hepatocellular carcinoma should have regular blood tests for abnormal elevations of alpha-fetoprotein and abdominal ultrasound every 3-6 months.

(3) Do not take drugs from unknown sources unless instructed by a doctor to avoid unnecessary burdens on the liver.

(4) Do not consume foods containing nitrosamine salts, such as ham, smoked meat, sausage, bacon and cured products, etc.

(5) Do not eat foods containing aflatoxin, the toxin is easily stored in moldy cereals or peanuts, if there is a potential risk, should avoid peanut candy, peanut butter, and other foods that do not see intact peanut particles.

(6) Reduce the amount of alcohol consumption to reduce the burden on liver metabolism.

Most importantly, we should maintain a balanced and nutritious diet, moderate exercise, maintain the ideal weight, work and rest normally, have enough sleep and do not stay up late, and maintain good habits, which will be of great help to liver health.