Liver fibrolamellar carcinoma

　　1. Etiology

　　The etiology of FLC is not yet clear. There is a difference in incidence between the two hemispheres, suggesting the possible role of racial or environmental factors. FLC does not exist in the background of hepatitis B virus infection and liver cirrhosis. It mainly occurs in young people under the age of 35, with a male-to-female ratio of 1:1.07, which is roughly similar, indicating that the age and gender distribution is similar to that of benign tumors. Some scholars believe that FLC originates from focal nodular hyperplasia; others believe that it originates from the proliferation of epithelial cells, followed by fibrous growth leading to fibrolamellar formation and cell carcinoma.

　　2. Pathogenesis

　　FLC mostly occurs in livers without cirrhosis, with the tumor mostly located in the left lobe of the liver, usually solitary, with clear tumor boundaries, marginal fan-shaped edges, hard texture, and transverse fibrous septa贯穿瘤体 in the cross-section; under the microscope, tumor cells appear in nests or clusters, some in mutually connecting tumor cell strands, surrounded by dense fibrous tissue that forms a lamellar-like sheath, with larger tumor cells showing cuboid or polygonal shapes, rich cytoplasm, and strong eosinophilia, with prominent nucleoli. The tumor tissue is rich in sinusoids.

　　Liver cancer can rupture spontaneously due to tumor development, necrosis, and softening, or due to external force, increased intra-abdominal pressure (such as severe coughing, forceful defecation, etc.) or rupture after physical examination. When liver cancer ruptures, the patient may experience severe abdominal pain, distension, and cold sweat, and in severe cases, shock may occur. Small ruptures of liver cancer can lead to small amounts of internal bleeding, which can often be adhered to by the omentum and stop bleeding spontaneously, with symptoms resolving within 3 to 5 days.

　　1. Hepatic encephalopathy

　　Accounts for 34.9% of the causes of liver cancer deaths. It is usually a complication at the end stage of liver cancer, caused by severe and widespread destruction of liver tissue due to liver cancer or concurrent liver cirrhosis. Drug-induced liver damage, bleeding, infection, electrolyte disorders, the use of large amounts of diuretics, or paracentesis often act as factors that trigger hepatic encephalopathy.

　　2. Gastrointestinal bleeding

　　Accounts for 15.1% of the causes of liver cancer deaths. Most are due to portal hypertension caused by liver cirrhosis or tumor thrombus, leading to variceal bleeding in the esophagus and gastroesophageal junction. Patients often die due to hemorrhagic shock or induced hepatic encephalopathy. In addition, late-stage liver cancer patients may also experience widespread bleeding due to gastrointestinal mucosal erosion, ulcers, and coagulation dysfunction.

　　FLC often occurs in children and adolescents aged 5 to 35, and occasionally in the elderly. However, in the 3 reported cases of FLC, only 1 case was under 35 years old, with an average age of 45.6 years. The incidence rate of males and females is roughly the same. Abdominal discomfort, abdominal pain, bloating, fatigue, anorexia, and weight loss are common complaints. Two-thirds of patients can feel abdominal masses. Jaundice is rare. The above symptoms and signs appeared on average 11 months before diagnosis, 2.8 months earlier than general hepatocellular carcinoma.

　　1. Strengthen physical exercise to enhance physical fitness, exercise more in the sun, and sweat can help expel acidic substances from the body through sweat, preventing the formation of an acidic constitution.

　　2. Develop good living habits, quit smoking and limit alcohol consumption. The World Health Organization predicts that if people stop smoking, the world's cancer rate will decrease by one-third in 5 years. Secondly, do not drink excessively. Cigarettes and alcohol are highly acidic substances, and people who smoke and drink for a long time are prone to develop an acidic constitution.

　　3. Do not eat too much salty and spicy food, do not eat overheated, cold, expired, and deteriorated food. The elderly, the weak, or those with certain disease genetic predispositions can prevent brain tumors by moderately consuming cancer-preventive foods and alkaline foods with high alkaline content, maintaining a good mental state.

　　4. Maintain a good attitude towards stress and combine work and rest, do not overwork. Traditional Chinese medicine believes that stress leads to overwork and physical weakness, which in turn causes a decrease in immune function, endocrine disorders, internal metabolism disorders, leading to the deposition of acidic substances in the body. Stress can also lead to mental tension, qi stasis and blood stasis, internal invasion of toxic fire, and other symptoms.

　　Liver function tests:For example, ALT, AKP, and serum bilirubin may have mild to moderate elevations; a small number of FLC patients (10%) have elevated serum AFP, and about 14% of patients are HBsAg positive.

　　Some tumor markers are often helpful in diagnosis:Serum unsaturated vitamin B12 binding capacity, vitamin B12 concentration, plasma neurotensin (neurotensin), CEA, and other indicators are often elevated. Due to the lack of clinical characteristics of FLC and the numerous liver tumors that need to be differentiated, it is necessary to identify them.

　　Three, pathological diagnosis of FLC

　　1, H-E staining shows abundant strong eosinophilic granules in the tumor cytoplasm.

　　2, Collagen fibers and fibroblasts are parallelly arranged in a lamellar manner around the nest-like, string-like, or plate-like distribution of tumor cell clusters.

　　Four, plain film:It can be seen that there are calcification foci in the tumor.

　　Five, ultrasound examination:It can show the homogeneous and fibrotic characteristics of the tumor, and the typical features are homogeneous hyperechoic nodules and shadows behind the hyperechoic nodules caused by calcification.

　　Six, CT enhancement scan:It shows a significant enhancement of the density of fibrolamellar carcinoma.

　　Seven, angiography examination:It shows as a highly vascularized mass with significant staining, and there are often gaps in the capillary phase.

　　Eight, radionuclide imaging shows radioactive defects.

　　1, Balanced Diet:Patients with liver fibrolamellar carcinoma have high energy consumption, and it is necessary to ensure that they have enough nutrition. The simplest way to measure the patient's nutritional status is whether they can maintain their weight. To maintain a normal weight, the best way is to maintain a balanced diet, and patients should also eat more fresh vegetables, and half of them should be green leafy vegetables.

　　2, Fats and Proteins:High-fat diets can affect and worsen the condition, while low-fat diets can alleviate symptoms such as nausea, vomiting, and abdominal distension in liver cancer patients. Liver cancer patients have poor appetite and eat less. If there is not enough balanced diet, it is necessary to increase the calorie intake and eat easily digestible fats and sweets, such as honey, royal jelly, sucrose, and vegetable oils, butter, and so on. Liver cancer patients should eat more foods rich in protein, especially high-quality protein, such as lean meat, eggs, beans, milk, and so on, to prevent a decrease in albumin. However, in the late stage of liver cancer, when liver function is poor, protein intake should be controlled to avoid excessive protein intake causing hepatic encephalopathy.

　　3, Vitamins:Vitamins A, C, E, K, and others have certain auxiliary anti-tumor effects. Vitamin C is mainly present in fresh vegetables and fruits. After beta-carotene enters the human body, it can be converted into vitamin A, so liver cancer patients should eat more animal liver, carrots, cauliflower, cauliflower, cabbage, figs, jujube, and so on. At the same time, they should also eat more fresh vegetables and fruits, such as radishes, pumpkins, bamboo shoots, asparagus, apples, wild plums, kiwi, and so on.

　　4, Inorganic salts:Namely, minerals. Nutritionists divide inorganic salts into two categories: macrominerals, such as calcium, sodium, potassium, phosphorus, iron, etc.; and trace elements, such as selenium, zinc, iodine, copper, manganese, and germanium. Scientists have found that minerals such as selenium, magnesium, copper, and iron have anti-cancer effects. Liver cancer patients should eat more foods containing trace elements with anti-cancer effects, such as garlic, mushrooms, asparagus, corn, seaweed, kelp, nori, clams, sea fish, egg yolks, brown rice, beans, whole wheat flour, nuts, pumpkin, Chinese cabbage, rapeseed, and the liver, kidneys of animals, as well as ginseng, wolfberry, yam, and lingzhi.

　　5, Liver cancer patients often have symptoms such as decreased appetite, nausea, abdominal distension, and poor digestion, so they should eat easily digestible foods:Such as sour plum soup, fresh orange juice, fruit juice, ginger sugar water, noodles soup, fresh millet porridge, etc., to help digestion and relieve pain. Do not eat too cold, too hot, or too full. Liver cancer patients often have nausea, vomiting, and anorexia, and should eat light and easy-to-digest foods such as almond milk, lotus root powder, corn porridge, tangerine cake, hawthorn cake, etc., and avoid eating greasy and fatty foods.

　　6. Liver cancer patients after surgery often suffer from weakness, fatigue, and anorexia due to injury to Qi and blood, and should focus on Qi and blood tonification:Rice soup, black chicken soup, ginseng tea, longan, silver ear, turtle, and avoid eating hard and cold foods.

　　7. Liver cancer patients in the late stage are often in a state of systemic failure, with difficulty in eating, and should focus on tonifying the body:In addition to increasing nutrition, it is common to brew American ginseng or Panax ginseng in water for drinking to enhance the function of each organ.

　　1. Treatment

　　FLC patients, due to the tumor being located in the left liver and the tumor boundary being clear, patients are young, and there is no history of liver cirrhosis, the first-line treatment can be a hemihepatectomy. If the tumor is huge and exceeds half of the liver, a left or right lobe resection of the liver can also be performed. The 5-year survival rate after FLC resection can reach 63%. For palliative resection, radiotherapy or chemotherapy can be supplemented; for patients with inoperable liver tumors but no extrahepatic metastasis. The 'two-step' plan can be adopted, which is to ligate the hepatic artery first, insert a catheter for chemotherapy, and then resect the tumor after the tumor shrinks; liver transplantation can also be performed. FLC is the only effective treatment for primary liver cancer by liver transplantation; it can also be treated by transcatheter hepatic arterial embolization to shrink the tumor and alleviate symptoms. Since FLC patients have a late recurrence and slow growth after tumor resection, recurrent tumors can be resected again or extraperitoneal metastases can be resected. Because FLC cells can secrete vitamin B12-binding protein and neurotensin. Therefore, these two indicators can be used for postoperative monitoring of tumor growth and shrinkage.

　　2. Prognosis

　　The median survival time for patients with hepatocellular carcinoma in the general clinical stage is 6 months, while FLC can reach 32-68 months. The overall 5-year survival rate is 36%. It is much better than the prognosis of hepatocellular carcinoma. The main reason is that FLC tumor growth is slow, the degree of malignancy is low, and the rate of surgical resection is high, even if the tumor cannot be resected and there is distant metastasis. The survival time of patients is also longer, averaging 24 months.