Liver Cancer

　　The main etiological factors of liver cancer in China include viral hepatitis infection, contamination of aflatoxins in food, and drinking water pollution in rural areas.

　　1. About one-third of liver cancer patients have a history of chronic hepatitis, and the positive rate of hepatitis B surface antigen (HbsAg) is significantly higher than that in low-incidence areas. It has been found that infection with hepatitis C virus is closely related to the incidence of liver cancer, just like hepatitis B virus infection. Hepatitis B virus and hepatitis C virus are definitely one of the promoting factors for cancer.

　　2. About 50% to 90% of liver cancer patients have liver cirrhosis. In recent years, it has been found that the proportion of chronic hepatitis C developing into liver cirrhosis is not less than that of hepatitis B.

　　3. Experimental evidence shows that the metabolites of aflatoxin B1, a metabolite of aflatoxin, have a strong carcinogenic effect and are present in food such as moldy corn and peanuts. In areas seriously contaminated by aflatoxin B1, the incidence of liver cancer is also high. Nitriles, azo compounds, alcohol, organochlorine pesticides, and other substances are all suspected carcinogens.

　　4. Some drinking water is often contaminated with polychlorinated biphenyls, chloroform, etc., and in recent years, it has been found that the blue-green algae growing in ponds is a strong carcinogenic plant that can contaminate water sources. Parasitic diseases such as Clonorchis sinensis infection can stimulate the proliferation of bile duct epithelium and can lead to primary bile duct cancer.

　　5. Chronic alcoholism is the number one killer of liver damage. This is because alcohol, after entering the human body, is mainly metabolized in the liver. The toxicity of alcohol to liver cells causes liver cells to have difficulty in the decomposition and metabolism of fatty acids, leading to fat deposition in the liver and causing fatty liver.

　　Complications of liver cancer can be caused by the liver cancer itself or liver cirrhosis, which is common in the late stage of liver cancer. The main complications of liver cancer include the following types.

　　1. Hepatic coma:Seen in the terminal stage of liver cancer, mild symptoms may include abnormal behavior, such as reversed sleep patterns (sleeping during the day, being restless at night), spontaneous urination, etc. Further development may lead to irritability, and eventually, coma. Hepatic coma is often induced by upper gastrointestinal hemorrhage, can also be induced by excessive intake of high-protein foods, or can occur without obvious triggers.

　　2. Upper gastrointestinal hemorrhage:Commonly caused by variceal bleeding from portal hypertension or bleeding from upper gastrointestinal ulcers. Mild cases may manifest as melena, while severe cases may vomit a large amount of fresh blood, leading to shock due to the large amount of bleeding, with a high mortality rate.

　　3. Liver cancer rupture and hemorrhage:It can present as sudden pain in the liver area and abdomen. If the capsule of the liver is not ruptured, bleeding can accumulate under the capsule of the liver, forming a local hematoma. If the capsule is ruptured, most of the bleeding is large, and a large amount of hemorrhagic ascites is formed. Patients may show symptoms of shock, such as palpitations, cold sweat, blurred vision, and a decrease in blood pressure.

　　4. Hepatorenal syndrome:It is a complication of advanced liver cancer, presenting as oliguria, large amounts of ascites, and edema. This complication is a secondary renal dysfunction after liver function failure.

　　5. Infection:It is also a common complication of liver cancer, because the immune function of liver cancer patients is low, and the liver function is incomplete, which is prone to infection. Common infections include spontaneous peritonitis, in which patients may present with fever, abdominal pain, and recent increased ascites. Laboratory tests may show an increase in white blood cells, cloudy ascites, increased ascites white blood cells, and bacterial culture can be grown from ascitic fluid.

　　Some typical symptoms of liver cancer only occur when the disease progresses to middle and late stages, and by then, the opportunity for surgery is often lost, so self-examination is very important in daily life.

　　First, early symptoms

　　It takes about 2 years from the formation of the first cancer cell in the liver to the onset of自觉 symptoms in the patient. During this period, patients may have no symptoms or signs, and only a few patients may experience symptoms such as decreased appetite, upper abdominal fullness, abdominal pain, fatigue, and anorexia. Some patients may also have mild liver enlargement, jaundice, and skin itching. However, in general, these symptoms are difficult to be noticed by people, and therefore, many patients with liver cancer often enter the middle and late stages when they are discovered.

　　Second, symptoms in middle and late stages

　　1. Pain in the liver area, most commonly intermittent or continuous dull or胀痛, the rapid growth of the tumor can cause the liver capsule to become tense and invade the diaphragm, resulting in pain, which can radiate to the right shoulder or back; tumors growing to the right posterior can cause right lumbar pain; sudden onset of severe abdominal pain and peritoneal irritation suggests subcapsular hemorrhage of the tumor nodules or rupture into the peritoneal cavity.

　　2. Gastrointestinal symptoms, such as decreased appetite, indigestion, nausea, vomiting, and diarrhea, are often overlooked due to their lack of specificity.

　　3. Fatigue, weight loss, and general weakness. A few patients in the late stage may present with cachexia.

　　4. Fever, usually low-grade, occasionally reaching above 39℃, presenting as persistent fever, low-grade fever in the afternoon, or remittent fever. Fever is related to the absorption of necrotic products of the tumor. Tumor compression or invasion of the bile duct can lead to concurrent biliary tract infection.

　　The development of science and technology has made it possible to carry out comprehensive prevention and treatment of liver cancer at different stages of its occurrence and development. In the past, liver cancer could only be 'treated after the disease has occurred', in China it was possible to 'treat early disease' in the 1970s, that is, to treat patients without symptoms and signs, and now it has shown 'treatment of similar diseases', that is, to treat the precancerous stage or the very early stage of cancer. Finally, it will be possible to 'prevent disease', which is the prospect of preventing liver cancer. Since liver cancer is often accompanied by liver cirrhosis, and this liver cirrhosis is mainly caused by hepatitis B, preventing hepatitis B may significantly reduce the incidence of liver cancer in several years. The specific measures for preventing hepatitis B are to vaccinate against hepatitis B. In addition, using a special, high-titer immunoglobulin can also interrupt or reduce the transmission of hepatitis B from mother to child. The occurrence of liver cancer may also be related to moldy grains, so achieving mold prevention and detoxification may also reduce liver cancer; drinking still water in some areas may also be related to the incidence of liver cancer, so improving water quality measures in these areas will also help prevent liver cancer.

　　The specific examinations that liver cancer patients need to do are as follows:

　　Firstly, liver cancer serum marker detection

　　1. Alpha-fetoprotein (AFP) serum determination: It has relative specificity for the diagnosis of this disease. Radioimmunoassay of continuous serum AFP ≥400μg/L, and the exclusion of pregnancy and active liver disease, can consider the diagnosis of liver cancer. Clinically, about 30% of liver cancer patients have negative AFP. If AFP heterogeneity is detected simultaneously, the positive rate can be significantly improved.

　　2. Blood enzyme and other tumor marker tests: Gamma-glutamyl transferase and its isoenzymes, abnormal prothrombin, alkaline phosphatase, and lactate dehydrogenase isoenzymes in the serum of liver cancer patients can be higher than normal, but they lack specificity.

　　Secondly, imaging examination

　　1. Ultrasound examination: It can display the size, shape, location of the tumor, and whether there are cancer emboli in the hepatic veins or portal veins. Its diagnostic accuracy can reach 90%, and it is a non-invasive examination method with good diagnostic value.

　　2. CT examination: It has high resolution, and the diagnostic accuracy for liver cancer can reach over 90%, and it can detect tiny cancer foci with a diameter of about 1.0cm.

　　3. Magnetic Resonance Imaging (MRI): Its diagnostic value is similar to that of CT. It is superior to CT in distinguishing between benign and malignant liver lesions, especially in differentiating from hemangiomas.

　　5. Selective abdominal aortic or hepatic artery angiography: For richly vascularized tumors, the resolution limit is about 1cm, and for

　　4. Fine needle aspiration cytology examination by liver puncture: Under the guidance of B-ultrasound, fine needle puncture helps to improve the positive rate. It is suitable for those who have undergone various examinations but still cannot be diagnosed, yet are highly suspected.

　　Liver cancer patients must ensure adequate nutritional intake, generally with a diet high in protein, sugar, vitamins, and low in fat, such as lean meat, eggs, yogurt, fresh fruit juice, and fresh vegetable juice. Especially fresh vegetables and fruits should be included in every meal to maintain smooth defecation. However, liver cancer patients often have esophageal varices and gastric fundus varices, so the food should not be rough and should not be hard or too hot to prevent bleeding.

　　In addition, liver disease patients should follow personalized principles according to the severity and urgency of their condition. The diet should be soft, cool, and easy to digest, such as steamed buns, noodles, noodles, egg soup, ham sausages, etc., but it is禁忌to eat high-protein foods in large quantities in a short period of time to prevent a sharp rise in blood ammonia concentration, causing hepatic coma. Patients should abstain from alcohol, and can eat some honey, royal jelly, soy milk, mushrooms, fish, etc. Soy milk can be used as a regular drink for chronic hepatitis patients, mushrooms are rich in nutrients, especially amino acids and vitamins, which have antibacterial, anticancer effects and the function of invigorating the spleen and appetite.

　　Liver cancer patients can choose traditional Chinese medicine for treatment under the guidance of a doctor according to their condition, such as strengthening the spleen and Qi method, nourishing Qi and blood method, regulating Qi and promoting digestion method, clearing heat and detoxifying method, activating blood circulation and removing blood stasis method, etc.

　　1. Strengthening the spleen and Qi method:Indicated for fatigue and weakness, weak pulse, thin tongue coating, and non-red tongue quality. Ginseng (or dangshen), Danggui, Baizhu, Yun Fuling, etc., can be used.

　　2. Nourishing Qi and blood method:Indicated for anemia or after hemorrhage, sallow complexion, pale lips and nails, dizziness and weakness, pale tongue, thin pulse. Astragalus, Danggui, Lycium barbarum, Herba epimedii, etc., can be selected.

　　3. Regulating Qi and promoting digestion method:Applicable for chest and hypochondrium fullness, epigastric distension, fullness after eating, poor appetite, or as adjuvant treatment for ascites. Prepared Rehmannia, Bai Shao, Zhishi, Chuan houpu, Da fu pi, Wu xiang, Jiao San xian, Ji neijin, Gu ya, etc., can be used.

　　4. Clearing heat and detoxifying method:Indicated for jaundice, or accompanied by heat syndrome, red tongue with yellow greasy coating, slippery and rapid pulse. Raw Chen, Job's tears, Herba Hedyotis diffusa, Lysimachia christinae, Rhizoma Lysimachiae, Rhizoma Polygoni multiflori, etc., can be used.

　　5. Activating blood circulation and removing blood stasis method:Indicated for liver area pain, tongue with spots of blood stasis, and other typical blood stasis symptoms. Curcuma, Raw Pu Huang, peach, Yuanhusuo, Yujin, etc., can be used, and attention should be paid to those with bleeding tendency and advanced liver cancer should be used with caution.

　　6. Softening hard masses and dispersing nodules method:Indicated for those with masses in the liver area. Radix Belamcandae, Prepared Bixie bark, Zhebeimu, Manis pentadactyla, etc., can be used.