Hepatic tumor

　　The etiology of liver tumors, after many studies, although there is a certain understanding, its cause is not yet clear. Currently, the research believes that the pathogenic factors are as follows.

　　Liver cirrhosis. About 80% of patients with liver cell liver cancer have liver cirrhosis, and most of them are large nodular cirrhosis. This may be due to the degeneration and necrosis of liver cells, the hyperplasia of interstitial connective tissue, the formation of fibrous septa, the nodular regeneration of residual liver cells, the formation of lobules, and the variation of liver cells during the repeated hyperplasia process, which can ultimately lead to carcinoma.

　　Viral hepatitis. The relationship between hepatitis B and liver cancer is relatively close; the incidence of liver cancer in patients with positive HbsAg is significantly higher than that in patients with negative HbsAg. There is also a close relationship between hepatitis C and the occurrence of liver cancer.

　　After the intake of food containing aflatoxin, it is absorbed through the digestive tract, reaches the liver, causing the degeneration and necrosis of liver cells, followed by hyperplasia and carcinoma.

　　4. Chemical carcinogens now clearly identified include nitrates and nitrites.

　　5. The immune status of the body. The occurrence of liver cancer is generally related to the low immunity of antibodies, especially closely related to the low cellular immune function.

　　Liver tumors often present with jaundice, ascites, and can be complicated by osteoporosis, multiple fractures, anemia, and thrombocytosis. Once malignant tumors appear in the liver, it can lead to serious consequences that threaten life. Due to the rich blood supply of the liver, its close relationship with important blood vessels in the human body, and the hidden onset, rapid growth of liver malignant tumors, treatment is very difficult, and the overall efficacy and prognosis are not very ideal at present.

　　In patients with liver tumors, children often present with irregular localized liver enlargement as the initial symptom, with the mass located in the right abdomen or upper right quadrant. The medical history often records rapid tumor growth, with some reaching below the umbilicus or beyond the midline. The surface is smooth, the edges are clear, the hardness is moderate, it can move slightly to the left and right, and there is no tenderness. In the early stage, in addition to mild anemia, the general condition is usually good. In the late stage, jaundice, ascites, fever, anemia, weight loss, visible varicose veins on the abdominal wall, and respiratory distress due to abdominal giant masses may occur. About 20% of cases of hepatoblastoma have osteoporosis, and severe cases can lead to multiple fractures.

　　Many patients have anemia and thrombocytosis when they come to the hospital, especially common in children with hepatoblastoma. The liver function of children with hepatoblastoma is often normal, but in cases of liver cell carcinoma, due to concurrent hepatitis or liver cirrhosis, serum bilirubin, alkaline phosphatase, and transaminase levels may be elevated. In 60% to 90% of liver cell carcinoma cases and more than 90% of hepatoblastoma cases, alpha-fetoprotein levels are elevated, and the excretion of cysteine in the urine of children with hepatoblastoma is increased.

　　Other primary liver tumors commonly include cavernous hemangioma and hemangioendothelioma. The former can compress liver tissue due to tumor growth, causing liver cell degeneration. Sometimes, there may be arteriovenous shunts within the tumor, which can lead to pediatric heart failure or death due to tumor rupture and bleeding. Small hemangiomas grow slowly and may not have clinical symptoms. Hemangioendothelioma is malignant, with the formation of blood sinusoids in the liver, and clinical symptoms may include pain, high fever, and jaundice. The course of the disease is slow, but the prognosis is poor. Liver hamartoma, teratoma, and solitary or multiple liver cysts are very rare.

　　Liver tumors often occur concurrently with liver cirrhosis or existing liver parenchymal lesions. As the number of cases of liver malignant tumors secondary to bile duct atresia and giant cell hepatitis increases, active prevention and treatment should be carried out. There is no special prevention for this disease, and early detection and early treatment are the key. If there is a high suspicion of liver cancer, it is recommended to undergo digital subtraction angiography (DSA) and hepatic artery iodinated oil contrast examination. One should be highly vigilant about symptoms such as anorexia, fatigue, poor spirit, prolonged low fever, edema, and pain in the liver area, and strive for early detection.

　　In the examination of liver tumors, the continuous development of serological and imaging techniques provides various methods for the early diagnosis of subclinical liver cancer. Clinically, serological diagnosis and imaging diagnosis are called localization diagnosis, and the comprehensive application of these methods can improve the accuracy of diagnosis. The specific examination methods of this disease are as follows.

　　1. Alpha-fetoprotein (AFP) detection

　　The accuracy of AFP for liver cells is about 90%, and its clinical value is as follows.

　　1. Early diagnosis: It can diagnose subclinical lesions and make a diagnosis about 8 months before the onset of symptoms.

　　2. Differential diagnosis: Since 89% of liver cell cancer patients have AFP levels greater than 20 ng/ml in their serum, those with AFP levels below this value and without other evidence of liver cancer can be excluded from liver cancer.

　　3. It helps to reflect the improvement and deterioration of the condition. AFP levels rising indicate deterioration, while levels decreasing and clinical improvement indicate improvement in the condition.

　　4. It helps to judge the completeness of surgical resection and predict recurrence or not. The AFP level decreases to the normal value after surgery shows complete resection, and if it decreases and then rises, it indicates recurrence. It can also predict recurrence 6 to 12 months before the onset of recurrence symptoms.

　　5. It helps to evaluate various treatment methods. The higher the AFP negative rate after treatment, the better the effect.

　　AFP false positive is not all AFP positive patients have liver cancer. AFP false positive is mainly seen in hepatitis and liver cirrhosis, accounting for 80% of false positive cases. In addition, there are also germ cell tumors, digestive tract cancers, pathological pregnancy, liver vascular endothelioma, malignant liver fibrous tissue tumor, and other diseases. For patients with AFP negative, if AFP negative cannot exclude the diagnosis of liver cancer, enzymatic tests can be performed, among which α1-antitrypsin (AAT), γ-glutamyl transferase (γ-GT), carcinoembryonic antigen (CEA), alkaline phosphatase (AKP), and other serological test results may increase in liver disease patients, but none of them are specific.

　　Liver Puncture Biopsy

　　For cases with a clear diagnosis, liver puncture examination can be omitted because liver puncture has certain complications, the most common being bleeding. In addition, when the needle is punctured, it may pass through the portal vein or hepatic vein and bile duct, which may lead to the spread of cancer cells into the blood vessels, causing metastasis.

　　Ultrasound

　　It can display tumors larger than 1 cm, with a correct diagnosis rate of 90%, and can display the size, location, shape, number, bile ducts, portal vein, spleen, abdominal lymph nodes, and other information. At the same time, it can also make a diagnosis of whether there is liver cirrhosis, splenomegaly, or ascites.

　　CT

　　The accuracy rate of diagnosis for liver cancer is 93%, with the minimum resolution display of 1.5 cm. Its advantage is that it can directly observe the size, location, and relationship between the tumor and the hepatic veins and portal veins, and can also diagnose whether there are cancer emboli in the portal vein or hepatic vein.

　　Vascular Angiography

　　Hepatic angiography can understand the blood supply of the lesion to judge the possibility and indications of surgery, and can display a tumor of about 1.5 cm. It is the highest resolution diagnostic method in the current imaging diagnostic methods, and it is of great significance for distinguishing liver hemangioma. At the same time, it can also understand whether there is a variation phenomenon in the hepatic artery, which is very helpful for liver resection surgery. If it is in the middle and late stage of liver cancer and cannot be treated surgically, embolism or chemotherapy can be given.

　　6. MRI and CT Compared

　　They are basically consistent, but they are helpful for some liver masses that are difficult to differentiate.

　　7. Radionuclide Scanning

　　For patients who are difficult to differentiate from hemangiomas, blood flow scanning can be used for differentiation, because the resolution of radionuclide scanning is low, it is generally rarely used as a diagnostic method for liver cancer.

　　8. Laparoscopy

　　For patients who are difficult to diagnose, laparoscopic examination can be considered, which can directly observe the liver, liver surface masses, and intra-abdominal conditions.

　　9. X-ray Examination

　　Under X-ray fluoroscopy, the right diaphragm can be seen to be elevated, movement restricted, or localized bulging, 30% of cases can be seen in X-ray films that there are calcified shadows within the tumor, and about 10% of cases have lung metastases at diagnosis.

　　Patients with liver tumors should pay attention to a light diet, eat more fruits and vegetables, and eat more fat-reducing foods. Patients should also strictly avoid alcohol, avoid animal oil, and the total amount of vegetable oil should not exceed 20 grams. The yolk of the eggs they eat should not exceed two, and they should also pay attention not to eat animal offal (i.e.,下水、下货), chicken skin, fatty meat, fish roe, and crab roe. Scallion, garlic, ginger, chili, and other 'four spices' can be eaten, but they should not be eaten in large quantities.

　　The most effective treatment for liver tumors is surgical resection of the lesion, both benign and malignant tumors can be resected, and about 95% of the cases can be completely resected. The liver tissue can be rapidly repaired 4 to 6 weeks after surgery, at this time, a复查 CT and AFP and B-ultrasound should be reviewed as a basis for future follow-up. Tumors are relatively insensitive to radiotherapy, and the combination of cisplatin and doxorubicin (adriamycin) is effective for hepatoblastoma, which can transform inoperable tumors into resectable lesions and can clear lung metastases.

　　For patients with extensive benign liver tumors that cannot be resected, there is currently no effective treatment. For children with inoperable hemangiomas involving the left and right liver lobes, if the liver hemangiomas that cause heart failure cannot be resected, a hepatic artery ligation can be performed. Currently, it is advocated to perform hepatic artery catheter embolization treatment.