JMT: How to diagnose liver cancer? Symptoms are easily overlooked

JMT: How to diagnose liver cancer? Symptoms are easily overlooked.  The bone scan dose is extremely low and will not affect health.

“I obviously have no discomfort. I eat, sleep, and go to work normally every day, and I have no physical problems. How can I get liver cancer?!” Many patients who have been diagnosed with liver cancer usually cannot accept: Why does the liver have tumors? I don’t even feel it at all?

Symptoms of liver cancer

Unlike other organs or tissues of the human body, liver nerves are mainly distributed on the surface, and rarely in the liver. Therefore, when a small tumor develops in the liver, people will hardly feel pain and will not have any symptoms. If there is no regular screening, it is easy to ignore.

Small liver cancer is like a silent killer. It breaks out in silence. About 60% of small liver cancers do not produce symptoms. If the tumor is just near the bile duct or portal vein, symptoms will appear quickly.

Under normal circumstances, when the symptoms of liver cancer appear, it is usually the advanced stage of liver cancer.

It takes about 2 years for liver cancer to develop from the first cancer cells in the liver to the patient’s symptoms. During this period, the patient may have no symptoms or signs. Only a few patients may experience symptoms such as loss of appetite, upper abdominal distension, abdominal pain, fatigue, loss of appetite, etc., and some patients may experience mild hepatomegaly, jaundice and Itchy skin.

However, under normal circumstances, these symptoms are difficult to be paid attention to. Therefore, many patients with liver cancer in clinical practice are often in the middle and advanced stages of their disease when they are discovered.

1 How to diagnose?

Early liver cancer has no obvious symptoms, and the right thoracic cavity covers most of the liver, making it difficult to diagnose smaller tumors. Therefore, most patients can only be diagnosed in the middle to advanced stages of liver cancer.

The doctor will first learn about the past medical history from the patient, check whether the liver is swollen by pressing on the abdomen, check the skin and whites of the eyes for signs of yellowing, perform a blood test for liver function tests and check whether the alpha-fetoprotein (AFP) is high, or Scan the liver with ultrasound. However, because the ultrasound resolution is not high and the image is not clear, CT Scan or hepatic artery angiogram (angiogram) may also be performed.

Although scanning imaging can show liver lumps, it is not enough to determine whether the lumps are benign or malignant. At this time, it may be necessary to perform whole-body magnetic resonance (MRI) or positron scan (PETscan) to check for cancer cells in other parts of the body to determine whether the tumor originated in the liver or metastasized to the liver from other parts. If a more precise examination is required, tumor slices can be performed. The following briefly describes various diagnostic methods:

Liver function test (Liver function test, LFT)

Before liver cancer develops, many patients have suffered from hepatitis or cirrhosis, and only part of the liver remains healthy. Blood tests can assess liver function and check whether the liver can maintain the normal functioning of the body, so as to determine whether the patient is suitable for tumor resection.

Blood alpha-fetoprotein test

The tumor marker of liver cancer cells is Alpha Fetoprotein (AFP). If the AFP index in the blood of adults is high, it means that they may develop liver cancer.

AFP is generally only found in the blood of the fetus and will disappear automatically shortly after birth. However, when liver cells become cancerous, the body will reproduce AFP. Studies have found that the AFP index of patients with liver cancer has risen more than half a year before the onset of symptoms. Therefore, the AFP index can help diagnose early liver cancer, so it is often used for liver cancer screening in patients with high-risk liver disease and monitoring the effectiveness of liver cancer treatment.

However, the accuracy of diagnosing liver cancer by AFP index alone is not high, and the results can only be used as a reference. Studies have found that about 20% of patients with liver cancer have a normal AFP index. Liver cirrhosis, hepatitis, testicular tumors, ovarian tumors, metastatic liver cancer, and pregnancy can all increase the AFP index. Therefore, doctors generally cooperate with other scans for examination.

Liver ultrasound

The doctor will apply a lubricating gel on the skin surface of the patient near the liver, and then detect it with a sonic meter. The bounced sound waves will be converted into images by the computer in real time, allowing the doctor to observe the liver from the screen to confirm the location and size of the lumps. The liver ultrasound is painless and non-radiation. The whole process only takes more than ten minutes and can be performed in general clinics. Fast for six hours before the test.

CT scan

Computer scanning can take X-rays from different angles for the liver to form a three-dimensional image to determine the three-dimensional shape, size and location of the tumor. The image is clearer than ultrasound.

Before the scan, the patient must fast for at least four hours, and then drink or inject a contrast agent to improve the clarity of the test site on the X-ray film. After the contrast agent enters the body, the patient may feel a slight fever, but it will return to normal after a few minutes. The filming process takes about five to ten minutes. During this period, you only need to lie still without anesthesia. You can usually go home after completing the examination. The amount of radiation scanned by a computer is higher than that of X-rays, but it will not harm the human body, so you can rest assured to contact the human body.

If the patient has ever suffered from asthma, rubella, eczema, allergic rhinitis, or is allergic to certain foods, drugs or X-ray imaging agents, you must tell your doctor beforehand so that you can arrange an examination, take or inject anti-allergy drugs.

MRI scan (Magnetic resonance imaging, MRI)

MRI scans are similar to computer scans. The difference is that a magnetic field is used instead of X-rays to form images of the cross-section of the body. It can display the position, size and three-dimensional shape of the tumor to distinguish whether the tumor is benign or malignant, and to observe the condition of soft tissue and liver blood vessels.

Before the scan, the patient must fast for four to six hours. The doctor will inject a contrast agent into a vein in the patient’s arm to increase the clarity of the image. The patient only needs to lie down in a large hollow cylinder for about 30 minutes, during which time he can talk to the technician who operates the scanner in the adjacent room at any time. Due to the noise during scanning, medical staff will provide earplugs. There is no radiation during scanning and no anesthesia is required.

Due to the extremely strong magnetic field of MRI, patients cannot carry metal objects on their body during scanning. In addition, people with metal medical supplies such as pacemakers, surgical clips, bone pins, people who have been exposed to metal for a long time, or pregnant women must consult their attending doctors in advance to determine their suitability Perform an MRI scan. If the patient is claustrophobic or feels oppressed by staying alone in the large cylinder of the instrument, please tell the doctor as soon as possible to understand the relief method.

Liver angiography (Hepatic angiogram)

Generally speaking, computer scans and magnetic resonance scans can already observe the condition of blood vessels. If the patient is still undiagnosed, hepatic angiography is another option. Hepatic angiography uses X-rays to observe the blood flow in the liver. After the patient receives local anesthesia, the doctor inserts a hollow tube into the artery on the inner thigh, extends it upward into the hepatic artery, and then injects a contrast agent to show the blood vessel.

Liver angiography can find out the blood vessels that supply nutrients to the tumor, so as to understand the exact location of the tumor. If the tumor is close to an important part, it is difficult to perform resection, or other treatment methods may be required.

Liver biopsy

Biopsy can determine whether a tumor is benign or malignant, and is also suitable for common liver diseases such as hepatitis, abnormal liver function, liver failure, and cirrhosis.

Patients must start fasting six hours before the examination. After the doctor performs local anesthesia in the upper abdomen, he will cut an opening on the skin surface, and then ask the patient to hold his breath temporarily, pass a hollow needle through the epidermis of the right abdomen, and then extend into the tumor to extract tissue. The whole process takes about 10 to 15 minutes.

After the tissue is extracted, the doctor will observe the cell sample through a microscope to determine the nature of the tumor and the number of cancer stages. The biopsy may cause minor bleeding. After the doctor has ensured that the patient’s wound is healing well, he can be discharged home from the hospital.

According to needle thickness, biopsy can be divided into the following three categories:

①Fine needle aspiration

The advantage of fine needle aspiration is that the needle is small, so it is less invasive; however, because the number of cells that can be sucked is small, even if the tumor can be distinguished from benign or malignant, it is not enough to determine the type and number of cancer cells.

②Core acupuncture

The needle of core acupuncture is larger than fine needle aspiration, so it is more traumatic, but the range of cells that can be sucked is relatively wide, which can determine the type and number of cancer cells.

③Laparoscopy to check the slices

After the patient receives general anesthesia, the doctor will open a small opening in the abdomen, and then extend the laparoscopic tube with a spotlight and a camcorder into the examination site to detect the position, shape and size of the tumor, thereby judging the risk of tumor resection. If the tumor is suitable for resection, a small scalpel will be inserted along the way to cut a small piece of tissue, so that the attribute and cancer stage can be distinguished under the microscope.

The above three types of examinations are generally carried out in hospitals and day treatment centers, and patients can go home after the anesthetic has dissipated.

2 Further examination of metastatic cancer

After completing the preliminary examination, if it is determined to be the primary liver cancer, the doctor will formulate a treatment plan for the patient; if the cancer cell is found to have metastasized from other parts, the patient must undergo further examination to determine the original site of the cancer cell before the appropriate treatment plan.

Bone scan (bone scan)

Before performing a bone scan, the doctor will inject a small amount of radioactive material into the vein and wait for several hours. After the damaged tissue in the bone has absorbed the radiation, the whole body can be scanned.

If cancer cells invade the bones and destroy normal tissues, the damaged parts of the bones will absorb more radioactive materials, and they will show up as hot spots in the image scan. However, the radiation hot spot can only prove that the tissue is damaged, and cannot distinguish whether the damage is caused by cancer. To determine whether cancer cells have entered the bone, X-ray, MRI, and bone sectioning must be performed at the same time to determine whether the cancer cells have spread to the bone.

The bone scan dose is extremely low and will not affect health.

PET Positron Scan (PET scan)

PET is a scan after the patient is injected with radioactive materials, that is, internal radiography is used to observe whether there is tumor metastasis, but in fact it is not specific, inflammation and tumor are often unclear, and the anatomical positioning is very inaccurate , In terms of anatomical positioning and specificity, it is incomparable with CT and NMR. PET-CT is better in positioning.

(source:internet, reference only)

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