Hepatocellular liver cancer: signs, therapy, prognosis. Hepatocellular carcinoma of the liver: diagnosis, symptoms and treatment

Cancer tumors liver tissues occupy a leading position among the causes of death of people with cancer. Annually hepatocellular carcinoma claims about 600,000 lives worldwide. The main problem is the late diagnosis of the disease, when it is no longer possible to provide the patient with adequate treatment.

Late detection of pathology is due to the asymptomatic course of the initial phase of the disease. The terminal stages of HCC imply exclusively symptomatic therapy aimed at eliminating individual manifestations of malignant growth and the maximum possible improvement in the life of a seriously ill patient.

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Hepatocellular carcinoma of the liver: causes and risk factors

Malignant transformation of hepatocytes occurs for several reasons. Main etiological factors hepatoma is considered to be a chronic viral infection and hepatitis.

In oncological practice, doctors distinguish the following provoking circumstances:

1. Hepatitis B and C virus.
2. Abuse fatty foods and strong alcoholic drinks.
3. Cirrhosis of the liver tissue, which has a huge potential for cancerous degeneration.
4. Frequent contact with carcinogens.
5. Sex and age factor. According to statistics, the most susceptible group of people are older men. Although in Lately hepatocellular carcinoma in children increased significantly.
6. Systemic obesity and diabetes.

Tumor Growth Symptoms

The initial period of development of hepatoma, as a rule, does not cause complaints in patients. The main manifestations of the pathology are associated with the existing liver disease.

A significant increase in tumor volume is accompanied by the following clinical picture:

• pain attacks that are concentrated in the right quadrant of the abdomen;
• hardening and enlargement of the liver;
• abnormal accumulation of fluid in abdominal cavity and progressive jaundice;
• specific noise in the hepatic region, which is caused by the passage of blood through the arteries.

The terminal phase of liver cancer is characterized by the following symptoms:

• growth pain syndrome in which the pain is intense and constant;
• bloating and enlargement of the abdomen;
• dysfunction of the gastrointestinal tract;
• general malaise and weakness;
• loss of appetite and anorexia;
• exacerbation of symptoms of cirrhosis;
• oppression of the central nervous system;
• intermittent fever.

Hepatocellular carcinoma in children

In children and people young age oncological pathology this area proceeds as fibrolamellar hepatocellular carcinoma. Symptoms of the disease are almost identical to the manifestations of classical hepatoma. Forecast, in this case, somewhat more positive. Thus, the average survival of patients is 12-36 months. Treatment is exclusively surgical.

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Diagnostics

Establishing an oncological diagnosis in patients with hepatoma goes through the following stages:

1. Physical examination, which includes visual assessment skin And general condition sick.
2. Palpation. Feeling the affected area of ​​the body determines the consistency and size of the pathological tissue.
3. Ultrasonography. The technique informs about the size and localization.
4. CT scan. Layered X-ray scanning of the liver and nearby organs identifies the distribution and structure of the neoplasm.
5. A blood test that consists of biochemical research and concentration calculations.
6. . In some cases, doctors resort to cytological examination of a small area of ​​mutated tissue to confirm the diagnosis. Biopsy sampling is carried out by puncture method.

Hepatocellular carcinoma - modern treatment

Healing of patients with cancerous lesions of the liver is possible only at an early stage of tumor growth. Recovery comes after partial resection organ or transplant. In most cases malignant neoplasms identified on terminal stages when treatment is palliative.

Surgery

Excision of the tumor within healthy tissues ensures the recovery of the cancer patient. But this technique has its limitations. Neoplasms up to 5-7 cm in diameter can be operated on without signs of damage to the portal vein and nearby systems. Such a radical intervention is rarely performed due to late diagnosis and serious condition cancer patient.

Liver transplant

To perform an organ transplant, the patient must meet the following criteria: malignant neoplasms up to 5 cm, which are single in nature. This technique allows us to talk about a 50% postoperative survival rate.

Local effect on hepatoma

Scientific studies have determined that the hepatic artery plays a key role in the blood supply to mutated tissues. Based on this, local therapy is aimed at blocking the flow of blood to the neoplasm using embolization, ablation. Also, through given vessel cytostatic agents are delivered to the affected area.

Systemic chemotherapy

The complex effect of cytostatics is rarely used in hepatocellular carcinoma of the liver. This is explained by the accompanying kidney failure, cirrhosis and the general unsatisfactory condition of the patient.

Palliative care

It consists in the relief of pain, detoxification and the maximum possible maintenance of the functions of organs and systems.

Forecast

The prognosis of pathology is unfavorable. Average duration life does not exceed 6 months. Increased survival rate for patients diagnosed with " hepatocellular carcinoma» is only possible with timely diagnosis and radical intervention.

Diagnosis is based on α-fetoprotein (AFP) levels, imaging findings, and sometimes liver biopsy. At an advanced stage of cancer, the prognosis is poor, but in the case of a small tumor, without spread beyond the boundaries of the liver, it is possible palliative care consisting in resection.

Hepatocellular carcinoma is one of the most common types of primary liver cancer. The estimated incidence in the US in 2012 is 23 thousand new cases, the expected death rate is about 14 thousand. However, hepatocellular carcinoma is more common outside the US, especially in East Asia and in sub-Saharan Africa.

Causes of hepatocellular carcinoma of the liver

Hepatocellular carcinoma is usually a complication of liver cirrhosis.

The presence of hepatitis B virus increases the risk of developing hepatocellular carcinoma by more than 100 times among HBV carriers.

Other diseases that cause hepatocellular carcinoma include cirrhosis of the liver, hemochromatosis, and alcoholic cirrhosis.

Can play a role of carcinogens environment; for example, eating foods contaminated with fungal aflatoxins is thought to increase the incidence of hepatocellular carcinoma in subtropical regions.

Symptoms and signs of hepatocellular carcinoma of the liver

Most often, clinically stable patients with cirrhosis develop abdominal pain, weight loss, and a palpable mass in the right hypochondrium. Fever may develop. In some patients, the manifestation of hepatocellular carcinoma is manifested by hemorrhagic acite, shock, or peritonitis as a result of bleeding from the tumor.

Some patients develop systemic metabolic complications.

Diagnosis of hepatocellular carcinoma of the liver

• Measurement of the level of α-fetoprotein (AFP).
• Visual methods (CT, ultrasonography, MRI).

Clinicians may suspect hepatocellular carcinoma if:

• palpated enlarged liver
• Unexplained decompensation observed chronic disease liver,
• with the help of imaging methods performed for other reasons, especially in patients with cirrhosis, the formation of the right upper quadrant of the abdomen is detected.

However, in many patients, hepatocellular carcinoma is detected during screening before the onset of symptoms.

The diagnosis is based on the determination of the AFP level and the results of visual examination methods. In adults, an increase in AFP means dedifferentiation of hepatocytes, which most often occurs in hepatocellular carcinoma; in 40-65% of patients with liver cancer, AFP levels are high (>400 µg/l). High level AFP is rarely seen in diseases other than testicular teratocarcinoma, a tumor that is much less common. More low level AFP is less specific and may reflect liver regeneration processes (eg, hepatitis). Other laboratory tests such as AFP-1.3 (an isoform of AFP) and des-γ-carboxyprothrombin are being studied as possible markers. early diagnosis hepatocellular carcinoma.

The choice of the first visual diagnostic method depends on the preferences of the doctor and the capabilities of the institution. Selective angiography may be useful in cases of doubt and may be used to clarify the course of vessels in preparation for ablation or resection.

The diagnosis becomes apparent when characteristic changes according to the results of visual methods and an increase in the level of AFP. To clarify the diagnosis, sometimes they resort to a liver biopsy under the control of ultrasound or CT.

Screening

Screening programs are identifying an increasing number of cases of hepatocellular carcinoma. The introduction of a screening system for patients with liver cirrhosis is reasonable, despite the fact that this measure is considered controversial and has not been shown to reduce mortality. TO frequent methods screening include AFP levels and ultrasound every 6 or 12 months. Many experts advise screening patients with long-term hepatitis B infection even in the absence of cirrhosis.

Staging of hepatocellular carcinoma of the liver

Once a diagnosis of hepatocellular carcinoma is made, follow-up examination should include CT chest without contrast enhancement, examination of the portal veins with MRI or contrast-enhanced CT to rule out thrombosis, and sometimes a skeletal scan.

Various scoring systems are used for staging hepatocellular carcinoma; none of them apply universally. One of the systems is the TNM system based on the following criteria:

• T: the number of primary tumors, their size, germination in the surrounding organs;
• N: involvement of regional lymph nodes;
• M: presence of metastases to other organs.

TO Latin letters T, N and M add a number (from 0 to 4) to indicate the severity of the malignant process.

Other scoring systems include the Okuda classification and the Barcelona classification of liver cancer staging. In addition to tumor size, regional spread, and metastases, these systems also include information on the severity of liver disease.

The TNM scoring system is more focused on determining prognosis in patients after tumor resection, while the Barcelona system is used more often to determine prognosis in patients without previous surgical treatment.

Treatment of hepatocellular carcinoma of the liver

• In the presence of several foci of small sizes, transplantation is indicated.

For single foci<5 см или <3 очагов, размеры которых <3 см, и они ограничены печенью, трансплантация печени может дать такие же хорошие результаты, как трансплантация, проведенная по поводу неопухолевого заболевания. В качестве альтернативы можно рассматривать резекцию печени, однако в этом случае опухоль обычно рецидивирует.

Palliative treatments that slow tumor growth include ablation (eg, hepatic artery chemoembolization, Υ90-labeled microsphere embolization [selective internal radiofrequency therapy], drug-eluting bead transarterial embolization, radiofrequency ablation).

If the lesion is large (> 5 cm) or multifocal with portal vein invasion or metastasis (stage III or more), the prognosis is much worse. Radiotherapy is usually ineffective. It is possible to use some more modern chemotherapeutic methods.

Prevention of hepatocellular carcinoma of the liver

Vaccination against hepatitis B ultimately reduces the risk of developing hepatocellular carcinoma, especially in endemic regions. Prevention of liver cirrhosis of any etiology is important (including treatment of chronic hepatitis C, early detection of hemochromatosis, control of alcohol intake).

The last stages of any malignant disease are considered an extremely unfavorable prognostic sign.

Can only be used in small doses. Alternative methods of cancer treatment can only slightly alleviate the patient's well-being.

Diet food

The body of patients with stage 4 liver cancer is severely depleted and weakened, so nutrition should be organized in such a way that a person has enough strength to fight the disease, and important organs continue to function as long as possible.

Dishes should be easily digestible, and those products should be used for their preparation, which help to remove toxins from the body and expel bile.

• It is necessary to eat small portions, but often - up to 8 times a day.
• Requires digestive stimulation. This is achieved by eating raw plant products at the beginning of the meal, ready-made meals are consumed after them.
• Most of the diet should be vegetables, fruits, herbs, berries. It is only necessary to limit the use of tomatoes, and peel the hard skin of the fruit first.
• Sprouted grains of wheat should be regularly included in the diet, they are a source of trace elements, stimulate digestion and immunity.
• Vegetable, cereal soups should be eaten daily. Only soups on strongly boiled meat broth are not recommended.
• Liver cells are well cleansed with fresh carrot juice, it should be drunk every day for half a glass. Other freshly squeezed juices are also useful for the body.
• Fiber-rich foods are useful - brown rice, wholemeal bread, oatmeal and buckwheat porridge.
• Cancer patients need protein, it is found in fish, poultry, and lean meats.
• Dishes are steamed, boiling, stewing, baking are allowed.
• From fats, preference is given only to vegetable.
• Two to three times a week, you need to eat a two-egg omelette, this dish stops weight loss well.
• Dairy products should be on the menu every day.
• Appetite is improved by eating soaked sauerkraut or herring.
• Of the confectionery, jam, marshmallow are allowed, honey is also useful.
• It is best to drink herbal teas, compotes, rosehip broth.

To refuse completely with liver cancer is necessary from:

• alcohol.
• chocolate.
• Coffee.
• Pastries and cakes.
• Spicy condiments.
• Fatty varieties of fish and meat.
• Fried meals.
• Pickled dishes, smoked meats, too salty foods.
• legumes.
• Nut.
• Semi-finished products and products enriched with various additives.

How long do patients live

The prognosis for liver cancer of the last, that is, stage 4, is the most unfavorable.

Palliative care prolongs life by several months. And only 2% of people with this diagnosis live longer than five years.

The literature also describes cases of complete suspension of cancer development in the last stages, so you should never refuse the treatment proposed by doctors.

According to statistics, among malignant liver tumors, hepatocellular cancer is the most common form of the disease. Tumors of this type occur in most cases due to the presence of a person with chronic liver diseases.

Development of a malignant tumor

Treatment of hepatocellular cancer is a long, gradual and rather difficult process, which does not always lead to a positive result.

In most cases, the tumor acts as a secondary neoplasm, that is, the neoplasm was formed as a result of another organ, but the appearance of a primary tumor is not excluded.

Types and forms of hepatocellular liver cancer

Hepatocellular cancer is classified into several forms:

• massive - this is a single large node, and / or a formation with metastases on the periphery of the liver;
• nodular - these are several nodes of the tumor of equal size. Neoplasms are formed in one lobe or immediately in both. Larger neoplasms may have areas of necrosis in the center, and are surrounded by small nodes in a circle. Possible fusion of nodes as they grow, while affecting most of the organ;
• diffuse - is quite rare. Malignant cells affect the entire liver - this leads to the formation of many small nodes or infiltration.

According to histological features, hepatocellular liver cancer is divided into the following types:

• trabecular - malignant cells form trabeculae, which are separated by sinusoidal vessels;
• pseudoglandular - is formed in the form of tubules, in the lumens of which bile and fibrous exudate accumulate;
• compact - trabeculae fit tightly to each other, the sinusoids between them are almost invisible;
• scirrhous - develops similarly to the trabecular type, but differs in abundant fibrous stroma.

Causes of hepatocellular liver cancer

The development of hepatocellular liver cancer is more susceptible to the male sex than. This is due to a predisposition to alcohol and drug abuse.

Alcohol dependence leads initially to the development of fatty hepatosis, then hepatitis, and subsequently to cirrhosis, which is the main cause of hepatocellular cancer.

Viral lesions (hepatitis B or C viruses) of the liver lead to significant functional disorders in the functioning of the organ, and later to the degeneration of healthy cells into malignant ones.

The risk group includes people who eat foods with aflatoxin, high concentrations of which are found in Asian cuisine.

Some drugs can also provoke the occurrence of hepatocellular liver cancer, such as:

• anabolic steroids (with prolonged use and excess dosage);
• contraceptives based on estrogen;
• drugs that contain vinyl chloride.

Also, the development of hepatocellular liver cancer can provoke hemochromatosis or Wilson's disease.

The appearance of hepatocellular carcinoma is impossible without damage to the liver cells (hepatocytes), it leads to inflammation, which regenerates and, ultimately, leads to cirrhosis of the liver. The danger of this disease is that the newly formed tumor in morphology may resemble absolutely healthy hepatocytes.

Symptoms and manifestations of hepatocellular liver cancer

Hepatocellular liver cancer, depending on and metastatic formations, has various signs. The initial stage with small tumors can be diagnosed by a standard ultrasound diagnostic procedure. As a rule, during this period, patients do not feel any discomfort.

When the cancer actively progresses, an increase in the size of the organ is observed, patients complain of pain in the right hypochondrium, general weakness and malaise. Sudden weight loss and early satiety indicate the growth of a malignant tumor.

Also, the progression of the tumor is indicated by jaundice, which appears as a result of obstruction of the bile ducts. In frequent cases, it is accompanied by hemorrhage in the gastrointestinal tract. There is also diarrhea, loss of appetite, bone pain, shortness of breath, and in the case of a metastatic process, pain in the chest and cough. Ascites often develops in patients with cirrhosis.

Fatal complications in hepatocellular liver cancer are abdominal bleeding - as a result of tumor rupture. Or fever, which arose against the background of central necrosis of the liver. These symptoms are accompanied by bloody vomit, as well as the presence of blood in the stool.

Liver dysfunction or venous congestion in the gastrointestinal tract are clinical signs of the disease. At the same time, patients have vascular "asterisks" on the skin and dilated veins in the navel area.

How to diagnose hepatocellular liver cancer?

During the examination, an experienced doctor should take into account all the risk factors for this disease, special attention is paid to family history, that is, the presence or absence of liver cancer in blood relatives.

Diagnosis of liver cancer is a very complex process that includes several stages:

• a blood test for the presence of certain markers;
• visual diagnostics;
• histological studies.

When it comes to elective resection, a preoperative test is not necessary, as it can cause complications in patients with cirrhosis.

The first thing the doctor should pay attention to, upon examination, is a change in the size of the liver, as well as possible cirrhosis.

In this case, standard studies are assigned:

• general blood analysis;
• functional liver tests;
• determination of HBV/HCV antigens;
• the level of serumal alpha-protein (AFP).

The detection in the blood of a specific protein called alpha-fetoprotein (AFP) in most cases indicates a cancerous process.

Despite the fact that an elevated AFP level is diagnosed in all patients with hepatocellular carcinoma, a number of additional examinations are carried out for a more accurate diagnosis. After all, increased rates are also observed in patients with various viral hepatitis or other pathologies. It is noteworthy that this element is normally found only in the serum of the embryo.

It is worth noting that in most patients this disease is detected at the last stage. The insidiousness of hepatocellular liver cancer is that at an early stage it is almost impossible to diagnose it, due to the absence of symptoms. As for patients with chronic liver diseases, cancers are diagnosed using an analysis for an increase in AFP, in addition, ultrasound, CT or MRI help to identify the disease.

As for patients without significant abnormalities or pathologies of the liver, the diagnosis is established in the presence of any unclear etiology or lesions of a different nature. In this case, a biopsy test is allowed.

If primary hepatocellular liver cancer is diagnosed, then it is imperative to determine the presence of fibrogenesis and the extent of the spread of vascular invasions. To make any predictions, it is also necessary to determine the severity of the disease, the number of tumor formations, their nature, location, and also determine the presence of metastases. To build a treatment for an organ, it is necessary to establish its functional diseases against the background of a malignant tumor.

Treatment of hepatocellular liver cancer

To choose the right treatment for hepatocellular liver cancer, first of all, you need to contact a highly qualified specialist who will conduct and be able to determine the clinical picture of the disease. Of course, the degree of development of cancer formation plays a major role in building a treatment strategy.

So, in the first stages of liver cancer, hepatocellular carcinoma is removed by organ transplantation, as well as its resection.

They significantly prolong human life and guarantee a high percentage of survival. Operations are reasonable for less than 20% of patients. This is due to the size and location of the cancer, the presence or absence of pathologies, as well as the general condition of the patient.

The essence of surgical resection is the complete removal of the tumor in the form of a solitary node with minimal involvement of the area of ​​the liver parenchyma. This avoids the insufficiency of the operated organ.

This procedure is possible for patients without signs of portal hypertension, with solitary tumors, without invasion into the vascular network of the organ. A positive result is enhanced by relatively normal liver function.

As for orthotopic transplantation, there are criteria for selecting patients. For a liver transplant, the size and number of tumors are taken into account. Experts believe that patients with a single tumor up to 5 cm in diameter are allowed to this procedure. A maximum of 3 tumors are allowed, each no larger than 3 cm. Although some surgeons expand this criterion and operate on patients with such indicators: a single tumor up to 7 cm in size, three tumors less than 5 cm and five tumors less than 3 cm.

Another method of treatment for hepatocellular carcinoma is localized treatment. Before using this technique, the doctor conducts a detailed diagnosis regarding the number, size and location of cancer, involvement of the portal vein, and the possible presence of various metastases. The essence of this method is the maximum reduction of blood flow to the cancer, as well as the localized introduction of special chemicals directly into the tumor.

An ineffective way to fight liver cancer is systemic. This is due to the fact that against the background of other pathologies, such therapy can lead to unpredictable results and the critical condition of the patient.

Also, patients with hepatocellular cancer should be encouraged to participate in clinical trials, to various experimental programs, which in their case can give a positive trend. As for patients with a severe stage of the disease, they should be transferred to maintenance therapy.

Life prognosis in hepatocellular liver cancer

If we talk about prognosis, then in the presence of liver cancer, it is unfavorable. This is due to the fact that in the vast majority, tumors in this organ are diagnosed in the last stages. In the absence of timely quality therapy, the survival of patients is about 4 months.

Informative video

What is Hepatocellular Carcinoma (HCC)

HCC (primary liver cancer) is one of the most rapidly progressive fatal cancers.

Definition. It is one of the most common malignant human tumors.

What causes hepatocellular carcinoma (hcc)

A significant role in the development of HCC is given to chronic liver diseases associated with hepatitis B, C, D viruses and alcoholism. Clinical and epidemiological evidence suggests that hepatitis C virus is more carcinogenic than hepatitis B virus. HCV lb genotype is the most common and is responsible for the development of HCC. Rare causes of carcinoma include oral contraceptives, radiopaque agents, carcinogenic mycotoxins, in particular the presence of aflatoxin in foods. The presence of cirrhosis increases the risk of developing a tumor hundreds of times. In more than 80% of cases, malignant transformation is observed in a cirrhotic liver. About 80% of all cases of the disease are associated with cirrhosis of the liver.

Prevalence. In terms of frequency of development, HCC ranks 8th in the world. Among malignant neoplasms of the liver, it accounts for 80-90% of all primary malignant tumors of this localization. The incidence of HCC in men is in 5th place after cancer of the lung, stomach, prostate and colorectal cancer; in women - in 8th place after cancer of the breast, cervix, colorectal cancer, cancer of the lung, stomach, ovary and body of the uterus. In Russia, the frequency of HCC in men is 16th, and in women - 15th. The incidence of carcinoma has been steadily increasing since the second half of the 20th century due to an increase in the number of patients with viral hepatitis. There is a progressive shift in the incidence of HCC towards a younger age.

Pathogenesis (what happens?) during Hepatocellular Carcinoma (HCC)

The development of primary liver cancer against the background of cirrhosis is associated with regenerative and proliferative processes. It was found that the hepatitis B virus is determined directly in the liver tumor, and the virus virion - in the genome of hepatocellular carcinoma. It has been established that the risk factors in the development of hepatocellular carcinoma in patients with chronic viral hepatitis are age over 50 years, male gender, low viremia level, genotypes 2a, 2b, lb virus, high activity of the process according to morphological features, portal hypertension, iron accumulation in the liver tissues. . In the development of hepatocarcinoma, in addition to hepatotropic viruses B, C, G and F, an important role is played by immunogenetic factors (the predominant vulnerability of men), an unbalanced diet with a deficiency of animal protein, and repeated liver injuries. As precancerous conditions, adenomatous hyperplasia or dysplastic nodes are currently considered.

Risk factors for developing HCC include:

• male gender;
• age over 50;
• increased bilirubin;
• decrease in prothrombin time;
• expansion of the veins of the esophagus;
• increase in afetoprotein;
• hepatocyte dysplasia.

Some researchers consider the presence of HBsAg, HCVAb, alcohol abuse, and increased ALT as additional risk factors.

The group with a low risk of developing HCC includes patients with autoimmune diseases, Westphal-Wilson-Konovalov disease.

Symptoms of Hepatocellular Carcinoma (HCC)

Features of clinical manifestations:

From the moment of infection with a hepatotropic virus, chronic hepatitis develops after about 10 years, after 20 years - cirrhosis of the liver, after 30 years - HCC. The development of primary liver cancer should be suspected in patients with cirrhosis of the liver with a sharp decrease in its function, the development of acute complications (ascites, encephalopathy, bleeding from varicose veins, jaundice) or with the appearance of pain in the upper abdomen and fever. HCC due to HCV is more often multifactorial. It is characterized by a slower course than HCC of a different etiology. There are nodular and diffuse forms of carcinoma growth. The clinical picture in HCC, which develops against the background of liver tissue unchanged by cirrhosis, is characterized by a short history and nonspecific symptoms, progressive weakness, cachexia, and sometimes adynamia and fever. Already at the beginning of the disease, there is a feeling of heaviness and pressure in the epigastric region, constant and moderate pain in the right hypochondrium, occasionally it is paroxysmal. The liver increases rapidly, often the patients themselves notice this. The edge of the liver is dense and uneven. Hepatomegaly and a palpable tumor, along with pain in the upper abdomen, are the constant and most frequent clinical signs of hepatocellular liver cancer. Jaundice, ascites and enlargement of the superficial veins of the abdomen are late symptoms of cancer. Patients complain of a feeling of heaviness, pressure in the right side of the abdomen, dyspeptic disorders, rapidly progressive weight loss, fever, pale gray (“earthy”) shade of the skin.

In addition to the typical course, there are primary liver cancer, which proceeds according to the type of acute febrile illness, and an asymptomatic form of primary liver cancer.

A specific subtype of HCC is fibrolamellar carcinoma, occurring in patients without cirrhosis or previous viral infection. In the countries of the Western Hemisphere, it is about 15% of HCC.

Paraneoplastic phenomena, hypercholesterolemia, hypercalcemia, hypoglycemia, hypokalemia, erythrocytosis, and cutaneous porphyria are described.

The absence of metastasis is a characteristic feature of HCC.

Diagnosis of Hepatocellular Carcinoma (HCC)

Features of diagnostics. In liver cancer, toxic granularity of erythrocytes, leukocytosis with a shift to the left, and an increase in ESR are detected. There are indications that an increase in fractions II of ALP isoenzymes is characteristic of cholangiocellular, and fractions II and III - for hepatocellular liver cancer. Diagnostic value has a blood test for the presence of cancer embryonic antigen. Instrumental methods: in more than 90% of cases, a radionuclide study of the liver gives a picture of a parenchymal defect. Ultrasound imaging makes it possible to suspect HCC in 80-90% of cases. The selection of patients to clarify the diagnosis is not unified. The detection of hypoor hyperechoic nodes should be alarming in relation to HCC. About half of the nodes up to 1 cm in diameter do not have a tumor nature. In these cases, dynamic observation every 3 months is rational, and with an increase in the size of the node with a diameter of more than 1 cm, the use of additional research methods. The absence of node growth during this period does not exclude its malignant nature, since it sometimes takes more than 1 year to increase the size of HCC. If the nodule is less than 2 cm in diameter, a liver biopsy is recommended because in such situations, ultrasound and AFP levels are not accurate enough to distinguish HCC from benign tumors. The accuracy of morphological diagnostics increases with the simultaneous conduct of cytological and histological studies. In tumors larger than 2 cm in diameter, ultrasound and other methods of instrumental imaging can diagnose HCC without a biopsy. Tumor diagnosis is difficult in the presence of liver cirrhosis. Computed tomography is less informative and is used in the presence of any diagnostic doubts. Laparoscopy reveals a large nodule or tumor-occupied lobe of the liver in massive cancer. With the help of selective celiacography, it is possible to visualize the vessels tightly covering the tumor.

Differential diagnosis should be carried out with secondary liver tumors, liver cirrhosis, focal liver lesions.

Treatment of Hepatocellular Carcinoma (HCC)

Treatment for HCC:

Surgical intervention is advisable for a massive form of cancer, when the tumor grows in the form of a solitary node and is performed only in 20% of patients.

A modern and effective treatment for primary liver carcinoma is complete or partial resection, orthotopic or complete liver transplantation. Resection and transplantation of the liver and percutaneous methods of treatment allow to achieve a relatively high rate of full effect of treatment and classify these methods as effective. These methods improve the course of the disease, prolong the survival of patients with single nodes less than 5 cm in diameter or no more than three nodes less than 3 cm in diameter. After resection of the liver lobe, about 50% of operated patients live for about a year. The use of adequate selection of patients with HCC allows to increase the 5-year survival rate up to 50% in patients with normal bilirubin concentration without portal hypertension - up to 70%. The main problem of resection compared with transplantation is the high recurrence rate, which exceeds 50% at 3 years and 70% at 5 years.

In the treatment of carcinoma, embolization of the hepatic artery with gelatin foam is used, which leads to tumor necrosis by blocking its vascularization, as well as orthotopic (the recipient's own liver is first removed and a graft is transplanted in its place) liver transplantation.

Chemotherapy is most effective when drugs are injected into the hepatic artery or umbilical vein supplying the tumor area. For this purpose, after catheterization of these vessels, infusion therapy is most often used. Currently, mitosanctron, adriamycin, mitomycin C, cisplatin, subcutaneous ethanol injections, and interferons are used as drugs. Apply percutaneous injections of ethanol, inducing tumor necrosis as a result of protein denaturation, cellular dehydration and occlusion of small vessels. The method is effective for tumors up to 3 cm in diameter, when the full effect can be observed in 80% of cases. Ethanol injections are considered the standard method, which can be compared in effectiveness with radiofrequency, microwave, laser therapy and cryotherapy.

Gene therapy strategies include drug sensitization using "suicidal" genes, genetic immunotherapy, protection of normal tissues by drug multiresistance gene transfer, gene protection (tumor suppressor gene transfer), suppression of oncogenes, and intervention to alter tumor biology (antiangiogenesis).

It was found that the number of antitumor cytotoxic lymphocytes is higher in HCC with a good prognosis. The inability of the immune system to eliminate tumor cells is determined by the absence of recognizable tumor antigens, with their inability to stimulate an effective immune response. Stimulation of the production of antitumor cytotoxic lymphocytes can be carried out by means of cytokines (IL-2, IL-4, IL-6, IL-7, IL-12, interferon, TNF-a, granulocyte-monocytic colony-stimulating factor).

Forecast

The prognosis is unfavorable. In the absence of adequate therapy, survival is about 4 months. The prognosis for fibrolatellar HCC is better than for other forms, and the 5-year survival rate after liver resection is 40-50%.

Which doctors should you contact if you have Hepatocellular Carcinoma (HCC)

• Gastroenterologist
• Oncologist
• Surgeon