Malignant tumors of the liver. Benign and malignant liver tumors Are there benign liver tumors in alcoholism

The term "liver tumors" is commonly understood as the presence in the liver of formations of a benign or malignant nature. Most often, they originate in the actual cells of the liver (parenchyma), the epithelial part of the bile ducts inside the organ, or the vessels that feed it.

Classification of liver formations

Hepatologists divide all types of liver neoplasms into benign and malignant tumors. Moreover, the first type is relatively rare. It is distinguished by an asymptomatic course and the slow development of the disease. In most cases, benign liver tumors are diagnosed incidentally during an examination for other diseases. Moreover, laboratory methods are not informative here, most often tumors of this type are detected during ultrasound, computed tomography, and laparoscopic intervention.

The classification of malignant transformations of the liver tissue is more complex and includes primary and secondary changes. Malignant tumors of the liver, which are of a primary nature, originate from the hepatic structures, and the secondary ones are metastases of neoplastic processes in other organs. Due to the fact that the liver is the filter of the body and passes through itself all the blood coming from the organs, there is a hematogenous pathway for the spread of cells that have undergone cancerous degeneration. This may explain the fact that malignant liver tumors of metastatic origin are diagnosed twenty times more often than primary cancers. In general, primary neoplastic processes of the hepatic tissue can be found relatively rarely. More common in men over 50 years of age.

Given the origin of malignant cells, the following classification has been developed for primary neoplastic changes in the liver:

hepatocellular carcinoma - originates in the parenchymal cells of the liver, it accounts for eighty-five percent of all malignant degenerations of the liver tissue;

• cholangiocarcinoma - develops from degenerate epithelial cell structures of the bile ducts;
• angiosarcoma - its source is the inner wall of the liver vessels;
• hepatoblastoma - a type of liver tissue cancer, characteristic of childhood.

Causes of malignant degeneration of liver cells

Chronic hepatitis B and C are the most common cause of primary cancerous changes in liver cells. The probability of cancerous degeneration of hepatocytes in patients with established hepatitis increases by about two hundred times. Among other causes of primary liver tissue cancer, the main chronic conditions can be called:

• chronic forms of viral hepatitis, especially when combined;
• alcoholic hepatitis - an inflamed process in the liver tissue due to prolonged toxic effects of alcohol;
• cirrhosis of the liver is a serious disease when the connective tissue replaces the normal liver structures, while the function of the organ is lost.

In addition, there are several factors that predispose to the development of the disease:

Among oncologists, a classification of malignant diseases of any TNM localization is accepted, which allows characterizing the size and prevalence of the neoplastic process.

So the T indicator characterizes the size of the cancer focus in the liver structures and how far its spread has gone:

• T1 - the focus does not exceed two centimeters, the vessels are not affected;
• T2 - a cancerous node no more than two centimeters, but there is damage to the vessels, or multiple foci up to two centimeters, located within one lobe of the liver, without spreading the disease to the vessels;
• T3 - the size of the tumor exceeds three centimeters, with spread to the vessels, or several nodes up to two centimeters with damage to the vessels, but within one lobe of the liver;
• T4 - disease damage to nearby organs (intestines, spleen, stomach, blood vessels).

The N indicator indicates the presence of malignant cells in the tissues of the lymph nodes of different levels:

• N0 - without the presence of cancer emboli in the lymph nodes;
• N1 - multiple lesions of the lymph nodes located near the gate of the liver or in the area of ​​the hepatoduodenal ligament;
• The M indicator indicates the spread of the malignant process to organs distant from the liver (lungs, bones, brain):
• M0 - without damage to distant organs;
• M1 - cancerous changes in organs distant from the liver.

Based on the degree of spread of the neoplastic process within the organ, the following classification of primary liver tissue cancer is used.

Stage 1 disease It is characterized by the presence in the liver of a small (up to two centimeters) and well-limited tumor from healthy tissues. No signs of spread of cancer emboli to the nearest clusters of lymph nodes and organs. Has a relatively favorable prognosis. It responds well to treatment. Patients live up to five years, and forty percent of them, after the treatment, are able to cross this line.

Disease stage 2 characterized by a tumor in the liver larger than two centimeters, without the presence of spread of the disease to the nearest lymph nodes.

Disease stage 3 is determined by the presence of a cancerous focus in the liver of various sizes with the spread of single cancer cells to regional lymph nodes.

Disease stage 4 characterized not only by nearby metastases, but also by the spread of the disease to distant organs (bones, brain). The prognosis at this stage is poor. Such patients live no more than six months, although ten percent of them are able to "stretch" up to two years.

If we are talking about secondary liver cancer (liver metastases), then when it is detected, we can definitely say that the primary disease is in the fourth stage, which means that the prognosis for its course is unfavorable.

How long a patient with a similar disease will live depends to a large extent on the number of cancer nodes in the liver. So, according to statistics, patients with a single focus in the liver live for five years in 41 - 51% of cases, with two nodes - from 32% to 37%, and those with more than three cancerous nodes - from 11% to 19%.

Factors affecting life expectancy in liver cancer

Among all types of malignant neoplasms, liver cancer ranks third in terms of mortality. Practice shows that very few patients can cross the five-year milestone of life with a similar diagnosis. And even experienced specialists cannot reliably answer the question of how long patients with malignant changes in the liver live. This is an individual prognosis for each individual patient, which depends on the following parameters:

• stage of tumor lesion;
• the presence of concomitant pathology, aggravating the course of the disease;
• at what stage the disease was detected;
• sensitivity of cancer cells to the treatment;
• how old is the patient;
• the psychological state of the patient.

Symptoms of the disease

At the initial stages of the development of a malignant lesion of the hepatic structures, the patient does not have specific complaints. A little later, the following symptoms appear: general malaise and inexplicable weakness, dyspeptic disorders (lack of appetite, bouts of nausea and vomiting), a feeling of heaviness and constant pain of a aching nature in the right hypochondrium, a rise in temperature to subfebrile numbers, weight loss.

In the later stages, the liver is clearly palpable, protruding a few centimeters from the costal arch, and has a characteristic tuberosity and density. The following symptoms are noted: severe anemia, yellowness of the skin and sclera, ascites (accumulation of free fluid in the abdominal cavity). The liver loses its function, in connection with this, signs of liver failure and symptoms of general intoxication increase. Possible endocrine disorders and internal bleeding.

Methods for the diagnosis and treatment of malignant processes in the liver

All neoplastic diseases of the liver tissue are characterized by changes in the biochemical parameters of the blood, which characterize the function of this organ. These are liver tests and alkaline phosphatase, coagulogram. With a hepatocellular type of cancer, a high concentration of fetoprotein is determined in the patient's blood.

Visualization of a cancerous focus in the liver tissue can be obtained using ultrasound, computed tomography of the abdominal cavity, magnetic resonance imaging, x-ray examination of the liver vessels.

The cellular composition of the liver tissues is examined by biopsy of a suspicious area for cancer, during laparoscopy or by puncture under the control of ultrasound or CT.

The treatment of malignant liver tumors is complex and includes several basic methods that are often combined to achieve a good result.

Surgical treatment. Surgical removal of a malignant nodule in the liver is currently the only method of treatment that is sufficiently effective. But the operation can be performed in only 15-20% of cases. The main contraindications to it are the significant spread of the disease and the unsatisfactory condition of the patient. How much tissue needs to be removed? Hepatic lobe resection or hemihepatectomy is most commonly performed. Single limited lesions in the liver tissue can be removed by cryoablation or chemoablation. To achieve the maximum effect of surgical treatment, it is often preceded by chemotherapy.

Chemotherapy- a type of drug treatment aimed at destroying malignant cells. Its modern technique involves the introduction of cytostatics into the vessel that feeds the liver, through a pre-installed special catheter. Thanks to this method of treatment, the maximum concentration of the chemotherapy drug is created in the tumor tissues, which contributes to a more pronounced therapeutic effect.

Radiation treatment. It is carried out through the use of radiation, often in combination with chemotherapy and surgical treatment.

If the disease has not crossed the borders of the liver region, then the patient can be transplanted a donor organ.

Prevention of liver cancer

Preventive vaccination against hepatitis B for all persons at risk of contracting this virus.

Refusal of alcohol and tobacco.

Strict adherence to safety rules and the use of personal protective equipment when working with chemicals.

Refusal of the uncontrolled use of iron supplements.

The use of anabolic steroids is strictly for medical reasons.

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Metastases may appear after the discovery of the primary tumor, sometimes they are its first clinical manifestation.

The most common primary liver tumor is hepatocellular carcinoma, which often develops in association with cirrhosis. On a global scale, its main causes are chronic hepatitis B and C. Other primary liver tumors are cholangiocarcinoma and sarcomas (angiosarcoma, leiomyosarcoma, fibrosarcoma, mesenchymal sarcoma).

Benign liver lesions include hemangioma, adenoma, focal nodular hyperplasia, and regeneration nodes.

Symptoms and signs of a liver tumor

Anamnesis. Liver cancer often develops against the background of cirrhosis of one or another etiology. A sharp deterioration in the condition of a patient with cirrhosis of the liver is a good reason to suspect hepatocellular carcinoma. Other risk factors are chronic hepatitis B and C (regardless of the presence of liver cirrhosis), food contamination with aflatoxins (found in Asia and Africa), contact with thorium dioxide in the past (X-ray contrast agent Thorotrast), fatty liver in obesity and diabetes mellitus . Rare manifestations of liver cancer - fever, portal vein thrombosis, hypoglycemia, erythrocytosis, hypercalcemia, porphyria, dysglobulinemia.

The incidence of liver cancer has doubled over the past 20 years and continues to grow, mainly due to complications of hepatitis B and C and cirrhosis due to fatty liver.

The average age of patients at the time of diagnosis is 65 years, 74% of them are men. At the age of 40, ordinary hepatocellular carcinoma is. You see a third of cases, its fibrolamellar variant (with a relatively favorable prognosis) is more common, as well as liver metastases.

The source of liver metastases may be unknown, so they are the first manifestation of the disease. Liver metastases are found at autopsy in about half of cancer patients.

Abdominal pain is a common complaint in liver cancer or liver metastases. Nonspecific symptoms are also possible - loss of appetite, weight loss, malaise.

Physical research. The liver is usually enlarged, nodular, and may be painful on palpation. Ascites is often observed. The noise of friction over the liver, which occurs during breathing, indicates the involvement of the organ capsule in the malignant process. Occasionally, a vascular murmur is heard (it is associated with abundant vascularization in hepatocellular carcinoma and some types of metastases). Jaundice usually appears late; early jaundice indicates the presence of underlying liver disease, obstruction of the large bile duct, or a massive tumor lesion.

Diagnosis of a liver tumor

Laboratory research. A characteristic symptom of liver cancer is anemia. It can be nonspecific (normochromic normocytic), associated with the long-term presence of the tumor itself, or macrocytic, characteristic of chronic liver diseases. The level of bilirubin rises with jaundice. An increase in the activity of alkaline phosphatase is characteristic, however, obstruction of even small bile ducts leads to the release of this enzyme. In doubtful cases, to confirm the hepatic origin of alkaline phosphatase, determine the activity of the 5'-nucleotide.

Radiation diagnostics includes ultrasound, CT, MRI, cholescintigraphy with iminodiacetic acid derivatives and scintigraphy with colloidal sulfur.

Many doctors, if a liver tumor is suspected, immediately perform a CT scan after a biochemical blood test, since it not only provides accurate data on the state of the liver, but also allows you to identify enlarged lymph nodes and other changes in the abdominal organs. In addition, CT-guided biopsy of the mass is important in diagnosis.

Liver biopsy. In tumor lesions of the liver with an increase in the activity of alkaline phosphatase, percutaneous liver biopsy makes it possible to make a diagnosis in 80% of cases. Another method - laparoscopy with liver biopsy - allows you to simultaneously assess the spread of the tumor in the peritoneum, lymph nodes and other organs of the abdominal cavity.

Angiography. Celiacography helps evaluate the operability of hepatocellular carcinoma or a single liver metastasis. If CT shows damage to both lobes of the liver, angiography does not show anything. Angiography can also distinguish hemangioma from malignant tumors when CT data indicate abundant vascularization of the mass.

Treatment and prognosis of a liver tumor

The prognosis for liver cancer remains extremely poor. It depends on the size of the tumor, liver function and the possibility of radical treatment (removal of the tumor or liver transplantation). In recent years, transplantation has become more affordable through the use of a liver lobe or segment taken from a living donor. With a single tumor less than 2-5 cm in size in the absence of liver failure, the five-year survival after transplantation reaches 70%. In more severe cases, the prognosis is much worse.

Liver resection only possible in a small proportion of patients. Contraindications are the prevalence of the tumor, liver failure, portal hypertension. Even with an operable tumor, the risk of recurrence is high. It is higher with large and low-grade tumors, as well as with the germination of large vessels in them. Well-differentiated hepatocellular carcinoma surrounded by a capsule, especially in size< 3 см, рецидивирует сравнительно редко.

Liver transplant in hepatocellular carcinoma is appropriate in the case of a single tumor size< 5 см или 2-3 опухолей размером < 3 см каждая. Следование этим критериям заметно уменьшает число рецидивов.

Radiofrequency destruction or percutaneous destruction with ethanol under the control of ultrasound or CT is an accepted alternative to surgery in patients without severe bleeding disorders or ascites. With a single tumor< 3 см безрецидивная выживаемость такая же, как после хирургического удаления опухоли.

Palliative Interventions used when radical surgery is not possible. Unfortunately, according to clinical trials, fluorouracil, tamoxifen, and tumor destruction with ethanol do not improve survival. Chemoembolization of the hepatic artery slightly increases the survival rate.

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Benign and malignant tumors

Not every liver tumor is cancerous. Benign formations include:

Lipoma and hemangioma of the liver are characterized by a long course without clinical manifestations. Only in the case of a congenital hemangioma, its size can increase over time so much that compression of the surrounding tissues will cause the appearance of characteristic symptoms.

The appearance of cysts in the liver is dangerous due to their growth and the appearance of new elements with the formation of polycystic liver disease. Most PCOS are asymptomatic.

Among the malignant tumors of the liver are:

• sarcoma.

primary cancer develops under the influence of various damaging factors: viral infections, injuries, bad habits. The disease is characterized by a significant deterioration in liver function, the appearance of pain, weight loss, which are aggravated as the disease progresses. The liver is enlarged, compacted. The patient's condition is severe, rapidly deteriorating with tumor growth.

At secondary cancer the liver is affected by metastases from tumors of other organs: the stomach, pancreas, lungs, etc. About 90% of all malignant processes in the liver are caused by metastatic lesions. In this case, the symptoms of the underlying disease predominate.

Liver sarcoma is a less common disease, characterized by its onset at a young age. Symptoms are similar to primary cancer.

Causes

One of the main reasons is the existing chronic hepatitis. In the presence of several different forms of hepatitis in the form of co-infection, the risk of developing and progressing cancer increases significantly. Prolonged viral inflammation of cells causes a violation of their function, involving neighboring cells, bile ducts and intercellular space in the process. As a result of damage, the cells are destroyed and the disease progresses from hepatitis to cirrhosis. Cirrhosis of the liver can be considered as a precancerous condition.

Another option for the development of the disease is prolonged damage and degeneration of cells under the influence of alcohol. At the same time, as in the case of viral hepatitis, cirrhosis develops, turning into cancer.

Symptoms

The onset of the disease is characterized by a gradual onset with the appearance of common symptoms of liver damage:

• weakness,
• loss of appetite,
• nausea,
• gravity,
• pain in the right hypochondrium.

It is possible to increase the temperature to 38-40 degrees. In most cases, the patient loses weight, anemia develops.

In the future, there is an increase in the size of the liver, a change in its structure. On palpation, a dense, bumpy surface is noted. In some cases, the tumor itself can be detected in the form of a dense enlarged area, painful to the touch.

The course of the disease is accompanied by jaundice and an increase in symptoms of liver failure. Metabolism is disturbed, in particular proteins. If large vessels are damaged, intra-abdominal bleeding may develop.

With the development of cirrhosis with a gradual degeneration into cancer, the symptoms of the disease progress rapidly. The pain becomes intense, the fever becomes protracted. Violation of the hemostatic function of the liver leads to frequent nosebleeds, bleeding from injection sites, the appearance of vascular "asterisks".

Diagnostics

Both serological and instrumental research methods are used for diagnosis.

• Screening for primary cancer

The method is based on determining the concentration of alpha-fetoprotein in the blood. The examination is carried out in risk groups, after which, with a positive result, an additional ultrasound is performed. Based on the data obtained, a diagnosis of "hepatocellular carcinoma" is made. The risk group includes patients with chronic liver diseases, as well as residents of endemic areas and carriers of the HBs- and HCv-antigen.

• tumor markers

The method for detecting tumor markers is based on determining the concentration of specific protein compounds in the blood, the number of which increases with the growth of the tumor.

In addition to the AFP described, there are several more substances that can be used to judge the presence and growth of a neoplasm. Analysis of the content of oncomarkers makes it possible to detect the development of metastases in 47% of cases. In addition, this method is effective for diagnosing relapses after surgical treatment.

With an increase in the concentration of markers, an additional examination is performed using tumor imaging methods.

• CT scan

The main diagnostic method. This is a relatively inexpensive and effective method that allows you to determine the location of the tumor, its size and number of foci, damage to neighboring organs and structures.

• Magnetic resonance imaging (MRI)

One of the most informative methods for diagnosing tumors of any localization. MRI allows to determine with high accuracy the location of the neoplasm relative to other anatomical landmarks, including in difficult cases when diagnosis using CT is ineffective. MRI, along with the definition of the tumor itself, provides data for a visual assessment of the state of the liver parenchyma in intact sections, as well as the bile ducts and gallbladder.

• Positron emission tomography

One of the new and advanced developments in the field of cancer diagnostics. The method is based on the introduction of a special labeled glucose into the patient's body, followed by tomography. As a result of the study, an analysis is made of the accumulation and breakdown of glucose by various tissues of the body. Studies have shown that tumor cells are more prone to accumulation of glucose. The study lasts about two hours and allows you to quickly get the most accurate result about the presence and localization of the tumor in a particular organ.

The use of positron emission tomography in some cases can replace the use of all other diagnostic methods.

Stages and course of the disease

There are four stages:

1. First stage corresponds to the presence in the liver of one limited tumor formation. At the same time, adjacent tissues and vessels remain intact. As a rule, at this stage the disease is asymptomatic.
2. On second stage a cancerous tumor grows through the vessels, causing hemorrhages. The size of the tumor, or several tumors, increases to 5 centimeters. Compression and damage to hepatocytes and surrounding tissues causes impaired liver function. At this time, the first symptoms appear: loss of appetite, weight loss, pain in the liver.
3. Third stage has three flow options:
   1. Stage 3a is characterized by the appearance of several tumors larger than 5 cm. As they grow, compression and damage to large vessels occurs, in particular, the hepatic and portal veins.
   2. The transition to stage 3b occurs when the tumor grows into neighboring organs (except the gallbladder) or increases in size inside the liver until the liver capsule is involved in the process.
   3. The spread of tumor cells to nearby lymph nodes with the formation of metastases means progression to stage 3c.

As the neoplasm grows, an increasing volume of cells is damaged, causing further impairment of hepatic functions. Violation of the hemostasis system causes frequent prolonged bleeding, including internal and subcutaneous hemorrhages.

The pain takes on a permanent character and is removed only by the appointment of narcotic analgesics. Damage to neighboring organs and lymph nodes creates favorable conditions for the development of infectious complications.

Metabolic and digestive dysfunction continues to progress and is manifested by constant weakness and exhaustion. The lack of a sufficient amount of protein in the body significantly reduces energy resources and negatively affects the body's immune system.

1. At the final fourth stage tumor decay and spread of metastases to other organs. Most often it metastasizes to the bones. First of all, to determine secondary tumors, it is worth examining the spine, ribs and other bones of the skeleton.

The fourth, terminal stage of liver cancer, means the development of irreversible changes, followed by the collapse of the tumor and the spread of metastases to distant organs. It is divided into two stages:

1. Stage 4a corresponds to the germination of one or more tumors through the branches of large blood vessels (hepatic and portal veins) and the spread of the process to neighboring organs (except the gallbladder) and regional lymph nodes.
2. The appearance of distant metastases, regardless of the size of the primary focus, means the transition of liver cancer to the final stage 4b. In addition to the bones of the skeleton, metastases can be found in the lungs, kidneys, peritoneum, pancreas and other organs.

The severity of symptoms in the fourth stage reaches its highest point. A sick person by this time is completely disabled. The liver loses the ability to bind proteins, which is manifested by weakness and exhaustion. A decrease in hematopoietic function leads to an increase in anemia and inadequate nutrition of all organs with a violation of their activity.

Inefficient removal of toxic metabolic products by the liver leads to their accumulation in the brain tissues. This process is accompanied by the development of mental disorders such as hepatic encephalopathy. As the tumor grows and liver cells die, the severity of brain damage progresses.

With the continued growth of the tumor, compression of the bile ducts occurs. As a result, bile accumulates in the gallbladder, causing jaundice and the accumulation of toxic waste products in the blood. The patient notes dry skin and itching. Constipation may occur.

Damage to large blood vessels can cause profuse bleeding with the formation of a subcapsular hematoma of the liver, as well as intra-abdominal bleeding, peritonitis and shock.

Treatment

Planning the amount of treatment needed depends on the stage of the process. For treatment, a surgical method is used, as well as radiation and chemotherapy in one form or another, as required by each specific case.

• The most effective treatment is a liver transplant. Although in practice this is quite difficult to implement, since transplantation can only be carried out in the early stages of the disease. Also, the difficulty lies in finding a suitable donor. At the moment, this method is not widely used.
• The positive effect of the treatment is also achieved with the surgical removal of the affected area of ​​the liver. The danger lies in the fact that not always the remaining part of the body is able to cope with the load, retaining all the necessary functions. As a result, progressive liver failure is noted after the operation. This method is effective only at an early stage of cancer, so often the ineffectiveness of diagnosis makes surgical treatment impossible.
• Chemotherapy in the form of chemoembolization is used to treat inoperable forms of liver cancer. The method is based on blocking blood flow in the vessels that feed the tumor tissue with the simultaneous administration of a chemotherapy drug that causes a delay or halt in the growth of cancer cells.
• Modern emboli are microspheres that can be filled with a drug. This significantly increases the effectiveness of the treatment.
• Another variation of this method is radiofrequency embolization. This method also involves the use of microspheres, but instead of a reactive substance, they are filled with radioactive Yttrium-90, which emits beta waves and causes necrosis of surrounding tissues. In a specific case, necrosis of tumor cells.
• Nonspecific systemic chemotherapy is not effective enough for liver cancer and can only be used as an auxiliary method in the complex of therapeutic measures.

At the fourth stage, the treatment of liver cancer is palliative in nature and is used only to achieve a temporary remission and partial improvement in the patient's general condition. Treatment is aimed at reducing the rate of tumor growth and normalizing liver function.

Treatment necessarily includes nutritional support, which consists of intravenous administration of nutritional mixtures, protein fractions, transfusion of blood products containing platelets and clotting factors. To remove toxins, hemosorption with ultrahemofiltration, plasmapheresis is used. These processes are performed using M.A.R.S (artificial liver) devices with plug-in additional filtration modules.

Along with maintenance therapy, preventive treatment of stroke, heart attack, thrombosis of the branches of the pulmonary artery and other vessels is prescribed.

To combat the development of metastases, the method of radiofrequency ablation is used. With the development of complications, emergency surgical treatment is performed, aimed at suturing liver ruptures with ligation of a bleeding vessel, treatment of intestinal obstruction and other life-threatening conditions.

Forecast

The prognosis for the patient's life depends on the stage of detection of the disease and the effectiveness of the treatment.

At the initial stage, in the absence of severe disorders and damage to other organs, the surgical treatment significantly increases the chances of recovery. Removal of localized forms provides more than 60% survival, and organ transplantation allows you to restore functions and provides a cure for more than 80% of patients.

In the later stages of the disease, survival is significantly reduced even with chemotherapy. At the third stage, only a five-year life expectancy was observed only in 6% of patients.

After the transition of the disease to the fourth stage, surgical treatment becomes ineffective. Given the palliative orientation of treatment, this stage has only a two percent five-year survival rate.

Nutrition and diet

Proper nutrition is an integral part of treatment. The diet requires careful planning in order to increase the intake of nutrients and eliminate harmful and toxic foods.

Allowed use:

• Cereal seeds, flakes, cereals;
• Fresh fruits, salads, vegetables;
• Dairy products, fresh milk;
• Bakery products made from wholemeal flour;
• Carrot and beet juice.

• Sugar;
• Canned food, semi-finished products;
• Drinks containing a large amount of caffeine, carbonated drinks;
• Fatty meats;
• Alcohol.

The daily diet is best divided into 5-6 doses. Eaten food should be thoroughly chewed and washed down with plenty of liquid (water or weakly brewed tea). Each meal should start with salads, and then move on to the main dishes.

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Liver tumors are tumors that can be benign or malignant. The most common manifestations of neoplasms in the liver are a sharp decrease in body weight, nausea, loss of appetite, yellowing of the skin, hepatomegaly, ascites. A neoplasm can be detected using ultrasound, organ biopsy, computed tomography and examination of liver tissues. Treatment of liver cancer cannot do without surgery to remove the malignant tumor and the diseased part of the organ.

Liver tumors fall into several categories:

• Primary benign neoplasms;
• Primary cancers in the liver;
• Secondary cancerous tumors in the liver, which are accompanied by the appearance of metastases.

Knowledge of the category and type of neoplasm makes it possible to prescribe the treatment of a liver tumor with complex and effective methods. A benign tumor of the liver is diagnosed quite rarely, since this disease does not manifest itself with symptoms and is usually determined during a routine examination. It is rarely possible to start treatment for liver cancer in the early stages, since the disease may be asymptomatic.

Types of benign tumors in the liver

The most common is a benign tumor of the liver, which manifests itself in the form of adenomas: bile duct adenoma, papillomatosis, hypatoadenoma, biliary cystadenoma. These diseases begin from the connective tissue and integumentary parts of the liver or bile ducts. Less common are benign diseases such as hemangiopa and lymphangioma. Very rarely, lipoma, hamartoma and liver fibroma are diagnosed.

A benign tumor of the liver, belonging to the category of adenomas, is characterized as a single or multiple neoplasm of a round shape that has a gray or dark bloody color. Such formations can be of different sizes. Their location is most often under the organ capsule or in the parenchyma. The causes of a liver tumor of a benign nature are associated with the prolonged use of contraceptives in the form of tablets by women. Some benign tumors in the liver can develop into cancer. Treatment of liver cancer should be prescribed taking into account the most likely causes of the disease.

Liver adenomas are considered the most common diseases among benign neoplasms. Vascular formations are characterized by a cavernous spongy structure and are formed from the venous-vascular network of the organ. This type of adenoma is divided into two types:

• Cavernoma;
• Cavernous hemangioma.

Most doctors consider vascular neoplasms not tumors, but congenital vascular anomalies.

The consequence of biliary and circulatory lesions in certain parts of the liver is nodular hyperplasia. This benign liver tumor is pink or red, has a non-smooth surface, and can be of various sizes. The structure of such a tumor is quite dense and can degenerate into cancer.

Symptoms of a benign liver tumor

Any type of benign tumor is not manifested by pronounced symptoms. A benign tumor of the liver for a long time does not disturb the well-being of a person and the functioning of the organ, i.e. symptoms of a liver tumor may appear in later stages.

Liver hemangioma can only appear if it is large. In this case, the patient may experience heaviness and pain in the epigastrium, belching and nausea. This disease is very dangerous because there is a risk of rupture of the tumor formation, which will cause intra-abdominal bleeding, bleeding into the bile ducts and deformation of the tumor base.

A large cyst on the liver is manifested by pressure and heaviness in the hypochondrium. Launched and not removed cysts can cause suppuration, bleeding, ruptures.

Liver adenoma begins to manifest itself only when it becomes large in size. In this case, the patient may experience pain in the abdomen. On palpation, the tumor is clearly felt in the right side of the abdomen. A complicated form of the disease can cause a rupture of the formation.

Nodular hyperplasia of the liver is completely asymptomatic. When feeling the right abdomen, hepatomegaly can be detected. This benign liver tumor rarely has complications in the form of ruptures and bleeding. Symptoms of a liver tumor may be subtle and not manifest themselves for some time, so at the slightest sign you should consult a doctor.

Identification and treatment of a liver tumor of a benign nature

To determine the presence or absence of a benign formation in the liver, you can use the following examination methods:

• Ultrasound examination of the liver;
• CT scan;
• Diagnostic laparoscopy with local tissue biopsy of the organ and a thorough study of the material obtained;
• Hepatoangiography.

If hyperplasia and adenoma are detected, a liver tissue biopsy procedure obtained by percutaneous penetration is prescribed.

A benign liver tumor of any type is treated only with surgery to remove the tumors. Such treatment of a liver tumor is due to a decrease in the risk of degeneration of a benign formation into a malignant one. During the operation, only a benign tumor of the liver or part of the liver along with the neoplasm can be removed. Depending on the size of the tumor and the complexity of the case, one of the following types of surgery can be performed: laparoscopic intervention, marginal cutting of the organ, lobectomy, segmentectomy and hemihepatectomy. If a patient has a cyst on the liver, then surgical intervention includes removal of the cyst.

Types of malignant liver tumors

Malignant neoplasms of the liver can be of two main types:

• A primary tumor is a formation that grows out of the tissues of the liver;
• A secondary tumor is a formation that appears by metastasis from other diseased organs of the body.

In medical practice, a secondary malignant tumor of the liver is many times more common than primary tumors. This is due to the fact that the blood of our body passes through the liver, and metastases from diseased organs move through the body through the blood.

Primary liver cancer is extremely rare. As a rule, this disease affects males over the age of 50 years. Depending on the origin, primary cancers can be of the following types:

• Angiosarcoma, emerging from the inner lining of the blood vessels of the liver;
• Hepatocellular carcinoma arising from the tissues of the organ;
• Hepatoblastoma - a cancerous growth in the liver that affects people of childhood;
• Cholangiocarcinoma grows from the cell layer of the bile ducts.

The causes of a liver tumor of a malignant nature are the chronic course of viral hepatitis B and C. In patients with hepatitis, hepatocellular liver cancer is diagnosed 200 times more often.

Symptoms of a liver tumor of a malignant nature

A malignant liver tumor can manifest itself as general poor health, weakness in the body, decreased appetite, nausea, vomiting, heaviness and pain in the right abdomen and hypochondrium, and weight loss.

As the liver cancer grows, it begins to bulge and can be seen visually. A patient has swelling on the right side of the abdomen in the region of the lower rib. On palpation, a tumor of a dense structure is detected.

Late stages of the development of the disease are accompanied by the appearance of anemia, ascites, jaundice, increased liver failure and endogenous intoxication.

Detection and treatment of liver cancer

A malignant tumor of the liver can be detected by taking a blood test for biochemical parameters that indicate liver function. With a decrease in albumin, an increase in transaminase activity, an increase in fibrogen and urea, creatinine and residual nitrogen, it may indicate the presence of cancer. With this result of the analysis, the doctor prescribes liver tests and coagulograms, as well as the initial treatment of liver cancer in Moscow.

To get a more accurate picture of a person's health, an ultrasound scan, MRI and CT of the liver, and angiography are done. To confirm or refute the diagnosis, most doctors recommend a needle biopsy of the tumor and liver tissue for a detailed and composite examination.

If a malignant tumor of the liver has begun to metastasize to other organs of the body, then it is important to establish the location of the metastases and start the treatment of liver cancer in time. For this, the following manipulations are carried out:

• EGDS;
• Radiography of the stomach;
• Ultrasound examination of the mammary glands;
• Mammography;
• Fluorography of the lungs;
• colonoscopy;
• Other methods of diagnosing organs.

Treatment of liver cancer in Moscow is carried out by medical and surgical methods. A malignant tumor of the liver can be completely cured only by the absolute removal of the diseased part of the liver and the formation itself. Usually, the treatment of liver cancer by surgical intervention is carried out by cutting off the affected lobe of the organ. If a single local malignant liver tumor is detected, then its treatment begins with intravascular or systemic chemotherapy.

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Classification of benign liver tumors

Liver adenomas are single or multiple round formations of a grayish or dark red color of various sizes. They are located under the capsule of the liver or in the thickness of the parenchyma. It is believed that the development of liver adenomas in women may be associated with prolonged use of oral contraception. Some types of benign liver tumors (trabecular adenomas, cystadenomas) are prone to degeneration into hepatocellular cancer.

Vascular formations (angiomas) are among the most common benign tumors of the liver. They have a cavernous spongy structure and come from the venous network of the liver. Among vascular tumors of the liver, cavernous hemangiomas and cavernomas are distinguished. There is an opinion that the vascular formations of the liver are not true tumors, but a congenital vascular anomaly.

Nodular hyperplasia of the liver develops as a result of local circulatory and biliary disorders in certain areas of the liver. Macroscopically, this liver tumor may have a dark red or pink color, a small-hilly surface, and a different size. The consistency of nodular hyperplasia of the liver is dense, the phenomena of local cirrhosis are microscopically detected. The degeneration of nodular hyperplasia into a malignant tumor of the liver is not excluded.

Symptoms of benign liver tumors

Most benign liver tumors do not have a well-defined clinical symptomatology. Unlike malignant tumors of the liver, benign tumors grow slowly and do not lead to a violation of general well-being for a long time.

Large hemangiomas of the liver can cause pain and heaviness in the epigastrium, nausea, belching with air. The danger of liver hemangioma lies in the high probability of tumor rupture with the development of bleeding into the abdominal cavity and hemobilia (bleeding into the bile ducts), torsion of the tumor stem. Large liver cysts cause heaviness and pressure in the hypochondrium and epigastrium. Complications of liver cysts can be rupture, suppuration, jaundice, hemorrhage into the tumor cavity.

Liver adenomas, when they reach a significant size, can cause pain in the abdomen, and can also be palpated in the form of a tumor-like formation in the right hypochondrium. In complicated cases, a rupture of the adenoma may occur with the development of hemoperitoneum. Nodular liver hyperplasia usually does not have severe symptoms. On palpation of the liver, hepatomegaly may be noted. Spontaneous rupture of this liver tumor is rare.

Diagnosis and treatment of benign liver tumors

In order to diagnose benign liver tumors, ultrasound of the liver, hepatoscintigraphy, CT, hepatoangiography, diagnostic laparoscopy with targeted liver biopsy and morphological examination of the biopsy are used. In adenomas or nodular hyperplasia, a percutaneous liver biopsy may be performed.

In view of the likelihood of malignancy and the complicated course of benign liver tumors, the main tactic for their treatment is surgical, which involves resection of the liver within the boundaries of healthy tissues. The volume of resection is determined by the location and size of the liver tumor and may include marginal resection (including laparoscopic), segmentectomy, lobectomy, or hemihepatectomy.

With a liver cyst, excision of the cyst, endoscopic or open drainage, the imposition of cystoduodenoanastomosis, and marsupialization can be performed.

Classification and causes of malignant tumors of the liver

Malignant tumors of the liver can be primary, that is, come directly from the structures of the liver, or secondary, associated with the growth of metastases brought from other organs. Secondary liver tumors occur 20 times more often than primary ones, which is associated with filtration through the liver of blood coming from various organs and hematogenous drift of tumor cells.

Primary malignant tumors of the liver are relatively rare. It occurs predominantly in males over 50 years of age. By origin, the following forms of primary malignant liver tumors are distinguished:

• hepatocellular carcinoma (hepatocellular carcinoma, hepatoma), originating from cells of the hepatic parenchyma
• cholangiocarcinoma originating from bile duct epithelial cells
• angiosarcoma arising from the vascular endothelium
• hepatoblastoma - a tumor of the liver that occurs in children

Symptoms of malignant tumors of the liver

The initial clinical manifestations of malignant liver tumors include malaise and general weakness, dyspepsia (worsening of appetite, nausea, vomiting), heaviness and aching pain in the hypochondrium on the right, subfebrile condition, and weight loss.

With an increase in the size of the tumor, the liver protrudes from under the edge of the costal arch, acquires tuberosity and woody density. In the later stages, anemia, jaundice, ascites develop; increasing endogenous intoxication, liver failure. If tumor cells have hormonal activity, then endocrine disorders (Cushing's syndrome) occur. When a growing tumor of the liver of the inferior vena cava is compressed, edema of the lower extremities appears. With vascular erosion, intra-abdominal bleeding may develop; in the case of varicose veins of the esophagus and stomach, gastrointestinal bleeding may develop.

Diagnosis and treatment of malignant tumors of the liver

Typical for all malignant tumors of the liver are shifts in biochemical parameters characterizing the functioning of the organ: a decrease in albumin, an increase in fibrinogen, an increase in transaminase activity, an increase in urea, residual nitrogen and creatinine. In this regard, if a malignant liver tumor is suspected, it is necessary to examine liver tests and a coagulogram.

For a more accurate diagnosis, they resort to ultrasound scanning, computed tomography, liver MRI, liver angiography. For the purpose of histological verification of the formation, a puncture biopsy of the liver or diagnostic laparoscopy is performed.

With signs of metastatic liver damage, it is necessary to establish the localization of the primary tumor, which may require the performance of radiography of the stomach, endoscopy, mammography, ultrasound of the mammary glands, colonoscopy, irrigoscopy, radiography of the lungs, etc.

Complete cure of malignant tumors of the liver is possible only with their radical removal. As a rule, with liver tumors, resection of the liver lobe or hemihepatectomy is performed. With cholangiocarcinomas, they resort to removing the duct and applying anastomoses (hepaticojejunoanastomosis, hepaticoduodenoanastomosis).

With single tumor nodes of the liver, it is possible to perform their destruction using radiofrequency ablation, chemoablation, cryoablation. Chemotherapy (systemic, intravascular) is the method of choice for malignant liver tumors.

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Benign tumors of the liver

Hemangiomas. They can be represented by two options: a true hemangioma, which develops from the vascular-embryonic tissue, and a cavernoma, representing, as it were, dilated blood vessels. More often the tumor is subcapsular in the right lobe, sometimes covered with a fibrous capsule. Possible calcification of the capsule. Clinical manifestations occur no more often than in 10% of patients and usually, if the tumor diameter exceeds 5 cm, there may be pain in the upper abdomen, with significant sizes, symptoms of compression of the biliary tract and portal vein and liver enlargement. Single hemangiomas grow slowly (tens of years). A rare but dangerous complication is a hemangioma rupture with symptoms of internal bleeding. In rare cases, multiple hemangiomatosis develops, which is characterized by a triad of symptoms: hematomegaly, skin hemangiomas, and heart failure, associated with the fact that the hemangioma acts as an arteriovenous fistula. Such patients often die of heart failure in childhood or young age. Vascular murmurs can sometimes be heard over large cavernomas.

adenomas. As a rule, single tumors are more often located subcapsularly in the right lobe. In many cases, they are asymptomatic, sometimes there is a moderately severe pain syndrome. Since the tumor is well vascularized, intraperitoneal bleeding is possible. Very rare malignancy.

Diagnostics

Liver function tests are usually normal. Their change occurs only with polycystic liver disease with cystic degeneration of a significant part of the parenchyma of the organ. The main role in the diagnosis is played by instrumental research methods. With the help of ultrasound, hemangiomas are detected as hyperechoic, clearly defined formations, adenomas have a uniform hypoechoic structure that repeats the structure of surrounding tissues, cysts are often rounded, echo-negative, with even and clear contours and thin walls. Focal formations with a diameter of at least 2 cm are recognized in 80% of patients. If necessary, CT and MRI are used. These methods provide additional information about the state of the surrounding tissues. Saves the value of radionuclide scintigraphy. The most accurate data for the diagnosis of hemangiomas gives celiacography.

For the differential diagnosis of benign liver tumors and malignant tumors, in addition to clinical symptoms, it is important that there is no increase in the concentration of alpha-fetoprotein in the blood serum. With malignant growth, ultrasound reveals foci of various sizes and shapes, with uneven and fuzzy contours, varying degrees of echogenicity (metastatic liver cancer, nodular form of primary liver cancer), heterogeneity of the structure with varying degrees of echogenicity, areas of the parenchyma of an unusual structure (diffuse-infiltrative form of primary cancer liver). Computed and magnetic resonance imaging may be more informative. If necessary, laparoscopy and targeted liver biopsy are used.

Treatment

Small hemangiomas without a tendency to grow do not need treatment. Hemangiomas larger than 5 cm in diameter that may compress vessels or bile ducts should be removed. Rapidly growing cysts are also subject to surgical treatment. All patients with benign liver tumors should be under constant supervision.

Malignant tumors of the liver

In the liver, metastatic tumors are possible (most often from the stomach, colon, lungs, breast, ovaries, pancreas) and primary tumors. Liver metastases are more common (ratio 7–25:1). Primary liver tumors occur with varying frequency in different geographical areas: in hyperendemic areas of liver cancer in Africa, Southeast Asia and the Far East, the frequency can exceed 100 per 100 thousand of the population, reaching 60-80% of all tumors detected in men, and in non-endemic areas of Europe and the USA, the frequency does not exceed 5:100,000. The average incidence rate in Russia is 6.2, but there are regions with significantly higher rates: in the Irtysh and Ob basins, they are 22.5–15.5, with predominantly the more common cholangiocellular carcinoma. In general, hepatocellular carcinoma predominates, accounting for up to 80% of all primary liver cancers. Among the diseased men predominate in a ratio of 4:1 and above.

Etiology

In 60-80% of patients, the development of hepatocellular carcinoma is associated with the persistence of hepatitis B and C viruses, of which 80-85% of the tumors occur against the background of viral cirrhosis of the liver.

• The hepatitis B virus, integrating into the hepatocyte genome, activates cellular oncogenes, which leads, on the one hand, to the stimulation of apoptosis - "programmed" accelerated cell death, and on the other hand, to the stimulation of cell proliferation.
• The hepatitis C virus acts differently: the predominant cirrhosis of HGV compared to HBV and the duration of the disease are probably of primary importance.
• Mixed infection (HBV/HCV) often leads to the development of carcinoma: in chronic HCV infection with liver cirrhosis, malignancy occurs in 12.5%, and in combination with HBV/HCV - in 27% of cases.

There are a large number of factors that predispose to the development of hepatocarcinoma in chronic viral infection: immunogenetic factors, in particular, ethnicity and gender (greater vulnerability in men), exposure to radiation and other environmental stresses, long-term use of certain drugs (oral contraceptives, cytostatics, androgenic steroids and etc.), drug use, persistent smoking, exposure to mycotoxins, in particular aflotoxin when eating mold-infected peanuts, an unbalanced diet with a deficiency of animal protein, repeated liver injuries, impaired liver porphyrin metabolism. An important role, given the degree of prevalence, is the abuse of alcohol. It is possible that some of these factors alone, without the participation of the virus, can cause the development of liver cancer, especially in patients with cirrhosis of the liver and against the background of an immunogenetic predisposition.

Macroscopically, three forms of primary liver cancer are distinguished:

• massive form with unicentric growth of the solidary node (44%),
• nodular form with multicentric growth of individual or confluent nodes (52%),
• diffuse form, otherwise called cirrhosis-cancer, which develops against the background of cirrhosis of the liver (4%).

The nodular form of cancer also often develops against the background of cirrhosis of the liver (hepatocellular carcinoma), as well as tumors emanating from the epithelium of the bile ducts (cholangiocellular carcinoma). Malignant cholangioma, unlike hepatocarcinoma, usually has a poorly developed capillary network and a rich stroma. Mixed tumors are possible - malignant hepatocholangiomas.

Primary liver cancer metastasizes intrahepatic and extrahepatic - hematogenous and lymphogenous. Most often, metastases occur in regional lymphatic vessels (primarily periportal), in the lungs, peritoneum, bones, brain, and other organs. Morphological classifications of primary liver cancer, division into massive, nodular and diffuse forms, as well as the International TNM system (Tumor-Nodulus—Metastasis) are used.

Symptoms

The most typical clinical hepatomegalic form of liver cancer is characterized by rapidly progressive liver enlargement that becomes stony. The liver is painful on palpation, its surface may be bumpy (with multiple nodes). Hepatomegaly is accompanied by dull pains and a feeling of heaviness in the right hypochondrium, dyspepsia, rapidly developing weight loss, fever. With this form of cancer, jaundice is a later symptom, more often associated with tumor metastasis to the liver hilum and the development of obstructive jaundice. Ascites in these patients is associated with (pressure of the portal vein by metastases or the tumor itself, or metastases to the peritoneum and is also a late symptom.

It is more difficult to diagnose the cirrhotic form of primary liver cancer, since the tumor occurs against the background of liver cirrhosis and is characterized by an increase in clinical symptoms typical of active liver cirrhosis: extrahepatic signs, signs of portal hypertension, in particular, ascites, hemorrhagic syndrome, endocrine disorders. There is no significant enlargement of the liver. Typically, the rapid development of decompensation, abdominal pain, rapid weight loss. The life expectancy of patients with this form of liver cancer since its

recognition usually does not exceed 10 months.

In addition to these typical forms of primary liver cancer, there are atypical variants. These include: abscess-like or hepato-necrotic form of liver cancer, acute hemorrhagic hepatoma, icteric or ictero-obstructive form, as well as masked variants, in which symptoms associated with distant metastases come to the fore.

The abscess-like form of the tumor is manifested by fever, symptoms of intoxication, severe pain in the right hypochondrium. The liver is enlarged and painful. With this form of cancer, some of the tumor nodes become necrotic and may suppurate. The average life expectancy of patients with this form of cancer does not exceed 6 months from the onset of obvious signs of the disease.

In those cases when the hepatoma sprouts vessels, there may be a rupture of these vessels with symptoms of internal bleeding into the free abdominal cavity. In cases of a latent course of the tumor until the moment of rupture, the diagnosis of liver cancer as the cause of an abdominal catastrophe (patients have low blood pressure, an increased pulse, skin and mucous membranes are pale and moist, the stomach is swollen, sharply painful) can be difficult.

In some patients, for some time, the clinical picture may be dominated by symptoms of mechanical (subhepatic) jaundice due to compression of the gates of the liver by a tumor node located near the gates of the liver, or their compression by enlarged metastatic lymph nodes. With this form of liver cancer, the tumor grows relatively slowly, but after a few months, a clinical picture typical of the hepatomegalic form of liver carcinoma may develop.

Masked variants of liver cancer are manifested by symptoms of damage to the brain, lungs, heart, spine, depending on the location of metastases, and hepatomegaly, jaundice, ascites appear only in the terminal stage of the disease. In rare cases (1.5-2%), a latent and slow development of a liver tumor is possible for several years, when the tumor is detected as a result of an instrumental examination of the liver undertaken for any reason.

In some cases, a liver tumor is accompanied by the appearance of paraneoplastic syndromes (in 10-20% of patients): hypoglycemic conditions associated with the production of an insulin-like hormone by the tumor or the production of insulinase inhibitors, secondary absolute erythrocytosis due to the production of hepatic erythropoietin, hypercalcemia due to the secretion of parathyroid-like hormone, Cushing's syndrome due to the development of hypercortisolism, nephrotic syndrome.

In the peripheral blood, an increase in ESR is typical, less often and in the later stages - anemia, sometimes - erythrocytosis. Leukocytosis can be with an abscess-like form of liver cancer. With the development of cirrhosis-cancer with a previous syndrome of hypersplenism, an increase in cytopenia is possible: leukopenia, anemia, thrombocytopenia. Typical manifestation of the cytolytic syndrome.

Of the laboratory tests, the immunological reaction to embryo-specific alpha-globulin (alpha-fetoprotein) is the most informative. This test is not absolutely specific, since alpha-fetoprotein is found in a number of patients with cirrhosis of the liver, with acute viral hepatitis B with high activity of regenerative processes, sometimes in pregnant women, but a high content of alpha-fetoprotein (above 100 ng / ml) is typical for hepatocellular carcinoma (with cholangiocellular carcinoma, alpha-fetoprotein usually does not increase), including in asymptomatic clinical variants of the disease.

An important role in the diagnosis is played by instrumental methods: radionuclide scanning of the liver reveals "silent zones", ultrasound, CT, MRI detect foci of various densities. Ultrasound is dominated by foci of mixed, hyperechoic and isoechoic density, with fuzzy boundaries and a heterogeneous structure. If necessary, laparoscopy and other invasive examination methods are used.

It is necessary to differentiate with other causes leading to hepatomegaly (heart failure with right ventricular decompensation, diseases of the blood system). In diagnosis, in addition to the analysis of the clinical picture, the absence of focal changes in the liver during instrumental studies helps. Benign liver tumors are distinguished by the absence or slight changes in liver function and clear boundaries of detected focal formations of a homogeneous structure. Metastatic tumors of the liver (most often from the colon, stomach, lungs, breast, ovaries, as well as from the gallbladder, pancreas and melanoblastoma metastases), according to ultrasound, CT, are difficult to distinguish from a primary liver tumor. Examination of other organs is needed to look for the primary tumor. Histological examination of the metastasis punctate quite often allows to determine the primary organ localization of the tumor. Liver metastasis is rarely accompanied by significant dysfunction of this organ. If a primary liver tumor is suspected, the determination of alpha-fetoprotein plays an important role.

Course and complications

Primary liver tumors are rapidly progressive tumors. Severe complications may develop: thrombosis of the inferior vena cava, hepatic veins with a rapid increase in liver failure, portal vein thrombosis, sometimes with the addition of infection and the occurrence of purulent pylephlebitis. Sometimes there is a disintegration of the tumor node and suppuration, or rupture of the tumor with bleeding into the abdominal cavity and peritonitis. Patients most often, especially with the development of a liver tumor on the background of cirrhosis, die from liver failure or severe esophageal bleeding. Cholangiocarcinomas often progress faster than hepatocarcinomas and metastasize to distant sites earlier.

Treatment

Surgery combined with chemotherapy. If surgical treatment is not possible, chemotherapy, in particular, regional chemotherapy, with the introduction of cytostatics into the artery supplying blood to the tumor zone. The most radical method of treatment is orthotopic liver transplantation. The best results are with hepatocellular carcinoma on the background of liver cirrhosis and tumor size up to 5 cm in diameter. In such cases, the survival time can reach 10 years or more, approaching those in liver cirrhosis without a tumor. Orthotopic liver transplantation can prolong life even in patients with extensive unresectable liver tumors in the absence of visible metastases.

Forms of malignant tumors

Hepatocellular carcinoma

Hepatocellular carcinoma develops from hepatocytes and is a primary malignant tumor. It occurs more often in men and in developed countries is 1-5% of all detected malignant tumors. The development of hepatocellular carcinoma in many patients is associated with the carriage of the hepatitis B virus, the gene apparatus of which can be associated with the gene apparatus of the hepatocyte. The chromosomes of the hepatocyte bind to the DNA of the hepatitis B virus, cirrhotic transformation of the liver develops, which can cause the development of carcinoma. In addition to the carriage of the hepatitis B virus, alcohol consumption is important in the etiology of hepatocellular carcinoma, which correlates with the incidence of carcinoma. Especially often a malignant tumor develops in patients with viral-alcoholic cirrhosis of the liver. Carcinogenic factors include aflatoxin, a metabolic product of a yellow mold fungus, often found on food stored outside the refrigerator. The nature of the carcinogenic effect of aflatoxin has not been established.

Symptoms. The clinical picture of primary liver cancer depends on its form. A common feature of all forms is the special condition of patients: according to many authors, patients show some strange calmness or indifference. Patients develop early dyspeptic disorders (loss of appetite, aversion to fatty and meat foods, flatulence, nausea, vomiting). Weight loss develops rapidly. Massive cancer is accompanied by a large increase in the liver. The edge of the liver is rounded and sometimes palpable below the umbilicus. Usually the whole liver is enlarged, but sometimes one of the lobes is enlarged. The liver is firm, painless. On its anterior surface, a large tumor can be felt through the abdominal wall.

In primary liver cancer, half of the patients have subfebrile fever, but in some patients it is high. Jaundice occurs in less than half of patients. It develops when the nodes of the bile ducts are compressed. The spleen in primary liver cancer is sometimes enlarged. This is usually observed in those patients in whom carcinoma has joined cirrhosis of the liver. In other patients, an enlarged spleen may be due to compression of the splenic vein by a tumor or its thrombosis.

Ascites develops in half of the cases. It is caused by compression of the portal vein by cancer nodes or even its blockage. Fluid accumulation in the abdominal cavity is a late symptom unless carcinoma develops in a cirrhotic liver. When the superficial vessels of the tumor rupture, the ascitic fluid becomes hemorrhagic (hemoperitoneum). At the same time, edema develops in the lower extremities. Anemia and an increase in alkaline phosphatase are often detected, sometimes polycythemia, hypoglycemia, acquired porphyria, hypercalcemia and dysglobulinemia. The course of the disease is usually fulminant, patients die within a few months.

Diagnostics. The diagnosis is confirmed by scintigraphic examination, which reveals one or more formations, but it does not make it possible to distinguish between regenerating nodules in cirrhosis of the liver and primary or metastatic tumors. Ultrasound and computed tomography confirm the presence of tumor formations in the liver. Hepatic angiography can reveal the characteristic features of a tumor: changes in the shape or obstruction of the arteries and neovascularization (“tumor hyperemia”) and its extent. This research method is used when planning a surgical intervention. Of great diagnostic importance is the detection in the blood serum of α-fetoprotein - fetal α1-globulin, which rises in the serum of pregnant women with a normal pregnancy and disappears soon after childbirth. In almost all patients with hepatocellular carcinoma, its level exceeds 40 mg / l. Lower values ​​of α-fetoprotein are not specific for a primary liver tumor and can be detected in 25-30% of patients with acute or chronic viral hepatitis. Percutaneous liver biopsy from a palpable node, performed under ultrasound or CT guidance, is of great diagnostic value in detecting hepatocellular carcinoma. To confirm the diagnosis, laparoscopy or laparotomy with open liver biopsy is performed.

Treatment. With early detection of a solitary tumor, it is possible to excise it by partial hepatectomy. But in most patients, the diagnosis is established late. The tumor is not amenable to treatment with ionizing radiation and chemotherapy. The prognosis is unfavorable - patients die from gastrointestinal bleeding, progressive cachexia, or impaired liver function.

Metastatic liver cancer

Metastatic malignant tumors are the most common form of liver tumor. Metastasis usually occurs hematogenously, and is facilitated by the large size of the liver, intense blood flow, and the dual circulatory system (network of the hepatic artery and portal vein). Tumors of the lungs, gastrointestinal tract, mammary gland, pancreas, and less commonly, thyroid and prostate glands and skin metastasize most frequently.

Clinical symptoms may be associated with a primary tumor without signs of liver damage, metastases are detected during examination of patients. Non-specific manifestations are characteristic, for example, weight loss, feeling of weakness, anorexia, fever, sweating. Some patients develop abdominal pain. In patients with multiple metastases, the liver is enlarged, dense, painful. At advanced stages of the disease, tubercles on the liver of different sizes are palpated. Sometimes friction noise is heard over painful areas.

Diagnostics. Liver function tests are little changed, typical is an increase in the levels of alkaline phosphatase, γ-glutamyl transferase and sometimes lactate dehydrogenase. To confirm the diagnosis, ultrasound and computed tomography are necessary, but these methods have low sensitivity and specificity. The accuracy of diagnosis is increased with percutaneous needle biopsy, a positive result is obtained in 70-80% of cases. The percentage of correct diagnoses increases if the biopsy is performed under ultrasound guidance two or three times.

Treatment of metastases is usually ineffective. Chemotherapy can slow tumor growth, but it does not cure the disease for a short time. The prognosis currently remains unfavorable.

Liver cancer is a malignant tumor that occurs in the hepatic lobes or ducts that excrete bile. The disease is characterized by rapid tumor growth and is difficult to treat. It is somewhat less common than other forms of cancer - 7% of all cancers. Every year, 700,000 people are diagnosed with this disease.

The liver is a unique organ. It is the body's laboratory and cleanses the blood of toxins. Therefore, if a cancerous tumor has arisen in the human body, then its cells with the bloodstream often enter the liver and cause metastases there - secondary tumors. But sometimes it also happens that cancer initially originates in the liver. These cases differ significantly from each other and require different approaches to treatment. Therefore, doctors first of all classify tumors by the cause of their occurrence.

1. primary cancer- This is a tumor based on degenerated liver cells - hepatocytes, cells of its ducts or vessels. There are several types of primary tumors: hepatoma from cells of the liver parenchyma, cholangiocarcinoma from cells of the biliary tract, angiosarcoma from cells of the hepatic blood vessels and hepatoblastoma, which occurs in childhood.


2. Secondary cancer- a tumor formed from cancer cells brought to the liver from a malignant neoplasm in another organ. Most often it is a metastasis of cancer of the intestine, adrenal gland or genital organs. Secondary liver cancer is 20 times more common than primary liver cancer.

The incidence in this region is associated with the wide spread of opisthorchiasis. This disease is associated with flatworms that enter the human body with raw fish.

But in India, China and South Africa, the disease is much more common. For example, in Senegal, liver cancer accounts for 67% of all tumors. This is due to the fact that in hot climates, cereals and beer contain metabolic products of fungi - aflatoxins. People over 30 who abuse alcohol are especially susceptible. Representatives of some nationalities are more likely to suffer from this disease, these are Pacific Islanders, Inuit Indians and Hispanics.

Men are 4 times more likely to develop liver cancer than women. Tumors found in them are malignant in 90% of cases. And in women, 40% of liver tumors are classified as cancerous, and 60% as benign neoplasms.

Symptoms and signs of liver cancer

Symptoms of liver cancer

1. General weakness and fatigue.
2. Dull aching pain and feeling of heaviness in the right hypochondrium.
3. Loss of appetite, nausea, vomiting.
4. Sharp weight loss.
5. Enlargement and soreness of the liver. When touched, it is bumpy and hard.
6. If the tumor blocked the outflow of bile, then jaundice develops (yellowing of the skin and eyes, itching).
7. Urine turns dark and feces white.
8. Nosebleeds occur.
9. A blood test reveals anemia (a decrease in the number of red blood cells).
10. Ascites or dropsy is an accumulation of fluid in the abdominal cavity.
11. In 15% of cases, internal bleeding may occur. It causes a sharp deterioration in well-being: pallor, weakness, loss of consciousness.

Causes of Liver Cancer

Liver cancer metastases

Most often, tumor metastases are allowed into the liver, which are located in the pancreas (50% of all cases), large intestine (20-30%), stomach (30%), mammary gland (15%), esophagus (25%).

Primary liver cancer can also form metastases. First, they affect the healthy lobules of this organ. After that, daughter tumors occur in the lymph nodes of the porta of the liver and the lesser omentum. At the next stage, cancer cells settle in the lungs, pleura, bones and organs that are located in the abdominal cavity (peritoneum, kidneys, pancreas). At the same time, new symptoms of the disease appear in patients, the condition worsens and intoxication intensifies.

In the case when the tumor has formed metastases, it becomes much more difficult to cure the cancer and the prognosis of the course of the disease worsens.

Consultation with an oncologist for the treatment of liver cancer

Stages of liver cancer

After diagnosis, the oncologist determines the stage of tumor development. It is indicated by Roman numerals from I to IV.

Stage I: a cancerous tumor can be of any size. It is solitary, does not go beyond the liver, does not grow into blood vessels, neighboring organs and lymph nodes.

There are practically no external manifestations at this stage. A person may feel weakness, fatigue and minor discomfort in the upper right side of the abdomen. After a few weeks, the liver increases in size.

Stage II: a solitary tumor that grows into the blood vessels, its size can be any. This stage also includes cases when there are several tumors in the liver that do not exceed 5 cm in diameter. They do not spread to lymph nodes or distant organs.

This stage is manifested by nausea, vomiting, aching pain in the right hypochondrium. The patient has long-term digestive disorders, diarrhea for no reason. The liver is markedly enlarged in size, dense to the touch. The person looks weakened and complains of chronic fatigue.

Stage III has 3 substages.

• Stage IIIA. Several tumors were found in the liver. At least one of them exceeds 5 cm in diameter. The malignant neoplasm does not spread to nearby lymph nodes and distant organs.
• Stage IIIB. One of the tumors grows into large veins of the liver - portal or hepatic. Lymph nodes and other organs are not affected.
• Stage IIIC. The tumor metastasizes to nearby organs, except for the bladder. The same substage includes cases when the tumor grows into a capsule that surrounds the liver from the outside. Distant organs and nearby lymph nodes are not affected by metastases.

Stage IV has two substages.

• Stage IV. Any number of tumors can be found in the liver. They grow into blood vessels and surrounding organs. The lymph nodes are affected. Metastases are not found in distant organs.
• IVB stage. The tumor affects nearby and distant organs and lymph nodes. The number and size of neoplasms can be any.

Depending on the stage of development of the disease, the doctor chooses the most effective methods of treatment.

Alternative methods of treatment of liver cancer

We offer to consider some of the most effective traditional medicine for liver cancer.

pure propolis
This is one of the easiest ways to fight liver cancer and prevent this disease. The daily diet includes 15 g of fresh propolis, which should be taken in equal doses 3 times a day 1 hour before meals. The course of treatment is 2-3 months.
But, unfortunately, this folk method will be effective only in the early stages of the disease.

A decoction of oats
Cooking: take 1.5 cups of oats, place in an enamel pan and pour 2 liters of cold water. Put on medium heat, bring to a boil and boil for another 20 minutes over low heat. Let cool.
Application:

divide the decoction into three equal parts. Consume 3 times a day 1 hour before meals. Every day you need to brew a fresh broth.
Depending on the stage of the disease, the first result will be noticeable in 1-2 months.

Hemlock tincture
Cooking: Pour 0.5 liters of vodka into a three-liter jar. Cut the hemlock shoots into small pieces so as to fill the jar 1/3. Pour in sliced ​​hemlock, mix. Let it brew for 2-3 minutes, then fill the jar with vodka to the brim, close with a nylon lid and place in a cool place for 2 weeks.
Application: the course of treatment begins with 1 drop of tincture per day. It should be taken every morning before meals, increasing the dose by 1 drop per day. It is very important to avoid overdose! Having reached 40 drops, it is necessary to start reducing the dose by 1 drop daily. After completing the course, you should take a two-week break. Then you can repeat the treatment. During the break in taking the hemlock, you should drink a tincture of celandine.
For the treatment of cancer with hemlock, 3-5 courses are usually sufficient.

Celandine tincture
Cooking: take 1 kg of celandine root and pass through a meat grinder. Using gauze, squeeze the juice out of the resulting mass. Pour 0.5 liters of celandine juice in a glass container with the same amount of vodka. Let it brew in a cool place for 20 days.
Application: drink tincture of 1 tsp. 4 times a day half an hour before meals for 2 weeks.

Infusion from chaga
Cooking: you need to take 100 g of birch fungus (chaga) and grate. Pour the resulting mass in a jar with 5 glasses of cold boiled water. Let it brew for 2 days and strain thoroughly. The shelf life of chaga infusion is 4 days.
Application: infusion take ½ cup 3 times a day, at regular intervals, but not earlier than half an hour before meals. The course of treatment is 1 month. While taking the infusion, it is forbidden to use penicillin and glucose.

This folk remedy for cancer treatment has won the most positive reviews.
But remember that folk remedies cannot replace surgery. It is used in the postoperative period to prevent the recurrence of tumors. An integrated approach will help to increase the effectiveness of the fight against liver cancer - a combination of medicines, proper nutrition and treatment with folk remedies.

Nutrition for liver cancer

What do we have to do?

1. Food should be fractional. It is recommended to eat 4-5 times a day in small portions.
2. You shouldn't overeat. But if there is a feeling of hunger, then you need to have a snack.
3. Meals should be easily digestible and stimulate digestion. Therefore, it is worth starting with raw foods - vegetables and fruits. And then move on to cooked food.
4. It is advisable to consume more plant products. Vegetables, herbs, fruits and berries should be fresh and ripe. They need to be peeled off. Doctors advise limiting the use of tomatoes.
5. Sprouted cereals will become a source of essential trace elements and improve digestion.
6. Carrot juice cleanses the liver well. Doctors advise drinking it daily for half a glass before meals. At the same time, starch, flour and sugar are excluded. Useful and other freshly squeezed juices.
7. It is recommended to use wholemeal bread, brown rice. These foods are rich in fiber. Buckwheat and oatmeal cereals are also very useful.
8. Soups should be eaten daily. They should be light - vegetable, cereal, and not on a strong meat broth.
9. Fish, animal meat and poultry are sources of essential protein. But remember that only low-fat varieties are allowed. It is better to cook for a couple, boiled meat is well suited. You can diversify the menu with stews and baked dishes.
10. Fats should be ingested in the form of cold-pressed vegetable oil (olive, linseed). It is advisable to limit butter and refined vegetable oil, margarine.
11. Fresh dairy products are very useful. Natural milk, dairy products and cottage cheese should be on the menu daily. Sometimes you can afford a piece of low-fat hard cheese.
12. Soaked herring and sauerkraut (in small quantities) will help improve your appetite.
13. Be sure to eat 2-3 eggs a week in the form of omelettes. They help stop weight loss.
14. The best confectionery products are jam, marmalade, marshmallow. Chocolate and products with cream (especially butter) are not recommended.
15. It is better to quench your thirst with compotes, black, green or herbal tea.

• fatty meats and fish (pork, lamb, goose, duck, brains)
• alcohol in any form
• coffee and chocolate, cakes and pastries
• hot spices (mustard, horseradish)
• instant and sugary carbonated drinks
• fried and smoked dishes
• products with food additives (crackers, products with monosodium glutamate)
• nuts and legumes
• marinated dishes and preserves

What determines life expectancy with liver cancer?

The indicator of successful treatment is a five-year survival rate. This is the percentage of people who live at least 5 years after treatment. Modern clinics achieve a five-year survival rate in more than 40% of operated patients. And most people continue to work and live a normal life. In other cases, the life expectancy is approximately 3 years.

If a person's liver cancer was not accompanied by cirrhosis, then the five-year survival rate exceeds 50%, and in the early stages 70%.

If the tumor has started up numerous metastases, then it is not operated on, but symptomatic supportive treatment is carried out. Patients who, for whatever reason, cannot be operated on live an average of 4-6 months.

The prognosis of the course of the disease in the later stages is unfavorable. The five-year survival rate for the third stage is 6%. If there are distant metastases (fourth degree), then 2% of patients have a chance to live longer than five years.

Modern methods of treatment help to increase life expectancy, stop the growth of tumors or even completely get rid of them.

Ablation - a method of local destruction of the tumor without surgery. Medical alcohol is injected into the tumor itself, which destroys diseased cells. The destruction of the tumor is also carried out using frozen gas (cryolysis), microwave radiation, high-energy radio waves. This procedure is guided by ultrasound. The method is used to destroy small tumors up to 3 cm in diameter.

Vascular embolization - Special substances are injected into the vessels of the liver, which help to block the access of blood to the tumor and thus stop its growth. Often used in combination with radiation, chemotherapy and ablation. Used to treat tumors up to 5 cm in diameter.

Radiation therapy Helps shrink cancer, relieve pain and increase life expectancy with high-energy X-rays. Doctors focus the beam of rays on the tumor, while healthy cells are irradiated slightly. Apply at all stages.

Chemotherapy - modern drugs Sorafenib and Nexavar are used for treatment. These are special toxins (poisons) that poison malignant cells. They act specifically on the tumor and slightly damage healthy tissue. Standard chemotherapy has little effect in treating liver cancer.

Surgery gives the patient the best chance of recovery. The best results are the complete removal of the tumor or a liver transplant.

It must be remembered that every person diagnosed with liver cancer has a chance for successful treatment. In oncological diseases, an optimistic attitude, the help of loved ones and the skill of a doctor play an important role.

- These are neoplasms with differentiated cells that can form from hepatocytes, liver epithelium or vascular structures and always have limited growth, are not prone to metastasis. Clinical manifestations occur only when the tumor reaches a large size and blood flow is disturbed, compression of the biliary tract or neighboring organs. Tumors of small sizes are often a diagnostic finding. Informative research methods include ultrasound, CT and MRI of the liver and biliary tract. With large sizes of education, surgical treatment.

General information

Benign liver tumors are neoplasms that form from the epithelial tissue of the liver, the stroma of an organ or vascular elements, are not prone to rapid growth and metastasis, have differentiated cells and in most cases are asymptomatic. In clinical gastroenterology, liver neoplasms of a benign nature are quite rare.

In 90% of cases, liver hemangioma is diagnosed, less often - hepatocellular adenoma, lipoma, fibroma, lymphangioma and mixed tumors - teratomas or hamartomas. Benign tumors of the liver also include cystic formations: retention, dermoid cysts, polycystic. Most often, such formations are a diagnostic finding, since clinical symptoms occur only when the tumor reaches a significant size, and portal blood flow is disturbed.

Causes

The reasons for the development of this pathology have not been established, but the role of a number of factors that increase the risk of the formation of benign liver tumors has been proven. It has been established that the incidence is higher among people with a family history of oncopathology burdened with an unfavorable environmental situation. An important role is given to the intake of hormonal drugs, including oral contraceptives, as well as nutritional habits: an excess of animal fats in the diet, a lack of fiber, vitamins, and protein. Risk factors are bad habits: smoking and drinking alcohol. Induces the development of liver tumors and physiological hyperestrogenemia during pregnancy.

Classification

Gastroenterologists classify this pathology depending on the location and tissue from which the neoplasm occurs. There are hemangioma of the liver (a tumor from vascular elements), hepatocellular adenoma (formation directly from hepatocytes), local nodular hyperplasia (a round focus of liver cells), fibronodular hyperplasia (a single tumor focus from fibrous tissue), regenerative multinodular hyperplasia (multiple foci).

In addition, there are cystadenoma (formation from vesicle-shaped glandular cells), lipoma (tumor from adipose tissue), fibroma (from connective tissue elements) and fibromyoma (from connective and muscle tissue). Tumors of the bile ducts include cholangioadenoma (formed from glandular cells of the ducts), cholangiofibroma (from connective tissue) and cholangiocystoma (cavitary formation).

Symptoms

In the vast majority of cases, neoplasms are asymptomatic until they reach a significant size. Small tumors can be detected when examining a patient for another pathology. With large sizes of neoplasia, there are complaints about a feeling of heaviness in the right hypochondrium, epigastric region, constant aching pains that are not associated with food intake (pain is a consequence of compression of adjacent organs by the tumor or impaired blood flow with tissue necrosis). Dyspeptic symptoms are possible: nausea, belching, a feeling of bitterness in the mouth.

All benign liver tumors have a number of features that allow them to be distinguished from malignant ones: in the first case, there is no syndrome of tumor intoxication (severe weakness, fatigue, loss of appetite, pallor of the skin, rapid weight loss), there is no rapid growth of the formation, specific tumor markers are not detected in blood tests. , no burdened oncological anamnesis.

Complications

Extremely rare manifestations of portal hypertension: an increase in the volume of the abdomen, hepatosplenomegaly. In some cases, mechanical jaundice is detected, which develops with compression by the formation of the bile ducts and a violation of the outflow of bile, gastrointestinal bleeding as a result of portal hypertension, fever (with necrotization of the area with impaired blood supply) and heart failure (due to massive arteriovenous shunting).

Diagnostics

Benign liver neoplasias are detected during an examination for another pathology or when the formation reaches a large size, compression of neighboring organs, or impaired blood flow. A consultation with a gastroenterologist allows you to find out how long ago complaints about a feeling of heaviness appeared, whether there is a pain syndrome, how quickly the clinical picture developed. During an objective examination of the patient, the doctor may detect an increase in the size of the liver (hepatomegaly) with a palpable uneven edge.

A complete blood count usually does not reveal any abnormalities. In liver tests, a slight increase in markers of cytolysis and cholestasis (alkaline phosphatase, ALT, AST, LDH, bilirubin) can be determined. It is mandatory to determine specific oncomarkers in the blood: alpha-fetoprotein, CA 19-9 antigen and cancer-embryonic antigen. The absence of an increase in their concentration testifies in favor of the benign nature of the disease.

The main role in the diagnosis is played by instrumental research methods. Ultrasound of the abdominal organs allows you to visualize the formation, determine its size, boundaries, assess the condition of neighboring organs. Solitary or multiple well-defined hyperechoic foci are identified. Under ultrasound control, a puncture biopsy of the liver is performed, followed by a morphological study of biopsy specimens. This method allows you to determine the type of tumor cells, the degree of their differentiation and distinguish them from malignant pathology.

Computed tomography and MRI of the liver and biliary tract are highly informative, since they make it possible to determine formations of even small sizes, assess the nature of their growth, the absence of germination in surrounding tissues and metastasis to regional lymph nodes and distant areas. If a hemangioma is suspected, angiography is performed (the features of blood flow in the formation are assessed, the connection of the tumor with the vessels of the liver is established), as well as Dopplerography of the focal formation.

Treatment of benign liver tumors

As a rule, tumors that occur without clinical symptoms do not require treatment. However, the patient should be constantly monitored by a hepatologist to assess the nature of the growth of education. When using hormonal drugs (especially contraceptives by women), the issue of their cancellation is being decided. In some cases (with hepatocellular carcinoma), this leads to a regression of the formation if it is hormone-dependent.

With a large size of the tumor, compression of blood vessels or bile ducts, it is removed with resection of the liver lobe. Also, cystic formations with a high risk of rupture and bleeding are subject to surgical removal. Benign liver tumors are often hormone-dependent, therefore, even with small sizes, they can be removed in women planning a pregnancy.

Forecast and prevention

The prognosis for this disease is favorable. Formations can exist for a long time without significant growth, without causing discomfort to the patient, and rarely degenerate into malignant tumors. Complications such as rupture of the formation and intra-abdominal bleeding are possible. There is no specific prevention. It is necessary to observe a balanced diet, stop smoking and drinking alcohol, and also the absence of uncontrolled use of drugs, especially hormonal ones.