Jaundice and ascites are common features of liver cancer. Liver cancer examination focuses on 4 important indicators

Liver cancer is one of the most common malignant tumors in clinical practice, with a high mortality rate. It is beneficial for early detection and treatment of the disease if everyone is aware of its common symptoms and signs. So what are the common signs of liver cancer?

1. Jaundice

Diffuse liver cancer and cholangiocarcinoma are the most common. When the cancer infiltrates extensively, it can cause hepatocellular jaundice. When the cancer invades the intrahepatic bile duct or the hilar lymph nodes compress the bile duct, it can cause obstructive jaundice. When necrotic tumor tissue and blood clots fall into the bile duct, they can block the bile duct and cause obstructive jaundice.

2. Hepatomegaly:

About 90% of liver cancer patients will have this sign, which is mostly progressive and manifested as a hard liver with an irregular surface and edges, often in a nodular shape. In a few cases where the tumor is deeply buried in the liver parenchyma, the liver surface is smooth, with or without obvious tenderness.

3. Splenomegaly

Splenomegaly is common in cases with combined cirrhosis and portal hypertension. In addition, congestive splenomegaly can also be caused when tumor thrombus in the portal vein or splenic vein or the tumor itself compresses the portal vein or splenic vein.

4. Ascites:

It is common in middle and late stage liver cancer, and the onset is mostly caused by chronic liver damage leading to reduced albumin synthesis or portal hypertension.

Ascites is generally light yellow in color, and a few cases are bloody ascites. Bloody ascites is mostly caused by rupture and bleeding of cancerous nodules, and some bloody ascites can also be caused by the shedding of tumor cells.

5. Corresponding signs of metastasis:

Pathological fractures may occur in case of bone metastasis;

Pleural metastasis may cause chest pain and bloody pleural effusion;

Lymph node enlargement may occur when there is lymph node metastasis;

Paraplegia may occur when there is spinal cord metastasis;

When the disease metastasizes into the brain, neuropathic signs such as hemiplegia may occur, etc.

6. Vascular murmurs in the liver area:

Vascular bruits in the liver are special signs of liver cancer, which are mostly caused by the compression of large blood vessels in the liver by the enlarging tumor or the rich blood vessels of the tumor itself.

There are 4 important indicators for liver cancer examination

The main thing that is scary about cancer is that it is difficult to detect in the early stages. Currently, there are four indicators that can provide valuable diagnosis for primary liver cancer through blood tests.

Primary liver cancer is one of the common malignant tumors in my country, and its mortality rate ranks third among digestive system malignant tumors, second only to gastric cancer and esophageal cancer. Serological testing combined with imaging examinations can make a diagnosis of liver cancer in the subclinical stage (before symptoms appear), thereby significantly improving the long-term efficacy of liver cancer. At present, the following serum indicators commonly used in hospitals for diagnosing liver cancer are AFP, abnormal prothrombin (AP), γ-glutamyl transferase isoenzyme II (GGT2) and serum fucosidase (AFU).

4 important indicators of liver cancer examination

Alpha-fetoprotein (AFP)

Alpha-fetoprotein is an embryo-specific alpha globulin discovered in fetal serum in 1956. In 1964, it was measured in the serum of liver cancer patients.

Reference value:

Pathological significance: Under normal circumstances, this alpha-fetoprotein present in the early embryonic serum disappears rapidly after birth. If it reappears in the adult serum, it indicates the possibility of liver cancer.

In addition, alpha-fetoprotein may be falsely positive in genital embryonal tumors and a few metastatic tumors such as gastric cancer, as well as in pregnant women, hepatitis, and cirrhosis patients, but the increase is not as obvious as that of liver cancer. Alpha-fetoprotein is now widely used in the survey, diagnosis, judgment of treatment effect, and prediction of recurrence of hepatocellular carcinoma. The positive result in the survey may be 8 to 11 months earlier than the onset of symptoms. The alpha-fetoprotein positive rate of patients with hepatocellular carcinoma is 70% to 90%.

Diagnostic criteria: AFP > 500 μg/L for 1 month, or > 200 μg/L for 2 months without evidence of liver disease activity, and exclusion of pregnancy and genital embryonal tumors, should be highly suspected of liver cancer. Usually, the AFP concentration is related to the size of the tumor, but there are large individual differences.

20% to 45% of patients with active chronic hepatitis and cirrhosis have low-level positive alpha-fetoprotein, which usually does not exceed 200 micrograms per liter (μg/L). Serum alanine aminotransferase often increases significantly first, and alpha-fetoprotein increases at the same time. Within 1 to 2 months, it decreases as the condition improves and serum alanine aminotransferase decreases. However, if low-level positive alpha-fetoprotein persists for 2 months or more, and serum alanine aminotransferase has returned to normal, one should be highly alert to the presence of subclinical liver cancer.

The clinical value of alpha-fetoprotein for hepatocellular carcinoma can be summarized as follows:

1. It is a diagnostic method second only to pathological examination;

2. It is one of the best early diagnosis methods currently available and can be diagnosed 8 to 11 months before clinical symptoms appear;

3. A sensitive indicator that reflects changes in the condition and treatment effects;

4. It helps to detect subclinical, recurrent and metastatic liver cancer.

Abnormal prothrombin (AP)

Abnormal prothrombin is also called γ-carboxyprothrombin.

Reference value:

Clinical significance: The positive rate of abnormal prothrombin in the serum of patients with liver cancer is 69.4%. Most data show that abnormal prothrombin has a high specificity for primary liver cancer, while only a small number of benign liver diseases and metastatic liver cancer are positive, so it has early diagnostic value for subclinical liver cancer.

Gamma-glutamyltransferase isozyme II (GGT2)

The positive rate of γ-glutamyltranspeptidase isoenzyme II for the diagnosis of primary and metastatic liver cancer can reach 90%, and the specificity can reach 97.1%. The positive rate in patients with non-cancerous liver disease and extrahepatic disease is less than 5%. γ-glutamyltranspeptidase isoenzyme II is not related to the concentration of alpha-fetoprotein. The positive rate of γ-glutamyltranspeptidase isoenzyme II is also high in patients with low alpha-fetoprotein concentration and false-negative liver cancer.

Serum fucosidase (AFU)

Reference value: 3.5~10.3 units/liter (U/L).

Domestic reports show that the positive rate of serum fucosidase in diagnosing primary liver cancer is 70% to 80%, and the positive rate of this indicator is not related to the concentration of alpha-fetoprotein and the size of the tumor. The positive rates of serum fucosidase in patients with alpha-fetoprotein-negative liver cancer and small liver cancer are 76.1% and 70.8%, respectively. It is negative for metastatic liver cancer and benign liver tumors, but the false positive rate is high in patients with cirrhosis and chronic hepatitis.

AFP, γ-glutamyltransferase isoenzyme II, and abnormal prothrombin have a positive diagnostic value for liver cancer and are also of early diagnostic significance in general surveys. The combined detection of the three items can greatly improve the accuracy of diagnosis. Serum fucosidase has a certain diagnostic value for liver cancer, but its specificity is not high. If it is detected in combination with AFP, it can be used as an auxiliary diagnosis for liver cancer patients with negative AFP results.