Persistent dull or distending pain: This is one of the most common symptoms of liver cancer. It is mostly persistent pain in the right upper quadrant or mid-upper quadrant. The degree of pain varies. Some patients can tolerate it, while others have severe pain.

Dull pain (may be mild in the early stage): The pain of early liver cancer may not be obvious, just a dull pain, which is easy to be ignored and is often mistaken for other diseases such as cholecystitis and gastritis.

Increased pain (tumor progression): As the tumor grows, the traction on the liver capsule increases, and the pain will gradually increase, and may be more obvious at night or after exertion.

Radiating pain (can radiate to the right shoulder or back): Due to the innervation characteristics of the liver, the pain in some patients can radiate to the right shoulder or back, causing pain in the corresponding parts.

Palpable mass (hard texture, uneven surface): As the disease progresses, the size of the liver increases, and a mass can be palpable in the right upper quadrant. It is hard in texture, has irregular edges, has an uneven surface, and may be accompanied by tenderness.

The size and location of the tumor vary depending on the tumor: the size and location of the tumor are different, and the degree and performance of liver enlargement are also different. In some patients, the tumor may be deep in the liver and difficult to reach in the early stage.

Lack of interest in food: Patients often show a loss of appetite for various foods and a significant reduction in food intake. This may be due to liver function damage caused by liver cancer, which affects the secretion of gastrointestinal digestive juices and gastrointestinal motility.

Gradual worsening (disease progression): As the condition worsens, the loss of appetite will become more severe, and even aversion to eating will occur.

Abdominal bloating, nausea, and vomiting: After eating, you often feel fullness and discomfort in the upper abdomen, accompanied by nausea and vomiting. The vomitus is mostly gastric contents, which may affect the patient's nutritional intake in severe cases.

Related to abnormal liver function and portal hypertension: abnormal liver function can lead to bile secretion and excretion disorders, affecting fat digestion; portal hypertension can cause gastrointestinal congestion, leading to digestive dysfunction.

Increased frequency of stools (shapeless or loose stools): Patients may have more stools every day and the stools may be looser and looser. This may be due to liver cancer affecting the normal absorption function of the intestine, or due to stimulation by certain substances secreted by the tumor. Intestine.

May be accompanied by abdominal pain (mostly dull pain): Some patients may be accompanied by dull abdominal pain during diarrhea, and the pain is mostly around the umbilical cord or lower abdomen.

Weight loss (unexplained): Without deliberate dieting or increased exercise, the patient gradually loses weight, loses body fat and muscle mass, and becomes increasingly weak.

Full -body fatigue and decline in activity endurance: I often feel extremely weak, and even mild activities will feel tired, which seriously affects daily life and work.

Low-grade fever (common, mostly persistent): The body temperature is generally between 37.5°C and 38°C. This may be due to heat absorption caused by necrosis and absorption of tumor tissue, or may be related to abnormal immune function in patients with liver cancer.

High fever (rare, can be due to infection and other reasons): When patients with liver cancer are infected, such as lung infection, abdominal infection, etc., high fever may occur, and the body temperature can reach above 39°C, which may be accompanied by chills, cough, abdominal pain and other corresponding infections. symptom.

Jaundice gradually appears: due to liver cell damage or bile duct compression due to liver cancer, bilirubin metabolism and excretion disorders, the bilirubin level in the blood increases, first showing scleral yellow staining, and then the skin also appears yellow staining, the color can vary from Light yellow gradually deepens to golden yellow.

Accompanied by skin itching: Hyperbilirubinemia can stimulate skin nerve endings and cause skin itching. Patients often feel unbearable skin itching, and scratching may cause skin damage.

Dark yellow urine color (like strong tea): Due to increased bilirubin excretion through urine, the color of urine changes. The more serious the condition, the darker the urine color.

Clay-like stool: When the bile duct is completely blocked by a tumor, bilirubin cannot be discharged into the intestines, and the stool becomes lighter in color and takes on a clay-like appearance, indicating severe biliary obstruction.

Abdominal distention: As ascites gradually increases, the patient's abdomen gradually distends, and there may be an obvious feeling of abdominal distension. In severe cases, breathing and eating may be affected.

Positive moving dullness (when there is a large amount of ascites): Doctors can find moving dullness during physical examination, indicating that there is more free fluid in the abdominal cavity. This is one of the common signs of late-stage liver cancer.

Pitting edema of the lower limbs (mostly starting from the ankles): Ascites can compress the inferior vena cava, causing obstruction of the venous return of the lower limbs, causing edema of the lower limbs. It usually starts from the ankles and gradually spreads upward. In severe cases, it can involve the entire lower limbs.

Cough and hemoptysis: Irritating cough may occur, mostly dry cough or accompanied by a small amount of white sputum. Hemoptysis may include blood in the sputum or a small amount of blood. The severity varies depending on the size and number of metastases.

Chest pain and dyspnea: When lung metastasis invades the pleura or causes lung tissue destruction, it can cause chest pain, which is mostly a dull or dull pain, may be accompanied by dyspnea, and worsens after activity.

Bone pain: pain occurs at the metastasis site, and the nature of the pain is diverse. It can be persistent dull pain, tingling pain, or soreness. The pain is severe and can affect the patient's sleep and daily activities.

Pathological fractures: Bones become fragile due to tumor invasion. Fractures can occur under the action of slight external force. They are common in the spine, ribs, pelvis and other parts. After fractures, local severe pain, swelling, deformity and other symptoms may occur.

Headache, dizziness, nausea, and vomiting: Patients may have headaches, mostly persistent distending or throbbing pain, accompanied by dizziness, nausea, and vomiting. The vomiting is mostly projectile. In severe cases, it can affect the patient's consciousness and limb activities, leading to hemiplegia. , aphasia and other neurological disorders.

Hepatitis B vaccination: Popularize hepatitis B vaccination for newborns and high-risk groups, and complete the three-shot vaccination at 0, 1 and 6 months according to the procedure to ensure the immune effect.

Hepatitis C screening and treatment: Hepatitis C antibody screening should be performed on people with high-risk factors for hepatitis C (such as history of blood transfusion, intravenous drug use, etc.). Those who are positive will be further tested for hepatitis C virus RNA, and timely antiviral treatment will be provided after diagnosis.

Hepatitis B antiviral treatment: For hepatitis B virus carriers, liver function, hepatitis B virus DNA quantification and other indicators should be monitored regularly. For those who meet the antiviral indications (such as high-level hepatitis B virus DNA replication, abnormal liver function, etc.), timely application of nucleotide similar Antiviral treatment with drugs or interferons can inhibit viral replication and reduce liver inflammation and damage.

Quit drinking: Promote alcohol’s damage to the liver, advocate quitting drinking, and reduce the risk of alcoholic liver disease. For chronic alcoholics, alcohol addiction support and recovery guidance are provided.

Use hepatotoxic drugs with caution: Strengthen medication safety education for medical staff and the public, strictly control drug indications, and avoid unnecessary drug use, especially acetaminophen, antibiotics and other potentially hepatotoxic drugs. Monitor during use. liver function.

Prevent and treat metabolic syndrome

Balanced diet: ensure daily intake of adequate protein (such as lean meat, fish, beans and other high-quality proteins), carbohydrates (mainly whole grains), fat (mainly unsaturated fatty acids), vitamins (eat more fresh fruits and vegetables) and minerals.

Increase the intake of antioxidant foods: blueberries, green tea, broccoli, etc. are rich in antioxidants, which can help reduce oxidative stress damage to the liver.

Reduce the intake of pickled and moldy foods: Pickled foods contain nitrite and moldy foods contain aflatoxin, both of which have cancer risks and should be avoided as much as possible.

Adequate sleep: Ensure 7-8 hours of high-quality sleep every night, which is beneficial to the repair and detoxification functions of the liver.

Balance work and rest: avoid overwork, arrange work and rest time reasonably, and reduce the adverse effects of long-term mental stress on the liver.

Aerobic exercise: As mentioned above, insisting on a certain amount of moderate-intensity aerobic exercise every week can enhance physical fitness, promote metabolism, reduce the burden on the liver, and improve the liver's disease resistance.

Exercise safety: Choose appropriate exercise items and intensity according to your physical condition, warm up properly before exercise, stop promptly and seek medical advice if you feel any discomfort during exercise.

People infected with hepatitis B and hepatitis C virus: Regardless of whether their liver function is normal or not, they should be screened regularly.

Patients with liver cirrhosis: including hepatitis B cirrhosis, hepatitis C cirrhosis, alcoholic cirrhosis, etc.

People with a family history of liver cancer: especially those with first-degree relatives suffering from liver cancer.

Long-term alcoholics: a history of drinking for more than 5 years, with an ethanol equivalent amount ≥40g/d for men and ≥20g/d for women, or a history of heavy drinking within 2 weeks (ethanol equivalent amount > 80g/d).

Patients with metabolic syndrome: people with obesity, diabetes, hyperlipidemia, etc.

serology test

Imaging examination

Indications

Surgical method

postoperative complications

Indications

Key points of surgery

Postoperative management

Indications

Treatment

Efficacy evaluation and follow-up

Indications

treatment process

Complications and treatment

Indications

Operational points

Protection and follow-up

Drug Types and Mechanisms of Action

Efficacy evaluation and adverse reaction monitoring

Nivolumab and pembrolizumab: By blocking the programmed death receptor 1 (PD-1) and its ligand (PD-L1) pathways, activating the body's own immune system to kill tumor cells, it is a second-line treatment for advanced liver cancer. The treatment has good curative effect and can significantly extend the patient's survival time.

Atezolizumab combined with bevacizumab: It is a first-line immune combination therapy that can act on tumor cells and tumor blood vessels at the same time, synergistically, and significantly improves the overall survival and progression-free survival of patients compared with sorafenib. , but the incidence of adverse reactions is relatively high.

Currently, the efficacy of immunotherapy can be predicted by detecting PD-L1 expression, tumor mutation burden (TMB) and other indicators in tumor tissue, but the accuracy is limited. Adverse reactions of immunotherapy can affect multiple systems throughout the body, such as immune pneumonia, hepatitis, enteritis, endocrine diseases, etc. The patient's physical condition should be fully assessed before treatment, and the patient should be closely monitored during treatment. Once adverse reactions occur, immunosuppression such as glucocorticoids should be administered promptly. drug treatment, and adjust the immunotherapy plan according to the severity of adverse reactions.

Commonly used chemotherapy regimens

Adverse reaction treatment

Liver stagnation and spleen deficiency syndrome: To soothe the liver and invigorate the spleen, use Xiaoyao Powder (modified or subtracted). Commonly used drugs include Bupleurum, white peony root, Chinese angelica, Poria, Atractylodes, etc.

Qi stagnation and blood stasis syndrome: To promote blood circulation and remove blood stasis, promote qi and relieve pain, use Xuefu Zhuyu Decoction, which includes peach kernel, safflower, angelica, raw rehmannia root, Chuanxiong, etc.

Syndrome of accumulation of dampness and heat: clearing away heat, diluting dampness and detoxifying, add or subtract Yinchenhao Decoction and Gendan Xiegan Decoction. Medicinally use Yinchenhao Decoction, gardenia, rhubarb, gentian, skullcap, etc.

Liver and kidney yin deficiency syndrome: To nourish the liver and kidneys, add or subtract Yiguanjian combined with Zhibai Dihuang Pills, such as raw rehmannia root, Adenophora japonicus, Ophiopogon japonicus, wolfberry, Soupelandia, Anemarrhena, etc.

Huaier granules: It has the effect of strengthening the body, promoting blood circulation and eliminating symptoms. It can improve the clinical symptoms of liver cancer patients, improve the quality of life and prolong the survival period. It can be used for adjuvant treatment of liver cancer after surgical resection and advanced liver cancer.

Huachansu Capsule: It has detoxification, swelling and analgesic effects. It has a certain anti-tumor effect on liver cancer and can relieve cancer pain and other symptoms. It can be used alone or in combination with other treatments.

Compound Cantharides Capsule: It can break blood and remove blood stasis, attack poison and ulcers, enhance the body's immune function, and play a certain role in the comprehensive treatment of liver cancer.

It is composed of multidisciplinary professionals such as liver surgeons, oncologists, interventionalists, radiotherapists, pathologists, and radiologists.

For liver cancer patients, MDT The team jointly discusses and formulates the best personalized treatment plan, taking into account the patient's tumor stage, liver function status, general physical condition, treatment willingness and other factors. For example, for patients with resectable liver cancer, discuss the feasibility and safety of surgical resection, and whether Preoperative neoadjuvant treatment is required; for patients with unresectable liver cancer, determine the sequence and combined application methods of local treatment and systemic treatment, adjust the treatment plan in a timely manner according to changes in the patient's condition during the treatment process, and conduct regular efficacy evaluation and follow-up to improve liver cancer. The overall effect of treatment and patient quality of life.