Malignant tumors of the liver

Liver cancer. Primary liver cancer is found, according to the materials of sections 1 to 3 : 1000. These figures And. And. Shirokogorov considers valid for Europe and leads (1946) their data in sections two institutions Baku: 4,7 : 1000 and 17 : 1000. According to the materials of American authors, primary liver cancer observed at 0.2% 48 900 sections (Edmondson, Steiner, 1954). Colleman with co-authors (1954) believes that liver cancer occurs in 1% of all autopsies. The ratio of men to women 18 : 5.
The frequency of primary liver cancer, according to hospital statistics, is different: 0,2% - by Heller (1925), 0,28% on Lemner (1950), Warvy (1945) - 0,05% to 353 971 observation. Most of the authors pay attention to the frequency of a combination of primary liver cancer with liver cirrhosis. 100 cases studied Edmondson and Steiner (1954), 1918-1953, cirrhosis met in 89,2%. Ewing (CIT. on Franclin and Diwaing, 1947) was observed cirrhosis of the liver, liver tumors in 80%, a Warvy (1945) 1200 studied primary tumours of the liver cirrhosis noted in 46%.
Pathological anatomy. Primary liver cancer is found as a single host or multiple hosts. A single node can be of various sizes, sometimes takes a whole lobe of the liver. Multiple nodes can be from a few millimeters in diameter and up to several centimeters. According to histological structure of the primary cancer is built of liver cells (hepatocellular carcinoma - hepatoma) or from the cells of bile ducts (carcinoma cholangiocellulare - cholangioma). Notes frequent the spread of cancer cells through the veins of the liver. The liver may be increased or normal in size, or even reduced. Hepatoma observed in 3 times more likely than holangita (Edmondson and Steiner, 1954). Metastases are found in the lungs, spleen, and bone.
As for the prevalence of primary cancer of men and women, the first sick almost 3 times more often. Primary liver cancer occurs mainly in the fifth and sixth decade of life.
Symptoms of primary liver cancer. The disease develops gradually: there has been a rapid increase in weight loss, there are a pain in the right hypochondrium, nausea, vomiting, diarrhea. Fever in 14% dominates at holangitah. Jaundice occurs in 61-80%, ascites is 58%, anemia - 97%. The tumor in the right hypochondrium is palpated in 91% of cases. Sometimes hidden, asymptomatic: sudden death from internal bleeding. Many authors have noted that the symptoms of liver cancer is talking about the significant development of tumor growth.
Diagnostics. For diagnosis of primary liver cancer should be used above symptoms. Diagnostic value is also high standing right half of the diaphragm, which is determined for percussion, and fluoroscopy. X-ray examination with liver cancer can be applied by the method of Leger, Proux, Arnavielhe (1953): the puncture spleen needle for spinal anaesthesia, the authors have introduced 20 ml of 70% solution of the preparation of diodon and immediately did an x-ray of the liver (splenoportography). On the x-ray contrast image portal vein system and detected defects accumulate on the location of the tumor. The injection of diodon not painful and easily tolerated. Rigler, Olfelt and Krumbach (1953) proposed for the detection of liver tumors contrast radiography of the liver with the introduction of contrast in thoracic aorta (aortography). In contrast to these authors, Auring et al. (1959) recommend the use of contrasting veins of the liver, the drug jouron 70% breeding, also puncture spleen, but under General anesthesia. Schatzky (1941) x-ray diagnostics of liver cancer builds on indirect guidance on the identification of varicose veins cardiac esophagus, based on the frequency combination of primary liver cancer and cirrhosis. Thus, with suspected cancer of the liver detection of varicose veins of the esophagus confirms the diagnosis of liver cancer.
L. D. Lindenbraten (1953) rather cautiously refers to a method of rentgenoterapii, since there are no more safe for humans contrast agent. It should be noted that the summer Palace, Lindenbraten is a supporter of the method of pneumoperitoneum for the diagnosis of liver cancer.
Method transparietal splenoportography has found application in national surgical clinics for the diagnosis of portal hypertension.
In recognition of liver cancer has a diagnostic laparoscopy in combination with optical biopsy.
So, basically diagnosis of liver cancer, is now based on clinical symptoms, the definition of a tumor by palpation, physical examination (chest x-ray to study right dome of the diaphragm: the height of standing of his, deformation), pneumoperitoneum and fluoroscopy cardiac esophagus to identify varicose veins of the esophagus, and puncture biopsy using laparoscopy.
Surgical treatment. Gradually dissipates view of primary liver cancer as a hopeless disease. The technique of resection of the left lobe of the liver is relatively simple. Great progress has been made in the field resection of large areas of the liver.
Secondary liver cancer. Secondary liver cancer occurs in 60 times more primary. It is known that the liver, lymph nodes, lungs, serous membranes, bones, kidney are the places of primary localization of secondary cancers, but in the first place is the liver. Metastases are recorded it on a. hepatica or v. portae and settle in its tissues. In secondary liver cancer him secondary containment is expected in organs, associated first of all with the system of portal vein: the stomach, colon, pancreas, bile passages.
In addition embolic migration of tumor cells in the liver, the cancer may upgrade to it from the adjacent organs per continuitatem. This transition is most often observed in gastric cancer, or cancer of the gallbladder, at least - in colon cancer, or kidney or pancreas. In stomach cancer most often affected the left lobe of the liver. Microscopically secondary liver cancer as the primary, occurs in two soft differentiated forms: in the form of isolated large metastases and multiple sites of various sizes up to the size of children's head.
Symptoms and diagnosis. As for the characteristic features of symptoms secondary liver cancer, they are not. Leading shall be signs of primary cancer of the authority. The vagueness of the primary symptoms of cancer of the body leads to diagnostic errors.
Treatment should be surgical in operable cases. If a secondary liver cancer developed as a result of the transition of the tumor with neighboring authority, the question about the operation decided by the possibility of removing the initially affected organ and absence of metastases in regional lymph nodes.
Chemotherapy drugs (sarkolizin) in the treatment of cholangio so far failed.