Liver Cancer - Symptoms

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What were the signs and symptoms of liver cancer in you or someone you know?

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What are liver cancer symptoms and signs?

The initial symptoms (the clinical presentations) of liver cancer are variable. It is becoming much more common for patients to be identified by screening people at high risk for the cancer and finding the cancer before there are any symptoms at all. In countries where liver cancer is very common, the cancer generally is discovered at a very advanced stage of disease for several reasons. For one thing, areas where there is a high frequency of liver cancer are generally developing countries where access to health care is limited. For another, screening examinations for patients at risk for developing liver cancer are not available in these areas. In addition, patients from these regions may actually have more aggressive liver cancer disease. In other words, the tumor usually reaches an advanced stage and causes symptoms more rapidly. In contrast, patients in areas of low liver cancer frequency tend to have liver cancer tumors that progress more slowly and, therefore, remain without symptoms longer.

There are NO specific symptoms of liver cancer, and in fact, the earliest signs are usually subtle and can be mistaken for simple worsening of cirrhosis and liver function. Abdominal pain is uncommon with liver cancer and usually signifies a very large tumor or widespread involvement of the liver. Additionally, unexplained weight loss or unexplained fevers are warning signs of liver cancer in patients with cirrhosis. These symptoms are less common in individuals with liver cancer in the U.S. because these patients are usually diagnosed at an earlier stage. However, whenever the overall health of a patient with cirrhosis deteriorates, every effort should be made to look for liver cancer.

A common initial presentation of liver cancer in a patient with compensated cirrhosis (meaning that there are no complications of liver disease) is the sudden onset of a complication. For example, the sudden appearance of ascites (abdominal fluid and swelling), jaundice (yellow color of the skin), or muscle wasting without causative (precipitating) factors (for example, alcohol consumption) suggests the possibility of liver cancer. What's more, the cancer can invade and block the portal vein (a large vein that brings blood to the liver from the intestine and spleen). When this happens, the blood will travel paths of less resistance, such as through esophageal veins. This causes increased pressure in these veins, which results in dilated (widened) veins called esophageal varices. The patient then is at risk for hemorrhage from the rupture of the varices into the gastrointestinal tract. Rarely, the cancer itself can rupture and bleed into the abdominal cavity, resulting in bloody ascites.

On physical examination, an enlarged, sometimes tender, liver is the most common finding. Liver cancers are very vascular (containing many blood vessels) tumors. Thus, increased amounts of blood feed into the hepatic artery (artery to the liver) and cause turbulent blood flow in the artery. The turbulence results in a distinct sound in the liver (hepatic bruit) that can be heard with a stethoscope in about one-quarter to one-half of patients with liver cancer. Any sign of advanced liver disease (for example, ascites, jaundice, or muscle wasting) means a poor prognosis. Rarely, a patient with liver cancer can become suddenly jaundiced when the tumor erodes into the bile duct. The jaundice occurs in this situation because both sloughing of the tumor into the duct and bleeding that clots in the duct can block the duct.

In advanced liver cancer, the tumor can spread locally to neighboring tissues or, through the blood vessels, elsewhere in the body (distant metastasis). Locally, liver cancer can invade the veins that drain the liver (hepatic veins). The tumor can then block these veins, which results in congestion of the liver. The congestion occurs because the blocked veins cannot drain the blood out of the liver. (Normally, the blood in the hepatic veins leaving the liver flows through the inferior vena cava, which is the largest vein that drains into the heart.) In African patients, the tumor frequently blocks the inferior vena cava. Blockage of either the hepatic veins or the inferior vena cava results in a very swollen liver and massive formation of ascites. In some patients, as previously mentioned, the tumor can invade the portal vein and lead to the rupture of blood vessels which drain through the portal vein, including what are referred to as esophageal varices.

Regarding distant metastases, liver cancer frequently spreads to the lungs, presumably by way of the bloodstream. Usually, patients do not have symptoms from the lung metastases, which are diagnosed by radiologic (X-ray) studies. Rarely, in very advanced cases, liver cancer can spread to the bone or brain. These are an infrequent problem in many patients who do not live long enough to develop these complications.

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See what others are saying

Comment from: LISAMARIE, 65-74 Female (Caregiver) Published: April 29

I am writing about my mom who got diagnosed with stage 4 cancer of the liver. It's been about a year that my mom's stomach was hurting, burning, and painful, she didn't want to eat because of how she felt. It got extremely worse, let me add this. She had diabetes for some years now. There were tests done on her but it seemed like her doctor just kept on giving her medicines probably making it worse. Eventually she ended up in the hospital, she had lost weight looked jaundiced, and her right side was hurting where she fell a couple of times, lot of pain from stomach to back. Even the drink of water would hurt her. And still no confirmed reason why she was feeling like this. My question is when is it a doctor's responsibility to send her or anyone that is a patient, to a specialist that is an expert in internal medicine, knowing she can't figure it out? She just kept giving her different kinds of medicines, but nothing was helping. I truly believe that she could have caught it earlier. I truly don"t know how to handle this.

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Comment from: hopefaithlove, 75 or over Female (Caregiver) Published: May 30

My 86 year old mother was diagnosed with primary liver cancer 7 months ago. She"d been losing weight for over a year prior to that. She went to the doctor because of pain in her side. She is not in a lot of pain and not on painkillers. So far her symptoms have been, in roughly chronological order: Loss of appetite and weight loss. Pain on her side. Swelling of stomach. Itching, mostly the lower leg area. Pain in the right shoulder. Some bruising in the lower leg area (just one leg, I believe). Both feet swelling at the same time as bruising occurred. The most recent symptom is a persistent cough (now for a couple of weeks). So far there is no jaundice of her skin or eyes. We feel happy that we have had this time of relative good health to spend with my mother and hope that the end will be easy for her.

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