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History:
Liver cancer usually has few symptoms or signs. However a history of hepatitis, whether or not the cause is known, will alert your health care provider to the possibility that you could have or are developing liver cancer. Risk factors for developing liver cancer are:
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Being of Asian or African origin |
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A family history of hepatitis or liver cancer |
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Heavy use of alcohol |
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Known intravenous drug use |
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Known liver problems, including the advanced liver disease cirrhosis |
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Known to be a Hepatitis B "carrier." This is a state where you may never have had any illness but carry the virus in your blood stream. Some people with this condition develop liver cancer later in life |
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Proven hepatitis C or hepatitis B infection in the past |
Physical Examination:
When examining you, your health care provider will look for:
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Signs of liver failure: for example, tiny red blotches on the skin of your neck chest and hands called spider nevi and a hand tremor. |
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Jaundice: a yellowing of the "whites of the eyes", a yellowish tinge to the skin, yellow palms. |
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Signs of blood clotting problems: bruises on your arms, legs, and abdomen, or bleeding in your nose and/or around your teeth. |
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Signs of cancer spread: weight loss, hardened lymph nodes in the neck, abdomen and groin. |
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Signs of cancer in the liver itself:
if the cancer is widespread, the liver may feel hard, irregular (knobby) and shrunken. However, because the liver retreats under the rib cage when shrunken, it may be difficult or impossible to feel. |
Investigations
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Blood tests will be done to look at the liver enzyme levels and the level of bile in the blood stream. A protein called alphafetoprotein will also be measured because this can be raised in liver cancer. |
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A plain x-ray of the abdomen may reveal calcification or irregularities in the liver region. |
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An ultrasound will give more information about the nature of the liver tissue, and whether there are any suspicious masses or cysts suggestive of cancer. |
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A liver scan, a CT (computed tomography) scan or an MRI (magnetic resonance imaging) picture of the abdomen, pelvis and chest may be used to further investigate suspicious masses, giving more information about their location, nature, number and possible origin. |
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Exploratory surgery using a laparoscope to look inside the abdomen and to take a biopsy provides the definitive diagnosis. The biopsy may also be made with a needle through the skin rather than at surgery. After inspection of the tissue by a pathologist, it can be determined whether the tumors are cancerous and whether or not they come from a different part of the body or are primary tumors of the liver. |
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Angiography, where dye is injected into the arteries leading to the liver, may be done to see more clearly what blood vessels supply nutrients to the tumor and what sections of the liver are involved. |
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Diagnosis is based on four examination techniques. The first is "questioning." The TCM practitioner will want to know what the individual's current complaints are, and will need their medical history and family health history. The second technique is "observation." Physical features of the body such as the face, tongue, hair, nails, sputum (mucus that is coughed up) and examining the area of pain all offer clues as to what the problem may be. Observation of the tongue is particularly used as a gage to assess illness. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest offer additional clues. The last technique used in examination is "touching." Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about the body's imbalance. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.
From a TCM point of view, liver cancer is generally classified according to the disharmony patterns each individual has. The symptoms section reviews the different disharmony patterns in detail.
Types of Disharmony Patterns:
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Spleen Deficiency |
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Stagnation of qi |
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Influence of Dampness and heat |
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Excessive Heat |
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Blood Stasis |
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Yin Deficiency |
When classifying the patterns there are several important points that need to be differentiated:
1. Classification of pain at the liver region
It is important to distinguish between pain due to stagnation of qi and pain due to blood stasis because it affects the choice of herbs and treatment strategies used. Pain due to qi stagnation usually feels dull while pain due to blood stasis feels sharp. In addition, it is also important to know whether a person with liver cancer has abdominal distention due to blood stasis because the patient may faint as a result of the disharmony.
2. Classification of abdominal distention Abdominal distention should be differentiated between qi stagnation and constrained liver qi because each is treated differently. Distention due to qi stagnation is known as "pi man" in TCM. It is characterized by the distention in the central upper abdomen, and it is usually aggravated after meals. On the other hand, constrained liver qi distention is characterized by distention at both flanks (below the chest) with dull pain and discomfort. Eating meals does not aggravate abdominal distension.
3. Classification of fever
In addition to fever, liver cancer patients usually have signs of exterior disharmony. Exterior disharmony is similar to having a cold or the flu. Symptoms include an aversion to cold, a high temperature, and a floating pulse. However, fevers associated with liver cancer usually come in the afternoon and is associated with profuse sweating and a hot feeling over the liver region.
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