Liver is a frequent target of metastases of many tumors. However, it can also accommodate a cancer that is born inside it. Liver tumour causes symptoms in many cases. These symptoms can be similar to those of liver metastases from other cancers.
Let’s see what these symptoms are to be on guard against their occurrence.
The most common way liver cancer get diagnosed is when it is found in an ultrasound or an abdominal CT scan. From there we make due to a check-up or part of the evaluative control of any abdominal disease. This is because liver cancer in its early stages, and sometimes even in advanced stages, usually doesn’t cause any symptom. People incidentally diagnosed of liver cancer sometimes only refer their doctor a slight decrease in their appetite, a very unspecific symptom.
When there is a very large tumour in the liver, it will increase in size. Although the liver is covered by the bottom of the ribs on the right side of the chest, if the tumour grows, we can find it below the last rib when we palpate the patient’s abdomen. Due to this increased in size, liver cancer will be observed easily in diagnostic tests. Such as an ultrasound or an abdominal CT scan. The enlarged liver usually causes no symptoms, although sometimes the person feels weight or an occupation sensation in the abdomen.
Liver cancer can cause pain in the upper right abdomen. This pain is usually a sharp pain that suddenly appears and rapidly worsens. Usually, it’s originated because one of the blood vessels of liver cancer breaks, causing a bleeding inside the liver. This accumulated blood causes the sudden stretching of the liver sheath, the Glisson’s capsule. The stretching stimulates the nerve endings of pain receptors that reach the liver, so pain will appear.
If bleeding does not occur, although the tumour grows in the liver and therefore is stretching the capsule that surrounds it. This nerve stimulation is low grade thus pain won’t appear. This can cause an unspecific nuisance, which is confused with other causes of abdominal discomfort.
Due to the growth of cancer, the output of bile is interrupted within the liver itself. Thus, bilirubin tries to get out the liver, stepping into the blood vessels. This can increase bilirubin blood levels.
Excess blood bilirubin tends to deposit in the elastic fibers of the skin and mucous membranes (especially in the sclera of the eye), which will show a yellow tint, a phenomenon called jaundice.
If liver cancer interferes with liver elimination of bilirubin, two visible phenomena may appear in urine and stools.
- Increased direct bilirubin in the liver will enter blood and will be eliminated through the urine. This elimination by the kidneys will create a change in the urine colour. It will darken, resembling the colour of cola.
- When bilirubin doesn’t access small intestine, being that it is its natural course, it will not meet urobilinogen, which is the pigment that gives colour to the stool. The stools will then change colour. It will acquire an increasingly light brown colour. It may even become white stool if there is a outflow obstruction of liver bilirubin .
The Pressure within these veins increases when liver cancer alters circulation of portal venous system (a system that carries blood from the abdominal organs, especially the small intestine to the liver). Due to the increased pressure, fluids will gradually leave these vessels. It will start accumulating in the peritoneal cavity, causing the swelling of the belly. Sometimes, we need to drain this excess of fluid, called ascitis. This is because it can push the diaphragm up, limiting lung expansion. If this occurs, the person will notice the act of breathing is very difficult, as the entry of air into the lungs is very limited.
Just like many cancers, including liver cancer, when it grows in size, the amount of tumour cells creates a kind of parasite. It’s kind of autonomous organism within the body. This parasite steals energy from food, as their cells are born and die faster than healthy cells. Our blood then can get intoxicated with the pieces of dying cells. The fact that the tumour is stealing nutrients from us. It explains why we are more tired and begin to lose weight. The big amount of pieces of dead tumour cells traveling in the blood will pass through the area of the brain, that is responsible for controlling our body temperature (the thermoregulatory centre). Hence driving its neurons crazy. The madness of the control centre causes the temperature to rise. Thus, creating a low-grade fever and even fever that usually has a typical evening pattern.
When the tumour is already outside the liver, it may escaped by one or more of these four ways:
- Liver cancer grows so much, that it infiltrates neighbouring organs and structures.
- Tumour breaks the peritoneum and spreads through the abdominal cavity.
- Liver cancer escapes through the lymphatic.
- Tumour cells enter the blood.
When liver cancer grows a lot, it could infiltrate nearby organs. Such as gallbladder, the right adrenal gland or even the large intestine. As these organs increase in sizes ,they will infiltrate the diaphragm, which is the muscle that separates the chest and abdominal cavities.
The involvement of the gallbladder and bile ducts that takes bile outside the liver, disrupts the elimination of bilirubin. This may intensify symptoms like the lack of colour in the stool, an excess urine coloration and can accentuate jaundice. In an uncommon way, irritation of the diaphragm by the liver tumour can lead to the occurrence of hiccups. This makes it difficult to treat. Moreover, these hiccups worsens the quality of life of patients hugely.
When tumour grows a lot, it can break out the wall of the liver. This rupture causes liver cancer cells to go to the peritoneal cavity and swims in it. After that, they will end up settling on the surface of any abdominal viscera. Groups of cells will grow and will cause symptoms of peritonitis with diffuse abdominal pain caused by the peritoneal irritation. When multiple tumour implants appear, it is called peritoneal carcinomatosis. If tumour implants are located on the outside wall of the small intestine, they can cause cessation of transit of intestinal contents. This is because they compress the tube from the outside. They produce a sub occlusion or intestinal obstruction.
When choosing the lymphatic route to escape the body, liver cancer cells tend to first accumulate in the nodes located in the region of the hepatic hilum. This is the area where blood vessels and bile ducts enter and exit the liver. Due to this accumulation of tumour cells, symptoms of compression of the bile duct may appear or become more pronounced. Leading to the blocking the bile flow from the liver to the gallbladder. It will increase the amount of bilirubin in the blood, as well as the amount of direct bilirubin eliminated with the urine. The urine will appear darkened like the colour of cola. It will also decrease bile pigment elimination through feces, so they’ll lose their brown colour, appearing white.
From hepatic hilum lymph nodes, tumour cells can spread to more distant lymph regions. Such as the lower zone of the diaphragm, or the region adjacent to the inferior vena cava. If they are located in this area, most often they will not produce symptoms.
Liver cancer cells can enter the blood because within the cancer itself. From there, the cells can penetrate a blood vessel of the tumour by breaking its wall. Once in the blood, these liver cancer cells can get anywhere in the body. Thus, causing various symptoms depending on its location. The most common sites where liver cancer cells that have escaped the blood can cause metastases are:
- Lung metastases – When tumour cells go to the lungs, they usually form separate groups, appearing with multiple metastases. If there’s enough lung function cancelled, the difficulty of breathing (a symptom called “dyspnoea”) can appear. However, irritation can appear if they touch a breathing tube (bronchus or its branches). This may lead to a very annoying dry cough. If placed near a blood vessel, they may break it, adding blood to the cough (hemoptysis).
- Bone Metastasis – When metastasis becomes very large, it means that the tumour cells grow inside bone has becomes very large. At this stage, they can break the layer overlying the bone that has great sensitivity (periosteum). This rupture will cause pain. Tumour growth can also compromise bone strength, especially if it’s a bone that has to bear weight. In that case, bone may break. When vertebrae are affected, a special case of bone metastases occurs. They can cause back pain, and if the vertebrae breaks, neurological symptoms will appear called the spinal cord compression syndrome.