Liver cancer: signs, symptoms and complications

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Signs and symptoms of liver cancer are usually the result of liver damage and may include yellowing of the skin (jaundice), pain in the right abdomen or shoulder blade, and a lump in the upper right part of the abdomen. However, many of the warning signs are not specific, such as weight loss and fatigue.

Sometimes the first symptoms are complications of liver cancer, such as bile duct obstruction, anemia, or bleeding. Since there are no screening tests for liver cancer , knowing the possible signs and symptoms is the only way to detect the disease early.

It is important to briefly differentiate primary liver cancer , which occurs in the liver, from liver metastases, which is the spread of cancer (eg, breast or lung) from another area of the body to the liver. Liver cancer is usually a single large tumor, while metastases (spread) are usually small and multiple.

Primary liver cancer usually causes symptoms relatively early, while liver metastases (which are much more common) can occupy a significant portion of the liver before they are detected .

Symptoms are similar to hepatocellular carcinoma (liver cancer) and cholangiocarcinoma (bile duct cancer), but bile duct cancer tends to cause symptoms of obstruction (such as jaundice) earlier than many liver cancers.

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Frequent symptoms

Like many other cancers, liver cancer usually has several symptoms or signs in the early stages of the disease. As the disease progresses, its symptoms begin to appear, forcing you to seek medical help. Because of the late onset of symptoms, liver cancer is often diagnosed at an advanced stage (unless the tumor occurs near the bile duct and causes early obstruction).

Symptoms that can occur include:

Mass or lump in the abdomen

You may feel a very hard lump or swelling in the area just below the rib cage on the right side. This formation is usually painless, and if you experience pain, you may feel more discomfort in the areas surrounding the formation.

Sometimes liver cancer also causes the spleen to enlarge, which can cause pain or a mass in the upper left part of the abdomen.

Right side abdominal pain

Pain, discomfort, or pain in the right side of the abdomen, just below the ribs , may be due to pressure from the liver tumor on other structures or nerves in that area. Take a deep breath and press slightly up under the rib cage on the right side; this is roughly where your liver is. If you have an enlarged liver (there are many reasons), the edge of your liver may feel lower in your abdomen.

Pain in the right shoulder

Pain in the scapula can be a hidden symptom, as the condition it warns you about may be far from the scapula (due to the way the nerves move in our body).

This is the case with liver cancer. A tumor (or the spread of a tumor) can irritate the nerves that tell your brain that pain is coming from the scapula when it is actually coming from the liver. This pain is usually felt in the right shoulder, although it can occur on both sides. The pain can also spread to the back.

If you are experiencing this, especially if you haven't done any physical activity recently that might explain it, contact your doctor.

Jaundice

Jaundice is a condition in which the skin, as well as the whites of the eyes, turns yellow. It is caused by the accumulation of bile salts in the skin.

It is easier to detect in natural light, such as outdoors, than in indoor lighting. In addition to the yellowish color of the skin, some people notice that their stools turn pale and whitish instead of brown. However, urine may appear darker than usual, even without dehydration.

Itching

The buildup of bile salts on the skin, leading to jaundice, can also cause itching. We don't usually think of itching as a serious symptom, but the itching associated with liver dysfunction can be very serious.

Bloating and shortness of breath.

A buildup of fluid in the abdomen, called ascites , can indicate liver cancer. Swelling may appear at first; some people find that their clothes do not fit well at the waist or that the belt size changes even though they have not gained weight. Over time, fluid build-up in the abdomen can push the lungs upward, causing shortness of breath.

Unintentional weight loss or gain

Some may welcome unintentional weight loss, but unless it's related to diet changes or exercise, it's always worth a doctor's appointment. Unexplained weight loss is defined as the loss of 5 percent or more of body weight without any attempt in a period of six to 12 months. An example would be a 200 pound man who loses 10 pounds in six months without changing his habits.

Unintentional weight loss was found to be associated with underlying cancers, including liver cancer, in a third of the people observed in the 2017 review of studies . There are other serious reasons, so it is important that you see your doctor immediately as soon as you notice such a change.

Rapid and unexpected weight gain is also a possible sign of liver cancer. This is usually due to the rapid accumulation of fluid in the abdomen (ascites).

Loss of appetite

Loss of appetite can occur with many diseases, but it can be quite serious with liver problems. This can be accompanied by a feeling of fullness very quickly, even if only eaten in small portions. Since these symptoms can be warning signs of not only liver cancer but also other cancers, a visit to your doctor is warranted.

Nausea and vomiting

There are several reasons why liver cancer can cause nausea and vomiting, and this is a common symptom at all stages of the disease. There are a myriad of causes of nausea and vomiting, but if they occur frequently or get worse, talk to your doctor.

Fatigue and / or weakness

Everyone seems to be tired these days, but cancer-related fatigue often takes things to the next level. Cancer fatigue is different from normal fatigue and is not the type of fatigue that improves after a good night's sleep. Sometimes this symptom is easier to see if you look back six to 12 months and measure your energy today against what you had at that time.

Hot

Mild but persistent fever, which doctors call "fever of unknown origin." o FUO is a fairly common symptom of liver cancer. FUO is defined as a temperature above 101 degrees that persists for three weeks or more and cannot be associated with an obvious cause after three or more visits to the doctor (or three days in the hospital). There are several other potential causes of a persistent fever, but having one of them is a good reason to see your doctor.

General feeling of discomfort

It's difficult to describe intuition as a symptom, but research tells us, often in hindsight, that people often feel when something is "wrong" with their body. If you have a general feeling that you are not feeling well, see your doctor. Sometimes it can be difficult to define symptoms using the terms listed above. Our body often tells us well when something is wrong, if we take the time to listen.

Rare symptoms

Certain types of liver cancer release hormones that can cause additional symptoms. These can include low blood sugar ( hypoglycemia ) , which can cause dizziness and fainting, especially in people who have not eaten for a while; breast enlargement ( gynecomastia ); testicular atrophy; and a high red blood cell count.

Complications

Liver cancer can cause a number of complications. They can be the result of tumor pressure on the bile duct or other organs, hormones produced by cancer cells, liver dysfunction leading to accumulation of toxins in the body, or other mechanisms.

Some possible complications include:

Anemia

Anemia , a low red blood cell count, is a very common complication of liver cancer and can be the result of several mechanisms, including the absence of blood clotting factors that cause bleeding. Anemia can be insidious at first and often causes symptoms such as fatigue, shortness of breath, heart palpitations, pale skin, and dizziness. Because liver cancer can sometimes lead to erythrocytosis (increased production of red blood cells), these effects sometimes cancel each other out.

Bile duct obstruction

Bile is produced in the liver. Several tubes carry it to the small intestine, either through the gallbladder or directly. Tumors of the liver or bile ducts can grow inside the duct or put pressure near it, resulting in blockage of the bile ducts.

Duct obstruction for any reason usually causes rapid onset of severe and persistent pain in the upper right abdomen, nausea, vomiting, jaundice, and itching.

Bleeding

The liver is responsible for making proteins (clotting factors) that help the blood to clot. When a large percentage of your liver is affected by cancer, these factors are no longer produced in sufficient quantities. As a result, bleeding can occur (even with a normal platelet count) and anemia can develop. The first sign is usually bleeding when brushing your teeth or frequent nosebleeds. More serious bleeding, such as internal bleeding, can occur when the cancer is in an advanced stage.

Portal hypertension

Liver cancer (and other liver diseases) can cause digestive tract bleeding in other ways. A tumor in the liver can obstruct blood flow through the organ's small veins that lead to the large portal vein. The resulting pressure in a vein ( portal hypertension ) causes pressure to rise in blood vessels upstream, such as the esophagus.

These veins are weaker than the large portal vein and can develop into varicose veins, as in people of the legs or abdomen, sometimes with liver disease. When these varicose veins rupture, massive bleeding into the esophagus can occur (bleeding from varicose veins in the esophagus , which can be life-threatening if not treated quickly. By the same mechanism, bleeding in the stomach and intestines can occur) .

Elevated levels of calcium in the blood (hypercalcemia)

Liver cancer can cause high levels of calcium in the blood (malignant hypercalcemia ) through several different mechanisms. This can cause nausea and vomiting, severe muscle weakness, and confusion, which can progress to coma and even death if left untreated.

Hepatorenal syndrome

Hepatorenal syndrome is a condition in which liver disease leads to kidney disease due to changes in the blood vessels and decreased blood flow to the kidneys. Hepatorenal syndrome is very common in liver cancer and other forms of liver disease, and it is estimated that 40 percent of people with cirrhosis will develop this syndrome within five years. Unfortunately , in these people, it is usually irreversible unless a liver transplant is performed. …

Hepatic encephalopathy

Hepatic encephalopathy can be a terrifying complication of liver cancer, but it is actually a reversible cause of symptoms that can resemble those of Alzheimer's disease.

The toxins that the liver cannot excrete end up in the brain. This can lead to memory loss, disorientation, personality changes, and severe disorientation. Symptoms can be mild with difficulty performing math tasks, such as balancing a checkbook. Other symptoms may include sweet-smelling breath and flapping of the hands when the hand is held out in front of the person. There are treatments for encephalopathy, but the outlook generally depends on the extent of the tumor.

When to contact a healthcare provider

If you notice any of the above signs and symptoms or can't explain them, see your doctor. While many may indicate a harmless condition, if liver cancer is present, the prognosis is generally better the earlier the disease is diagnosed. People who do not have risk factors for liver cancer can and do get sick from time to time, something to keep in mind if you are unsure about talking to your healthcare provider.

Learn more about living well and coping with liver cancer .

Discussion Guide for Healthcare Professionals on Liver Cancer Treatment

Get our printed guide to your next doctor's appointment to help you ask the right questions.

If you have risk factors for liver cancer, such as cirrhosis, your situation is a little more complicated. You may already be experiencing similar symptoms as a result of your existing health problem. In this case, it is important to be aware of changes in your symptoms.

One study found that symptoms that alerted healthcare providers to liver cancer in people with chronic liver disease included pain in the right upper quadrant of the liver, liver enlargement (cirrhosis usually causes it to shrink), fatigue, mood swings and worsening. portal hypertension, hemorrhoids, hemorrhages, and diabetes that have become difficult to control. If you notice any of these symptoms, contact your doctor immediately without waiting for your next appointment.

Frequently asked questions

  • Usually not. One of the first signs of liver cancer is a lump or swelling around the liver, but the rib cage can prevent you from feeling a mass. However, with primary liver cancer, you may have other symptoms quite early, such as abdominal pain, that you should discuss with your doctor . Screening with regular ultrasounds and AFP blood tests is often recommended for people at high risk for liver cancer.

  • Other diseases can significantly increase the risk of liver cancer, including chronic hepatitis B or C viruses. Cirrhosis and hemochromatosis , an inherited metabolic disorder, also put you at higher risk. Lifestyle factors that increase your chances include alcohol abuse, smoking, obesity, and type 2 diabetes.

  • May. Cancer that begins in the liver can start as a single tumor and spread to the surrounding organ and lymph nodes before it is diagnosed. Once the cancer has spread, it is considered stage 4 liver cancer .

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