First, the anatomy of the liver is located in the right upper abdomen, the body's largest organ, adult liver weight of 1200 ~ 1500kg, the li
First, the anatomy of the liver is located in the right upper abdomen, the body's largest organ, adult liver weight of 1200 ~ 1500kg, the liver is divided into left and right lobe, the left lobe and right lobe of the liver can be further divided into eight segments. Two, the main physiological function of the liver secretion of bile: Daily secretion of bile 600-1000ml. Participate in digestion and absorption of fats and vitamins. Metabolic function: including glycogen synthesis and decomposition, synthesis of proteins, phospholipids and cholesterol, urea synthesis; conversion of food in the sugar and fat, in order to obtain energy for the body. Hematopoietic function: liver contains a number of hematopoietic substances, indirectly involved in hematopoiesis. Detoxification function: the toxic substances into non-toxic substances. Phagocytosis and immune function: can kill bacteria, pigments and detritus.
Three, the classification of liver cancer
There are two main types of malignant tumors in the liver. It can be divided into two kinds of hepatocellular carcinoma, cholangiocarcinoma and mixed cell carcinoma (including hepatocellular carcinoma and cholangiocarcinoma). Secondary or metastatic cancer of the liver: the first occurrence of cancer in other parts of the body, followed by blood transfer to the liver, such as gastrointestinal cancer spread to the liver.
Four, the etiology of primary liver cancer
The research shows that China's main infection, liver cancer and hepatitis B virus and hepatitis C virus aflatoxin, water pollution and so on, some pesticides, liver fluke, genetic, may also and the incidence of hepatocellular carcinoma. Five, the primary symptoms of primary hepatocellular carcinoma and metastatic liver cancer early symptoms are similar, the two often has no symptoms, when the tumor gradually increased, patients may have the following symptoms: upper abdominal discomfort or pain. Right shoulder pain: due to liver enlargement, stimulation of diaphragm nerve (which is connected to the right shoulder nerve). Loss of appetite, weight loss, fatigue, nausea and lethargy; sometimes fever and chills. Jaundice: the skin and the whites of the eyes is slightly yellow, the skin is very urticant; because of biliary obstruction, bile accumulation in the blood. A lump in abdomen. Abdominal distension due to accumulation of fluid in the abdomen (called ascites).
Six, for the diagnosis of liver cancer
Blood AFP (AFP): when the liver cancer cell proliferation, serum AFP will increase. AFP is a specific marker of liver cancer, which is helpful for early diagnosis of hcc. Abdominal ultrasonography (b): determine the size, location and nature of the tumor. Computed tomography (CT): a X light picture taken at different angles to the patient's abdomen, which is fed into a computer, which produces a delicate image. It can help clinicians to clear the diagnosis of liver cancer, and accurately show the location, number and size of the lesions in the liver, and the relationship with the important blood vessels. Magnetic resonance imaging (MRI): using magnetic fields to obtain accurate images of the liver. Is a non radioactive inspection method, do not use of iodine contrast agent, can be used as supplementary means for the diagnosis of CT. Hepatic arteriography: This study examines the blood vessels in and around the liver. In local anesthesia for patients after in X- ray apparatus, a small catheter inserted into the patient's femoral artery, and then into the hepatic artery, injected contrast agent. The images obtained by the X- ray apparatus can correctly identify the location of the tumor and provide the blood vessels of the tumor, which is helpful for diagnosis and treatment. This method is an invasive technique, and the left liver and the lack of liver cancer showed slightly worse, in the positioning of the diagnosis of CT and B ultrasound. Biopsy: after the initial diagnosis of the tumor. After local anesthesia, a thin needle was used to puncture the tumor, and a few tissues were obtained to determine if there were any cancer cells. This check is usually performed at the same time as the B ultrasound to ensure that the needle is in place. Laparoscopic: in the operation room for patients after general anesthesia, the abdominal half inch incision, a fiber optic conduit to the patient's abdomen, which can directly check the various organs of the patient. This examination can reveal whether the liver tumor spread to other parts of the liver, or other organs and tissues. Usually, the above methods can be used to diagnose liver tumors or other abdominal tumors. When these tests are performed, the patient does not need hospitalization.
Seven, the treatment of liver cancer early, comprehensive and active treatment is the principle of treatment of liver cancer.
Surgical treatment is the main treatment for primary liver cancer, and is the most effective method, after resection of the patient's 5 year survival rate can reach up to 80%. If the tumor does not spread to other parts of the liver, and the tumor is localized, surgical treatment is recommended.
Interventional therapy (TACE): transcatheter arterial chemoembolization. Methods: after local anesthesia, a catheter was inserted into the femoral artery, and then into the hepatic artery or its branches, embolic agent or chemotherapeutic drugs, will supply nutrients to the tumor vessels blocked, tumors induced by ischemia and necrosis, to achieve the purpose of treatment.
Intratumoral injection of drugs: the skin will be anhydrous alcohol or other drugs directly into the tumor, killing cancer cells, this method is carried out under B ultrasound, to ensure that the needle inserted into the appropriate position.
Radiofrequency ablation is a new treatment method in Department of hepatobiliary surgery. In ultrasound guided percutaneous hepatic tumor, needle in tumor to distinguish the ten different directions of the hook needle, like ten warheads as circular distribution in the tumor, from fine needle head wave high frequency spectrum, and ion collisions, produce a lot of heat, the temperature reached to 60C thus, to kill tumor cells.
Systemic chemotherapy: the use of anti-cancer drugs, through oral or intravenous injection to disrupt cancer cell reproduction, killing cancer cells, and to achieve the purpose of treatment.
Radiation therapy: after the tumor is small or some interventional therapy, radiation therapy, also has certain curative effect.
Biological therapy: interferon, interleukin, tumor necrosis factor.
Chinese medicine treatment: anticancer, analgesia, liver and other effects.
Molecular targeted therapy: Sola Feeney has a positive effect on patients with receptor positive, effective patients can make the tumor completely disappear for a long time. The utility model is especially suitable for patients with recurrence after operation, and the patients with liver cirrhosis can not be tolerated.
Eight, the treatment of all kinds of care
1 surgical treatment
Preoperative preparation: 1-2 days before surgery, cough training deep breathing exercise, effective, on the toilet habits in the bed. The day before the operation, the operation of the site to do the preparation of the skin and body cleaning, including shaving, cleaning the navel, trimming the finger (toe) a, shave, shampoo, bath. Preoperative day with blood, drug allergy test preparation. One day before morning oral laxatives, and more water, improved semi fluid food. The night before surgery to clean the intestines, enema, 8 pm to start fasting, sleeping pills to sleep at bedtime. The day before surgery, measure the respiration, pulse, temperature 4 times, such as fever, severe colds, cough, menstrual cramps, should promptly report to consider whether to suspend operation. Morning temperature, respiration, pulse, dressing, removing hair clips, activities of dentures, watches and accessories and other items, to keep the family. On the morning of surgery for gastric tube and catheter and fixed, preoperative needle injection make the patient calm, and then into the operation room.
Note: postoperative nursing and postoperative position: according to the anesthesia and the patient is conscious and patient; if not clear, can go to the pillow, head to one side; if the patient is awake should bolster supine or semi supine, in order to facilitate the recovery of respiratory function. Postoperative oxygen inhalation: 12-24 hours, can promote the patient to recover from anesthesia inhibition of free breathing, while the supply of liver cells more oxygen, is conducive to the recovery of liver cell function. The function of gastric tube, catheter, wound drainage after surgery: stay out of gastric juice and gastric tube can stomach, reduce postoperative abdominal distension, pain relief, is conducive to wound healing; usually stay 2-3 days can be removed. Stay in the tube during oral hygiene. The use of indwelling catheter to drain urine can prevent postoperative urinary retention and is conducive to the observation of urine. Usually stay for 2 days, in the meantime, make urethral mouth cleaning and disinfection, to prevent infection; in the day, before pulling out the catheter catheter hostage, the bladder filling, bladder function training, open 3-4 hours or feel urinate. Retention of wound drainage tube is conducive to the elimination of the wound exudate and observation of bleeding after surgery, generally 2-3 days after removal. After fasting for 2-3 days, the recovery of gastrointestinal function, anal gas discharge, starting from liquid and semi liquid to the ordinary food, gradually eating. If the cough after operation, can be used to press the wound site, in order to protect the wound, reduce pain. Postoperative wound pain: pain generally do not need treatment, the patient can be distracted; pain was given appropriate medication painkillers, the number can not be too frequent, too much, otherwise, easy to produce paralytic ileus and addiction and side effects. After much take semirecumbentposition and early activities: 1-2 days after the operation, activity on the bed stand up, back, limbs, deep breathing, half sitting or sit up completely; for 3-4 days, if the condition permits, then gradually from the bed. Semirecumbentposition: can relieve the heart and lung of oppression, to breathe, to reduce abdominal wound tension, avoid pain, and is conducive to wound drainage and wound healing. Early activities: to promote the recovery of gastrointestinal function, promote blood circulation, increase vital capacity, is conducive to the early recovery of health. After surgery, most patients can be discharged within 8-10 days. But in the next few weeks, there will be pain, usually at least six weeks to complete recovery.
2 between treatment
More communication with the medical staff to understand the purpose, methods and significance of the treatment, to relieve their worries. Training in the toilet before operation on the bed. Drug allergy test and skin preparation. Do a good job cleaning the body, preoperative dressing. Preparation of drugs used in surgery and CT tablets. Injection needle.
Postoperative note: postoperative bandage bandage pressure to prevent bleeding, family members and patients can not loose. After the bed to be careful to avoid injury to the lower limb force. Lying in bed after operation for 6-10 hours, to prevent the injury of lower limb activity and bending, as soon as possible in the bed on the toilet habits, if not in the upper bed urination, urination function with the help of medical personnel, under the guidance, observe whether the wound bleeding. If the bandage on the lower extremity numbness discomfort, skin bruising, timely report. No fasting, drinking more water, is conducive to the elimination of drug toxins. The first time after the surgery will appear red, do not panic, this is the intraoperative injection of drugs through the urine discharge phenomenon, not bleeding.
Common side effects in interventional therapy
Interventional therapy generally has side effects, can cause some discomfort, but some patients are almost unaffected. All side effects can be controlled with medication, patients can rest assured. Fever: caused by the absorption of necrotic tissue after the operation. The general temperature at about 380C, no consciousness, no drug treatment, fever should drink more water; if there is fever (temperature above 390C), available ice, alcohol brush, or use antipyretic treatment etc.. Nausea and vomiting caused by chemotherapy drugs injected due to the stimulation of the gastrointestinal tract, severe symptoms can be the use of antiemetic treatment. Abdominal distension, abdominal pain: due to liver tissue necrosis, the liver volume increased, pulling the capsule caused. The pain can be severe treatment using painkillers. Liver function damage: embolism not only damage to the cancer nodules, of normal liver cells also have destructive effects, can cause the decrease of liver function, postoperative liver protection therapy.
3 systemic chemotherapy
Use of anticancer drugs to disrupt and kill cancer cells. Chemotherapy generally has side effects, can cause some discomfort, but some patients are almost unaffected. Most side effects can be controlled by drugs. Bone marrow suppression: chemotherapy drugs on cancer cells, the role of the bone marrow hematopoietic function of inhibition, the number of normal cells in the blood decreased, so that patients are more vulnerable to fatigue and infection. Chemotherapy, regular blood tests, when necessary, given the blood transfusion and the use of antibiotics to cope with infection. Gastrointestinal reactions: some drugs can cause nausea, vomiting and diarrhea, poor appetite; but now many kinds of antiemetic drugs, the effect is good, can greatly reduce nausea and vomiting; poor appetite drinking soft drinks or food nutrition. Oral mucosal changes: some chemotherapy drugs can make oral pain or ulceration, must according to the guide, gargle regularly. Hair loss: chemotherapy drugs have a common side effect is that scared off. However, not all chemotherapy drugs have this side effect. Find yourself without hair loss, worry too much, because after the completion of chemotherapy, hair will soon grow out. The temporary hair loss, many patients are wearing a wig, hat, scarf, etc..
Nine, early detection of the majority of patients with liver cancer at the time of initial diagnosis, the condition is very serious, can not accept any treatment. So early detection is very important. Main ways: regular screening of high-risk groups of liver cancer. High risk group refers to a person who had a history of hepatitis for more than 5 years or hepatitis B surface antigen positive, aged 25-65 years old. Annual physical examination: all belong to liver cancer high-risk groups and middle-aged people, in the annual physical examination, the need to detect serum AFP and B ultrasound liver.
Ten, liver cancer patients after treatment with
Follow up arrangements: to cure the patients after surgical resection, 1-2 years 2-3 months each time; 2-5 every 3-5 months at a time; 5 years every half a year after a review; palliative surgical resection and after interventional therapy, a review of each month.
Follow up project: physical examination, blood routine, AFP, ultrasound, liver and kidney function, chest X-ray, CT examination (if necessary, after every 3-6 months 1-2 years to do a CT check).
Eleven, the life of patients with liver cancer after treatment
Guide: the diet contains high protein and high carbohydrate foods, such as fish, meat, eggs, beans, etc.. Choose some light digestible food: vegetables, fruits, etc., in order to increase the variety of vitamins. The use of a small number of meals, reasonable processing and deployment, improve appetite. Avoid spicy food, such as wine, coffee, fried food etc..
Daily life: after the treatment, some patients are unable to do some work in the past that behoove, but the body gradually improved, can make some simple goal, slowly rebuild confidence, take a positive and healthy attitude. Listen to music at home and learn some ways to relax yourself. Walking, Tai Chi, qigong, and frequency of movement, depending on the patient's physical condition and decide, can be set to achieve the goal, to follow the prescribed order. Do something you love to do and keep your mind at ease.
Twelve liver cancer patients, psychological adjustment to know their feelings, most of the patients informed of their suffering from liver cancer, will feel helpless and at a loss, mood disorder and mood swings.
The most common emotions are: fear and not believing. Fear and anxiety: I will not hurt? Will not die? Denial: I'm fine. I don't have cancer. Anger: Why did you choose me? Why is it happening now?. Blame and guilt: if I don't, I don't have cancer. Hate: it's not you sick, how do you know the pain. Retreat and self isolation: ignore me, I don't care. Emotional response varies from person to person. There is no right or wrong mood, in the face of different stages of mood is a part of the patient to adapt to the disease process, it does not mean that you can not cope with cancer. Friends, family and friends often feel the same way, and you need constant support and guidance during the adjustment period. Under the guidance of medical staff to correctly understand the liver cancer, learn how to deal with the "cancer" of this terrible term, people always with misunderstanding and fear. Of all the patients who are suffering from cancer, the biggest worry is, will I die? Even though it is difficult to completely cure the liver cancer, modern medical treatment can relieve the pain or control the disease for a long period of time. Will it hurt? Can I stand it? Do you have any medicine? It's a common fear. Uncertainty about the future, will cause great mental pressure. Talk to your doctor about these fears, and his answers and information can help you reduce concerns. The more you know about the disease, the more it can help you feel at ease; talking about your feelings with your family and friends can also help you relax your doubts and concerns. Do not want to talk about their disease, but also do not want to come into contact with the "cancer" of any information, which is part of the patient's approach to cancer. If you have this idea, just use a firm tone to tell the people around you, you are not prepared to talk about their disease, at least temporarily do not want to talk about. But for families and friends who are eager to share your worries, it could be embarrassing. If you can tell them that you don't want to talk about your illness right now, but when you're ready, you can talk to them. Sometimes, it is your family and friends are not willing to talk about your illness, on the surface they ignore you have cancer in as little as possible about or even avoid talking about your illness, think that this will reduce your anxiety; but sometimes, this makes you feel lonely in the struggle. If the attitude of friends and relatives makes you feel sad, you can tell them that you know your illness, and you want to talk to them about your illness and feelings, and ask them for their support and help. Anger, resentment and annoyance is understandable, you can get everything to vent their dissatisfaction with the relatives, friends and even your medical doctors and nurses who, you don't have to feel guilty about angry thoughts or emotional instability, they will understand your anger is not for them but for your illness, when you anger subsided, but when appropriate, explain to them. After treatment, still need a long time to deal with emotional problems, not only need to accept the fact that cancer patients, but also to deal with the side effects of cancer treatment on the body caused by. Patients with secondary liver cancer also have to face the fact that the cancer has spread, some of whom had thought they had been cured. Even the feeling of their disease can't cope with, there is no need to feel sorrow and failure, it is important to live in their own way, to rest as much as possible, how to share your feelings with others, making them more likely to lend a helping hand. Personality and emotions also affect the development and prognosis of disease: strong willed, open-minded, happy personality, the disease develops slowly, the prognosis is good; but narrow-minded, and always melancholy and moody long-term tension, depression and anxiety, often disease development, poor prognosis. Therefore, even to learn that he had cancer, also do not always sad, complaining, long-term and depressed in the heart; the best way is to get the heart of the eve of pour out, will be in a good mood. To love life, to keep the mood cheerful, optimistic, with a strong will to overcome the disease.