Liver cancer – symptoms

Liver cancer symptoms and disease stages

In the early phase of liver cancer, the sufferers notice only minor or unspecific complaints such as a prolonged feeling of fullness in the upper abdomen. The feeling of pressure is not only present after meals, but also stops afterwards. Some patients also report a general malaise. They are tired quickly and not as efficient as they used to be. Even unwanted weight loss can indicate a cancer and should therefore always be taken seriously.

In the further course of the disease, the tumor affects the functions of the liver more and more. The decreased excretion of bilirubin (the breakdown product of the red blood pigment hemoglobin) can lead to jaundice (jaundice). If the tumor has already enlarged enough to press against the liver capsule, the patient often feels pain in the right upper abdomen. A reduced protein production of the liver can also cause fluid retention in the legs and stomach and affect blood clotting.

Structural changes in the liver can lead to a higher load on the portal vein in the advanced stage (portal hypertension). The increased blood pressure in the large vessel causes increased formation of bypasses (so-called portocaval anastomoses). These include varicose veins in the esophagus, stomach and around the navel (periumbilical). High pressure can cause the varicose veins to rupture, causing life-threatening bleeding.

Symptoms of liver cancer in the overview:

Early stage	Persistent feeling of fullness, pressure in the upper abdomen
	Loss of appetite, nausea and weight loss
	General malaise (fatigue and fatigue)
Advanced stage	Jaundice (jaundice) as a result of decreased excretion of bilirubin (the breakdown product of the red blood pigment hemoglobin)
	Water accumulation in the legs (edema) or in the stomach (ascites), as well as disorders of blood clotting due to a lack of protein production of the liver
	Varicose veins in the esophagus, stomach and in the area of ​​the abdomen
	Pain in the right upper abdomen

Symptoms of liver cancer: early stage

As with many other cancers, there are no specific liver cancer symptoms that are predictive of the condition at an early stage. Liver cancer runs relatively long without discomfort. The first signs of liver cancer are initially similar to those of gallstones or gall bladder infection. Typically, however, the symptoms persist for weeks:

Nausea and feeling of fullness

Those affected often report a feeling of pressure in the upper abdomen or a feeling of fullness, which not only occurs after a meal, but persists permanently. Other early onset liver cancer symptoms include loss of appetite and nausea. These liver cancer symptoms usually occur regardless of diet and lifestyle and do not sound off after a while on their own.

Weakness and weight loss

Persistent weakness and constant fatigue are also among the non-specific liver cancer symptoms. In everyday life the patients are noticeably exhausted and constantly tired despite sufficient sleep. Of course, it can be responsible for other diseases (for example, mental suffering or a thyroid dysfunction). Some sufferers also report unwanted weight loss without changing their lifestyle habits. An unwanted weight loss of more than ten percent of the initial weight within six months is considered a warning of a possible serious illness, especially cancer.

Symptoms Liver cancer: advanced stage

In the advanced stage of the disease, liver cancer symptoms may occur due to the loss of function of the organ. The further the liver cancer spreads, the more healthy liver tissue displaces the tumor. A concomitant decrease in liver function can cause the following liver cancer symptoms:

Jaundice (jaundice)

In liver cancer, the liver cells are often no longer able to sufficiently metabolize the degradation product of the red blood pigment (bilirubin) and excrete via the bile. The bilirubin then deposits first in the white part of the eye (sclera) and discolors it yellowish. Later, this also applies to the mucous membranes and the skin. Jaundice is often associated with itching. Bilirubin is probably deposited near sensitive skin nerves and irritates them.

Pain in the right upper abdomen

As a rule, liver cancer or metastases of other tumors in the liver lead to pain in the right upper abdomen only at an advanced stage. The liver tissue itself has no sensitive nerve fibers, which are responsible in other organs for the sensation of pain. This does not apply to the liver capsule that surrounds the liver: it is equipped with nerves that can transmit pain signals to the brain. If the tumor has already grown so much that the swelling presses against the liver capsule, the so-called “liver capsule pain” occurs.

Protein deficiency – water retention and disturbed blood clotting

The liver usually produces many important proteins (proteins). In the advanced stage, the organ can no longer produce certain proteins in sufficient quantity. This has several consequences: The protein albumin produced by the liver is normally responsible in the vascular system for binding fluid and maintaining blood pressure. This prevents fluid from settling in the tissue. Due to the albumin deficiency in liver cancer, water escapes from the vascular system into the surrounding tissue. It creates accumulations of water in the legs (edema), in the stomach (ascites) or in the legs. The latter are easily detected: if you press a finger on the outer edge of the tibia for a few seconds into the skin, after releasing a small dent remains visible, which only slowly regresses. An accumulation of water in the abdomen can be determined by an increase in the abdominal circumference. In principle, however, these water retention can also occur in other diseases, for example in the case of heart disease (heart failure).

Blood clotting also suffers from the lack of certain proteins. Blood clotting is a complex system that only works when there are enough coagulation factors in the blood. Coagulation factors are also proteins that are formed in the liver. A deficiency due to a liver dysfunction can lead to severe bleeding as normal blood clotting is no longer possible. This is particularly fatal in combination with increased blood pressure in the portal vein, as life-threatening bleeding may occur in the esophagus or stomach.

Increased blood pressure in the portal vein

Depending on its location, liver cancer can also impair the function of the portal vein (V. portae). It is a large vein in the abdomen, which transports low-oxygen and nutrient-rich blood from the digestive organs (stomach, intestine) and spleen into the liver.

Due to the pathological alterations in the liver tissue, the blood vessels of the organ change – they get under pressure and harden. This increases flow resistance for the blood that pushes into the liver. It begins to build up in front of the liver, and the blood pressure in the portal vein increases. In a permanent increase by more than 13 millimeters of mercury (mmHg) speak medical doctors of one portal hypertension.

Normally, the blood flows through the liver and on to the heart. Due to the backflow, the blood seeks alternative ways in portal hypertension. For this it bypasses the liver, it form so-called portocaval anastomoses, ie connection to the great vena cava of the heart (vena cava). In advanced liver cancer, these diversions expand and are filled with blood. Then it comes to the following phenomena:

Varices of the abdominal wall: In a so-called Caput Medusae (“head of the Medusa”), tortuous veins on the abdomen of the patient appear due to the increased venous pressure of the liver. These are sloughs of the veins in the abdominal wall. The name godmother of the apparition is Medusa, a figure from Greek mythology, from whose head snakes sprouted instead of hair.

Varicose veins of the esophagus (esophageal varices) and of the stomach: Due to the increased venous pressure in the liver, the veins of the esophagus and the stomach can enlarge and form varicose veins. Some sufferers then report a feeling of pressure or fullness. The Aussackungen cause but not necessarily complaints.

Bleeding in the esophagus and stomach

Although they initially do not cause discomfort, varices in the stomach and esophagus are problematic. The veins are very superficial and can be easily injured, rupture or burst and cause severe bleeding. Such bleeding can occur very suddenly and be caused by swallowing or coughing.

In bleeding from the esophagus or stomach, patients often vomit caffeine-like, brown-black blood. The blood from the esophagus or from the stomach reacts with the stomach acid – it turns dark and becomes grainy. The bleeding is very dangerous, because the affected people lose a lot of blood in a short time – a circulatory failure threatens. Such bleeding can usually be stopped by esophageal or gastroscopy. A preventive obliteration of the varices is possible.

Recognize liver cancer symptoms

Due to the initially symptom-poor course, it is difficult to differentiate early liver cancer from other diseases. However, if you feel persistent, unwanted weight loss, persistent nausea and bloating, you should always see a doctor. It does not necessarily have to be liver cancer symptoms. Since the symptoms can indicate a serious illness, you should definitely clarify.

Liver cancer symptoms that appear later in liver cancer are predominantly the result of impaired liver function. They therefore also occur in connection with other liver diseases – for example cirrhosis or chronic hepatitis infection. In order to be able to make the diagnosis of liver cancer beyond doubt, therefore, must always be a detailed diagnosis. Imaging techniques (computed tomography, magnetic resonance imaging) as well as the removal of a tissue sample are of essential importance in order to detect potential Liver cancer symptoms clearly clarify.