What is nodule rupture of primary liver cancer

Primary liver cancer refers to cancer that originates in hepatocytes or intrahepatic bile duct cells. It is one of the common malignant tumors in my country, and its mortality rate ranks third among malignant tumors of the digestive system, second only to gastric cancer and esophageal cancer. Spontaneous rupture and bleeding of primary liver cancer is a common and serious complication of liver cancer, with an incidence rate of 9% to 22.6%. It develops rapidly, is a severe disease, and has a poor prognosis. Early diagnosis and timely treatment are helpful in improving the patient's prognosis.

Pathophysiology

The mechanism of spontaneous rupture and bleeding of liver cancer is not yet fully understood. Most scholars believe that it is due to direct invasion of the tumor, which obstructs the venous outflow tract, causing venous hypertension, thereby causing bleeding and rupture. In general, it may be related to the following factors: liver cancer is highly malignant and grows rapidly, which leads to a relative lack of blood supply to the tumor, resulting in central ischemia, necrosis and liquefaction. If the tumor volume increases too quickly at this time and the tumor capsule cannot stretch, it may cause the surface of the tumor to rupture and cause bleeding; liver cancer ischemia, necrosis and secondary infection may also lead to rupture and bleeding; the tumor directly invades the intrahepatic blood vessels, causing vascular rupture and bleeding; after the portal vein is embolized by cancer thrombus, the superficial part of the tumor surrounding the tumor will have nutritional necrosis and rupture, which may also lead to bleeding. When the tumor is located in the superficial position of the liver septum, it is susceptible to external impact. The thin tumor capsule and the extremely fragile cancer tissue are also the causes of rupture and bleeding.

Clinical manifestations

Most patients present with acute upper abdominal pain. At first, it is usually epigastric pain, which occurs suddenly in about 95% of cases. As the disease progresses, it may gradually develop to the whole abdomen, accompanied by dizziness, cold sweats, nausea, vomiting and other symptoms. When liver cancer spontaneously ruptures and bleeds, there are also cases where the abdominal pain is limited to the upper abdomen and is milder. This may be due to the rupture of a smaller cancer nodule located superficially in the liver, with less bleeding, and the bleeding is limited to the liver capsule, which is called subcapsular hemorrhage. Most patients may have pale complexion, cold limbs, cold sweats, a weak pulse, and decreased blood pressure. The abdominal tenderness varies depending on the degree of tumor rupture. For patients with small ruptures and small amounts of bleeding, the abdominal tenderness may be limited to the lesion or the tenderness may not be obvious; for patients with large ruptures and large amounts of bleeding, there may be whole abdominal tenderness. Some patients may have rebound pain and abdominal muscle tension. The reason may be that a small bile duct ruptures, and some bile flows into the abdominal cavity to stimulate the peritoneum. When the amount of bleeding is large, the abdomen may be distended, the percussion sound may be solid, the shifting dullness may be positive, the bowel sounds may be reduced or disappear, and the blood test may show a decrease in hemoglobin, an increase in the total white blood cell count and neutrophils. Diagnostic abdominal puncture is of great significance for the diagnosis of ruptured hemorrhage of liver cancer, and uncoagulated fresh blood can often be seen. B-ultrasound plays an extremely important role in those cases that are difficult to diagnose at the moment, and can confirm the diagnosis.