Hepatitis patients should be alert to right shoulder pain to prevent liver cancer

Some liver cancer patients may experience right shoulder pain, and initially thought they had frozen shoulder. However, after several months, they discovered that their liver had become enlarged or they had pain in the liver area. During an ultrasound examination, they were diagnosed with liver cancer, which was already in the late stage.

Why do some liver cancer patients experience shoulder pain?

This is caused by liver cancer located below the diaphragm on the right surface of the liver invading the right diaphragm. The pain caused by visceral lesions is not as accurate as that caused by the skin on the surface of the body. The pain site on the surface of the skin is often the site of skin damage, while visceral lesions often cause reflex pain or referred pain, and the site of pain is not the site of the lesion.

For example, when appendicitis begins, the pain is felt in the upper abdomen, not in the right lower abdomen where the appendix is ​​located. Similarly, the diaphragm affected by liver cancer in the right lobe of the liver causes referred pain in the right shoulder. Therefore, if a patient with a history of hepatitis finds right shoulder pain, he should not simply think that it is frozen shoulder. Instead, he should undergo alpha-fetoprotein and ultrasound examinations in a timely manner. Since it is not easy to detect a tumor under the diaphragm of the right liver by ultrasound examination, it is best to do an enhanced CT examination to detect liver cancer in this area in a timely manner.

Diagnostic criteria for primary liver cancer:

1. Alpha-fetoprotein AFP ≥ 400 µg/L, which can exclude pregnancy, germline embryonic tumors, active liver disease and metastatic liver cancer, and can touch the enlarged, hard and nodular liver or imaging examination shows space-occupying lesions with characteristics of liver cancer.

2. Alpha-fetoprotein AFP < 400 µg/L, which can exclude pregnancy, germline embryonic tumors, active liver disease and metastatic liver cancer, and there are two imaging examinations with space-occupying lesions characteristic of liver cancer, or two liver cancer markers (DCP, GGTⅡ, AFU and CA19-9, etc.) are positive and one imaging examination has space-occupying lesions characteristic of liver cancer.

3. Patients with clinical manifestations of liver cancer and definite extrahepatic metastatic lesions (including bloody ascites visible to the naked eye or cancer cells found therein) and who can rule out metastatic liver cancer.