Effective diagnosis of liver cancer should be clearly four areas, namely, positioning, qualitative, quantitative and staging. The so-called positioning is to find out the location of tumors, for example, in the left lobe or right lobe of the liver, and adjacent vessels, the relationship between the bile duct. Qualitative that distinguish tumor benign or malignant, will have to distinguish between malignant tumors such as malignant tumor of epithelial origin or source of mesenchymal malignancy. Quantitative refers to the size of the tumor, the number of tumors, with or without extrahepatic metastasis. Stage refers to the set is based on positioning, qualitative, quantitative and other diagnosed stages. Diagnosis should be organically various means and methods used to obtain diagnostic evidence, but should not blind, unnecessary duplication of inspection, so as not to bring patients to unnecessary suffering and economic burden, and sometimes may delay treatment.
(A) the diagnosis of hepatocellular carcinoma sequence
The possibility of liver cancer is suspected, it can refer to the following procedures to effectively diagnose liver cancer:
1. First of all should be alpha-fetoprotein (AFP) check. If AFP> 400 g / L, and can rule out pregnancy, active liver disease, gonadal embryonal tumors and other diseases, B-substance lesions found in the liver, liver cancer can be diagnosed. Not seen as B-occupying lesions should be considered for CT or MRI, if there is a clear substantive holder can make the diagnosis.
2. Such as the AFP <200 g / L but two 20 g / L should be AFP heterogeneity analysis and (or) related to the serum enzyme tests (eg: – the first turn glutamine peptide enzyme West The isozyme, isozyme reduction awake A, fucosidase, antitrypsin, alkaline phosphatase I, 5 '- nucleotide phosphodiesterase isozyme activity V, pyruvate kinase workers enzyme, placental glutathione s-transfer enzymes), other markers such as abnormal thrombin, ferritin and acidic ferritin, which also contribute to the diagnosis, such as a positive, liver cancer likely to be continue to follow-up, and for imaging.
3. AFP <400 g / L but _ 200g / L, they should be B-ultrasound, if substantial liver lesions should be suspected as the liver, such as the further exclusion of pregnancy, active liver disease, metastasis liver cancer can be diagnosed. If no space-occupying lesion B ultrasonic examination should be regular follow-up AFP levels. Such as the AFP continue to rise, then the possibility of liver cancer is very large, should refer to the above method of the first imaging examination, such as lesions can be detected, diagnosis can be established. If follow-up AFP level gradually decreased to 20 g / L less, and no placeholder imaging, more active liver disease, generally can be excluded from liver cancer.
4. Because of liver cancer patients by about 30% of AFP-negative, so that even AFP <20 g / L, if any, clinical symptoms and signs of liver cancer, liver cancer can not be easily ruled out. You should be in accordance with the order of the first B-, CT, MRI and hepatic angiography and other tests, and check serum enzyme. Found the typical imaging findings of liver and alkaline phosphatase (AKP), – turn skin enzyme glutamic acid (-GT) abnormal increase can also be diagnosed with liver cancer. If only the serum enzyme abnormalities without clear lesions should be followed up regularly. Imaging studies such as space occupying lesions in the B-or CT guided liver biopsy down to obtain the pathological diagnosis.
On the liver cancer diagnosis and staging, the first of 1977 in our national development of liver cancer prevention and control research collaboration meeting. However, with advances in technology, the accumulation of experience, also found that many of the shortcomings, despite a local modification on several occasions, but the lack of a broader argument. During the International Union Against Cancer (DICC) has published TNM staging of primary liver cancer. Liver Cancer Association of Professional Committee of China taking into account the standards of the International Union Against Cancer pathologic examination to be made only after the judge, and cases of liver biopsy to surgery to remove or not many countries in the world with reference to a liver function and to consider the clinical stage programs, developed for the clinical diagnosis of China's national conditions and staging criteria. Held in Chengdu in 1999 academic conference on the country after the liver had caused much discussion. The past two years sought the views of all sides. On this basis, in September 2001 held in Guangzhou, the Eighth National Conference on liver formally adopted the "primary liver cancer diagnosis and staging." Are presented below.
Effective diagnosis of hepatocellular carcinoma (b) the diagnostic criteria of HCC
1. AFP <400 g / L, to get rid of pregnancy, fetal and reproductive system tumors, active liver disease and metastatic liver cancer, and there are two imaging characteristics of a liver or two lesions hepatoma markers (DCP, GGT "AFU and CA19-9, etc.) and a positive imaging characteristics of a space-occupying liver lesions.
2. AFP> 400 g / L, to get rid of pregnancy, fetal and reproductive system tumors, active liver disease and metastatic liver cancer, and can reach swelling, hard and nodular mass in large imaging the liver or characteristics of a space-occupying liver lesions.
3. Have clinical manifestations of liver cancer and a certain extrahepatic metastases (including visible or bloody ascites which found that cancer cells) and to exclude those with metastatic liver cancer.
Effective diagnosis of hepatocellular carcinoma (c) of the liver of the TNM staging
In accordance with standard International Union Against Cancer (1987), liver cancer TNM stage as follows.
T1: single nodule, less than equal to 2cm, no vascular invasion.
T2: a single nodule, less than equal to 2cm, with vascular invasion. Or multiple nodules, but limited to the leaf, less than equal to 2cm, no vascular invasion. Or a single nodule,> 2cm, no vascular invasion.
T3: a single nodule,> 2cm, vascular invasion. Or multiple nodules, but limited to the leaf, transport 2cm, vascular invasion. Or multiple nodules, limited leaf,> 2cm, with or without vascular invasion.
Said: multiple nodules, beyond the leaf; violations or violations of portal vein portal vein.
NO: No regional lymph node metastasis O
N1: a regional lymph node.
MO: no distant metastasis.
MI: distant metastasis.
Effective diagnosis of hepatocellular carcinoma (d) staging of liver cancer
Ia: single tumor diameter <3em, no thrombus, abdominal lymph nodes and distant metastases; liver function Child A-
Ib: a single or two tumor maximum diameter and <5em, in half the liver, no thrombus, no abdominal lymph node metastasis and distant metastasis; liver function Child A.
lla: single or two maximum diameter of the tumor and transport IDem, liver or both of the tumors in half the maximum diameter and 4 5em, about two and a half in the liver, no tumor thrombus, abdominal lymph nodes and distant metastases; liver function Child A.
llb: single or two maximal tumor diameter and> IDem, liver or both of the tumors in half the maximum diameter and> 5em, in the left and right half of the liver, or multiple tumors, no tumor thrombus, abdominal lymph node and distant transfer; liver function Child A. Situation regardless of the tumor, portal vein branch, hepatic vein or bile duct tied and (or) liver function Child Bo
illa: Cancer circumstances aside, there is portal vein or inferior vena cava tumor thrombus, one of abdominal lymph node or distant metastasis;
Liver function Child A or B.
illb: case regardless of the tumor, thrombosis, metastases regardless; liver function Child C. Should be noted that, AFP negative patients meeting the clinical diagnostic criteria, the diagnostic accuracy is still difficult for more than
90%.
Therefore, the effective diagnosis of liver cancer as far as possible obtained by liver biopsy pathology basis to improve the diagnosis rate of liver cancer.