Elderly primary liver cancer

　　The etiology and pathogenesis of elderly primary liver cancer have not been fully confirmed and may be related to the combined effect of various factors. According to many years of research, the occurrence of liver cancer may be related to the following factors:

　　1. Genetic factors

　　In high-incidence areas of liver cancer, there is sometimes a family aggregation phenomenon, especially among those living together and having blood relations, with a high incidence of liver cancer. This may be related to the vertical transmission of hepatitis virus.

　　2. Liver cirrhosis

　　About 50% of patients with primary liver cancer and liver cirrhosis found in pathological examination are those with large nodular cirrhosis after HBV hepatitis.

　　3. Aflatoxin

　　Animal experiments have shown that corn and peanuts contaminated with aflatoxin can cause liver cancer, due to the strong carcinogenic effect of aflatoxin B1, a product of aflatoxin. Epidemiological surveys have also found that in regions where grain is severely contaminated with aflatoxin B1, the incidence of liver cancer is also high. This suggests that aflatoxin may be a cause of high incidence of liver cancer in some areas.

　　4. Water pollution

　　In Qidong, a high-incidence area of liver cancer, those who drink pond water have a significantly higher incidence of liver cancer than those who drink well water. The survey found that the blue-green algae growing in the ponds are strong carcinogenic plants, and the occurrence of liver cancer is related to this.

　　5. Other chemical carcinogens

　　Some chemical substances, such as nitrosamines, azo compounds, alcohol, and organochlorine pesticides, etc.

　　6. Viral hepatitis

　　Research has found that there is a close relationship between hepatitis B virus and liver cancer, which is an important risk factor for the occurrence of liver cancer.

　　In the serum of liver cancer patients, the marker of hepatitis B is as high as over 90%.

　　In high-incidence areas of liver cancer, the chance of developing liver cancer in HBsAg-positive individuals is 6 to 50 times higher than in those with negative results.

　　Molecular biological research shows that in Chinese patients with liver cancer, simple integrated HBV-DNA accounts for 51.5%.

　　The X gene of HBV can change the gene expression of liver cells infected with HBV, which may be related to the possibility of canceration. Hepatitis B virus causes liver cell damage, followed by hyperplasia or atypical hyperplasia, making the cells sensitive to carcinogens. In the multi-causal and multi-stage pathogenesis process, various genes may be altered, where a group of proto-oncogenes are activated into oncogenes, and one or more tumor suppressor genes are inactivated, leading to uncontrolled cell growth, continuous proliferation, and ultimately causing canceration. Hepatitis C virus infection is also related to liver cancer.

　　7, Other

　　Trace elements, Schistosoma japonicum, alcohol, etc. In high-incidence areas of liver cancer, water, soil, grain, human hair, and blood contain high copper and zinc and low molybdenum. Schistosoma japonicum can stimulate the proliferation of bile duct epithelium and produce bile duct cell cancer.

　　Once symptoms appear and the elderly patients with primary liver cancer seek medical attention, the course of the disease is mostly in the middle and late stages. The most common clinical manifestations of middle and late-stage liver cancer are: large mass or multiple nodular masses in the upper abdomen, pain in the liver area, decreased appetite, weight loss, and fatigue.

　　1, Hepatic encephalopathy

　　It is often a complication in the terminal stage of liver cancer, and about 1/3 of the patients die of it.

　　2, Gastrointestinal bleeding

　　Bleeding accounts for about 15% of the causes of liver cancer death. Liver cancer often complicates with liver cirrhosis or portal vein, hepatic vein cancer thrombus, which can cause esophageal or gastric fundus varices to rupture and bleed due to portal hypertension. It can also cause bleeding due to gastrointestinal mucosal erosion, coagulation mechanism disorders, and other factors.

　　3, Rupture and hemorrhage of liver cancer nodules

　　The incidence is about 10%, and the liver cancer tissue can spontaneously rupture due to enlargement, necrosis, or liquefaction, or due to external force. If the rupture is limited to under the capsule, there may be local severe pain. If the bleeding under the capsule increases rapidly, it can form a tender mass. It can also break into the abdominal cavity, causing acute abdominal pain and peritoneal irritation signs, large amounts of bleeding leading to shock and death, while small rupture bleeding is manifested as bloody ascites.

　　4, Bloody pleural effusion and ascites

　　The diaphragmatic liver cancer can directly infiltrate or spread through blood or lymphatic transfer to cause bloody pleural effusion and ascites, which is common on the right side.

　　5, Secondary infection

　　Due to long-term consumption by the cancer, decreased resistance, or due to blood cell reduction caused by radiochemical therapy, resistance is weakened, and factors such as long-term bed rest, it is easy to develop various infections, such as pneumonia, intestinal infection, and fungal infection.

　　Primary liver cancer in the elderly has an insidious onset and lacks typical symptoms in the early stage. It is often discovered incidentally during follow-up of liver disease or physical examination. At this time, the patient has no symptoms, and physical examination also lacks signs of the tumor itself, which is called subclinical liver cancer. Once symptoms appear and the patient seeks medical attention, the course of the disease is mostly in the middle and late stages. The most common clinical manifestations of middle and late-stage liver cancer are: large mass or multiple nodular masses in the upper abdomen, pain in the liver area, decreased appetite, weight loss, and fatigue, with typical signs of liver enlargement, spleen enlargement, jaundice, ascites, vascular murmur in the liver area, friction sound in the liver area, and corresponding signs of metastatic foci.

　　(1) Liver area pain

　　The pain in the liver area is the most common, usually presenting as persistent swelling and dull pain. Liver pain is caused by the rapid growth of the tumor, which pulls on the liver capsule. If the lesion invades the diaphragm, the pain can radiate to the right shoulder, and a tumor growing to the right back can cause pain in the right waist. If the tumor grows slowly, it can be completely painless or only have mild dull pain. When the cancer nodules on the surface of the liver rupture, and the necrotic cancer tissue and blood flow into the abdominal cavity, it can suddenly cause severe pain, rapidly spreading from the liver area to the entire abdomen, producing symptoms of acute abdomen. If the amount of bleeding is large, it can cause fainting and shock. When there is metastasis of cancer to the peritoneum, it can also cause peritoneal irritation signs, but the pain is relatively mild.

　　(2) Gastrointestinal symptoms

　　Manifested as anorexia, poor digestion, nausea, vomiting, diarrhea, abdominal distension, or constipation. Anorexia and abdominal distension are common and lack specificity. For chronic liver disease patients, if the gastrointestinal symptoms worsen progressively and are difficult to alleviate, one should highly suspect the possibility of liver cancer and further examination is needed.

　　(3) General symptoms

　　Manifested as fatigue, weight loss, and general exhaustion. Advanced patients may present with cachexia.

　　(4) Fever

　　It is generally low fever, occasionally above 39℃, and fever is related to the absorption of necrotic products of the tumor. Compression or invasion of the bile duct by the tumor can lead to biliary tract infection and fever.

　　(5) Symptoms of metastatic sites

　　Symptoms correspond to the site of tumor metastasis, and sometimes they may be the initial symptoms of liver tumor discovery, such as cough and hemoptysis when metastasizing to the lung, and chest pain and bloody pleural effusion when metastasizing to the pleura. Embolism of the pulmonary artery or its branches by cancer thrombus can cause pulmonary infarction, manifested as sudden onset of severe respiratory distress and chest pain.

　　(6) Special clinical manifestations of primary liver cancer

　　Syndromes associated with cancer are endocrine or metabolic symptoms caused by metabolic abnormalities of the tumor itself or various effects of the tumor tissue on the body, which may appear before the symptoms of liver cancer itself.

　　To prevent elderly primary liver cancer, it is necessary to actively prevent and treat viral hepatitis and liver cirrhosis, pay attention to food and drinking water hygiene, keep grain well-preserved, prevent mold, protect water sources, and prevent pollution are the measures that should be taken at present.

　　Vaccination with hepatitis B or C vaccine can prevent hepatitis and also play a certain role in the prevention of primary liver cancer. Early detection, early diagnosis, and early treatment of liver cancer are known as 'secondary prevention' in oncology. Since the 1970s, when alpha-fetoprotein was used for liver cancer screening in China, the diagnosis of elderly primary liver cancer has entered the subclinical level, and the proportion of early liver cancer detection has continuously increased, and the 5-year survival rate has also significantly improved. To prevent elderly primary liver cancer, early detection and early diagnosis are essential:

　　1. High-risk populations for elderly primary liver cancer

　　① HBsAg positive.

　　② History of hepatitis or liver cirrhosis.

　　③ Liver cancer family history.

　　Regular follow-up observations of high-risk populations for liver cancer can discover many early elderly patients with primary liver cancer.

　　2. Discovery methods of subclinical stage (or small liver cancer) liver cancer

　　① AFP (or B-ultrasound) general survey in the general elderly population.

　　② High-risk populations should be tracked regularly with AFP (or B-ultrasound) detection.

　　③ Elderly patients may have occasional discomfort and be found through examination.

　　④ Other examinations or surgeries (such as splenectomy) are occasionally found.

　　For elderly patients with primary liver cancer, tumor markers need to be checked. Tumor markers are certain substances produced and released by cancer cells, often existing in the tumor cells or body fluids of the host in the form of antigens, enzymes, hormones, and metabolites. They can be identified or diagnosed based on their biochemical or immunological properties.

　　1. Laboratory examination

　　1. Alpha-fetoprotein

　　Alpha-fetoprotein (AFP) is the main indicator and the most specific marker for diagnosing liver cancer.

　　2. r-Glutamyltransferase (r-GT)

　　r-GT is very high in the fetal stage and rapidly decreases after birth, hence also known as oncofetal enzyme. Whether in the precancerous stage or the stage of liver cancer formation, the r-GT value in liver cells is significantly increased. Therefore, the determination of r-GT in the blood can be one of the criteria for early diagnosis of liver cancer.

　　3. Abnormal thrombinogen (AP)

　　The liver synthesizes an inactive precursor of thrombinogen, which is carboxylated to an active form by vitamin K r. In liver cancer, the vitamin K-dependent carboxylase in the microsomes of liver cancer cells is dysfunctional, leading to a decrease in carboxylase activity, resulting in incomplete carboxylation of glutamic acid and the formation of abnormal thrombinogen.

　　4. Serum fucosidase (AFu)

　　AFu belongs to the lysosomal acidic hydrolytic enzyme class, and its main physiological function is to participate in the decomposition and metabolism of biologically active macromolecules containing fucose, such as glycoproteins, glycolipids, etc.

　　5. Alpha-1-antitrypsin (AAT)

　　Liver cancer cells have the function of synthesizing and secreting AAT, which increases when tumors are accompanied by cell necrosis and inflammation.

　　6. Alkaline phosphatase isozyme I (ALP-I)

　　ALP-I is a tumor embryonic protein produced by liver cancer cells, almost only seen in hepatocellular carcinoma, with strong specificity but a low positive rate.

　　7. Serum ferritin and acidic isozyme ferritin (HIF)

　　The liver contains abundant ferritin and is also the main place for clearing ferritin in the blood circulation.

　　8. Aldehyde dehydrogenase isozyme A (ALD-A)

　　Aldehyde dehydrogenase isozymes have 3 forms: A, B, and C.

　　9. M2-type pyruvate kinase (M2-PyK)

　　Pyruvate kinase (PyK) is a key enzyme in glycolysis, with 4 isozymes: L, R, M1, and M2. The M2 type is mainly found in fetal liver and liver cancer tissues.

　　In summary, the above-mentioned liver cancer markers are of great significance for the diagnosis of primary liver cancer. According to practical experience, combined detection is better than single detection. The detection of serum AFP combined with 1 to 2 liver cancer markers can significantly improve the positive detection rate of primary liver cancer. In clinical analysis, it is necessary to combine medical history, imaging diagnostic data, or histological data for comprehensive judgment to reach an accurate conclusion.

　　II. Other auxiliary examinations

　　1. Ultrasound imaging

　　2. Computed tomography (CT)

　　3. Magnetic resonance imaging (MRI)

　　4. X-ray liver angiography

　　5. Radionuclide imaging

　　6. Liver biopsy

　　Primary liver cancer in the elderly refers to cancer that originates from liver cells or bile duct cells within the liver. Clinically, hepatocellular carcinoma is the most common. Liver cancer is one of the most common malignant tumors in the world, but primary liver cancer in the elderly is relatively rare. Here are several herbal diets suitable for elderly patients with primary liver cancer:

　　1. Goji Turtle Soup

　　Goji berries 30 grams, turtle meat 150 grams. Steam the goji berries and turtle meat together until they are tender and well-cooked. Both the goji berries and turtle meat soup can be consumed. Take once a week, not too much, especially not suitable for those with poor digestion or insomnia. Avoid drinking white wine, chili peppers, pork, leeks, fatty meat, fried foods, hard foods, and spicy seasonings. It has the effects of nourishing yin, clearing heat, dispersing phlegm, cooling blood, and enhancing the body's immune function.

　　2. Poria steamed mandarin fish

　　15 grams of poria, 150 grams of mandarin fish. Steam the water and seasonings together until they are tender and ready. Eat the fish and drink the soup, which has the effects of invigorating the spleen and promoting diuresis, invigorating Qi and nourishing blood.

　　3. Green rind tomato tofu soup

　　30 grams of watermelon rind, 50 grams of tomato, 150 grams of tofu. Cut the watermelon rind, tomato, and tofu into thin strips and make a soup for eating. Regular consumption has the effects of invigorating the spleen and promoting digestion, clearing heat and detoxifying, promoting diuresis and promoting diuresis, etc. It is not suitable for those with deficiency-cold physique and weakness to take it in large quantities.

　　4. Dandelion crucian carp soup

　　30 grams of dandelion, 1 crucian carp. Boil the dandelion and crucian carp together in a soup, add appropriate seasonings and it is ready. Regular consumption has the effects of removing blood stasis, stopping vomiting, and improving symptoms. However, those with deficiency-cold spleen and stomach, or without blood stasis, should avoid taking this medicine.

　　5. Lotus seed stewed with meat

　　30 grams of lotus seed, 100 grams of lean pork. Combine the two and simmer in a pot with an appropriate amount of water, remove the medicinal residue after boiling, and eat the meat and drink the soup. Regular consumption has the effects of reducing fire, removing phlegm, and promoting defecation; this recipe can be used for those with ascites.

　　6. Mint brown sugar drink

　　15 grams of mint, 60 grams of brown sugar. Boil the decoction and add sugar for seasoning. It can be taken as tea, this medicine diet clears heat, promotes diuresis and jaundice; it can be chosen for those with jaundice and ascites.

　　7. Green fruit fried egg

　　20 grams of green fruit, 1 egg. Boil the green fruit first, then add the boiled egg, and cook together. It can be eaten after mixing. Take 1 egg per week, 3 times a week, which can break blood stasis and is suitable for patients with liver pain and significant ascites.

　　8. Kiwi root stewed with meat

　　100 grams of fresh kiwi root, 200 grams of lean pork. Boil the above two ingredients in a nitric pot with water, remove the medicinal residue after boiling, and it is ready. Regular consumption has the effects of clearing heat and detoxifying, promoting diuresis and activating blood circulation.

　　Early treatment is the most important factor in improving the prognosis of elderly primary liver cancer. Early elderly primary liver cancer should be treated by surgical resection as much as possible. For large liver cancers that cannot be resected, multimodal comprehensive treatment can be adopted.

　　1. Surgical treatment

　　(1) Surgical resection

　　The treatment of elderly primary liver cancer still focuses on surgical resection as the first choice. Early resection is the key to improving survival rates, with the smaller the tumor, the higher the 5-year survival rate. Surgical resection is mainly used for small liver cancers diagnosed early.

　　(2) Palliative surgical treatment

　　Palliative surgical treatment includes methods such as hepatic artery catheter chemotherapy, hepatic artery ligation and intraoperative embolization, liquid nitrogen freezing, and high-power laser vaporization. The combined treatment of these methods is mainly applicable to large liver cancers that cannot be resected in one operation.

　　(3) Application of liver transplantation in the treatment of liver cancer

　　In 1955, the medical literature first reported the method of liver transplantation. Liver transplantation has provided a new means of clinical treatment for severe liver diseases. The fundamental factors affecting the success of clinical application of liver transplantation are the rejection reactions occurring after transplantation and the complexity of the surgical procedures.

　　2. Non-surgical treatment

　　(1) Hepatic artery chemotherapy and embolization (TACE)

　　Hepatic artery chemotherapy and embolization is the organic combination of embolization therapy and local therapy, and is now widely recognized as the first-line non-surgical treatment for liver cancer, having completely replaced the simple ligation of the hepatic artery.

　　(2) Alcohol Injection into the Tumor

　　Intratumoral drug injection utilizes the toxic effects of drugs to directly act on tumor cells, causing tumor cell变性 and necrosis, and can also be used for tumors.

　　(3) Guided Therapy

　　(4) Chemotherapy

　　In the past, the evaluation of chemotherapy for elderly primary liver cancer was not high, but with the application of new chemotherapy drugs, hope has been brought to the treatment of liver cancer. Combination chemotherapy is better than single-drug chemotherapy, and hepatic artery catheter chemotherapy is better than systemic chemotherapy.

　　(5) Biological Therapy

　　Biological therapy not only plays a role in配合 surgery, chemotherapy, and radiotherapy to reduce immunosuppression and eliminate residual tumor cells, but also has other effects.

　　(6) Gene Therapy

　　A large number of studies in tumor molecular biology have determined that the occurrence of tumors is mainly due to uncontrolled expression of oncogenes or inactivation of tumor suppressor genes.

　　(8) Multimodal Comprehensive Treatment

　　In recent years, comprehensive treatment has been widely used in the treatment of intermediate large liver cancer, which sometimes can transform inoperable large liver cancer into operable small liver cancer.

　　3. Optimal Treatment Plan

　　(1) Early Liver Cancer

　　① Patients who can undergo surgery should choose surgical resection.

　　② Patients who cannot be surgically removed but have good liver function can choose hepatic artery chemotherapy and embolization. The method is cisplatin 80-100 mg, fluorouracil (5-fluorouracil) 1000 mg, mitomycin 10 mg, first perfused intravenously, then mixed with mitomycin 10 mg in 131Ⅰ or 125ⅠLipiodol emulsified by ultrasound for distal hepatic artery embolization.

　　③ Patients who are not suitable for surgery due to poor liver function can choose alcohol injection into the tumor. The amount of injection is determined by the size of the tumor, generally 2-6 ml each time, up to 10-20 ml each time, 1-2 times a week, 4-6 times for a course.

　　(2) Intermediate Liver Cancer

　　The preferred treatment plan is based on hepatic artery ligation + hepatic artery catheter chemotherapy + radiotherapy + biological therapy. After the tumor is reduced, efforts should be made to perform two-step or sequential surgical resection. Biological therapy primarily uses interferon, 4 million U/m2, 3-5 times a week. Interleukin-2, 100,000 U, once a day, 30 days as a course, alone has poor effects, often combined with chemotherapy drugs.

　　(3) Advanced Liver Cancer

　　The primary treatment is a comprehensive treatment with Chinese and Western medicine, mainly focusing on traditional Chinese medicine and herbs.