Liver tumors are classified as benign or malignant. Benign tumors are relatively rare, while malignant tumors—commonly known as liver cancer—are more common. Liver cancer is further divided into primary liver cancer and secondary liver cancer.
Primary liver cancer refers to cancer that originates in liver cells (arising from the liver itself) or the intrahepatic bile duct system; secondary liver cancer refers to cancer that has metastasized to the liver from other organs or tissues in the body. This type of liver cancer is called secondary liver cancer. Most cases of liver cancer are secondary liver cancers, in which cancer first develops in other organs or tissues, and the cancer cells metastasize to the liver via the bloodstream or lymphatic system, subsequently forming a new tumor. Because metastatic liver cancer often presents primarily with symptoms caused by the primary tumor outside the liver, by the time a tumor is detected in the liver, the disease is already at an advanced stage. Surgical resection is not an option, and chemotherapy and radiation therapy are extremely ineffective; consequently, once metastatic liver cancer is diagnosed, patients typically survive only a few months to half a year. Here, we will focus on the diagnosis and treatment of primary liver cancer.
The incidence of primary liver cancer is relatively low, accounting for only 1% to 2% of all cancers. However, in mainland China and Taiwan, the incidence is higher, particularly in the southeastern coastal regions, and it is most common in the 40–50 age group. It affects men more frequently than women.
Primary liver cancer often falls under the categories of “pi hen” (mass), “ji ju” (accumulation), “xie tong” (flank pain), “huang dan” (jaundice), and “gao zhang” (abdominal distension) in Traditional Chinese Medicine.
I. Etiology and Pathogenesis of Primary Liver Cancer
Traditional Chinese Medicine holds that primary liver cancer is often caused by emotional disturbances and dietary imbalances, which damage the liver and spleen, leading to qi stagnation and blood stasis, as well as the accumulation of damp-heat. Over time, these factors coalesce into a mass, resulting in liver cancer.
Anger injures the liver; when liver qi becomes stagnant, it disrupts the spleen and stomach, potentially causing symptoms of liver-stomach disharmony; If liver qi fails to flow smoothly, leading to qi stagnation and blood stasis, it may eventually result in an enlarged liver and pain in the flanks; if liver depression transforms into fire over time, causing the accumulation of damp-heat, and this damp-heat steams the liver and gallbladder, jaundice may occur; if liver disease damages the spleen and stomach, spleen deficiency impairs its transport and transformation functions, and kidney deficiency hinders qi transformation, causing water and dampness to accumulate in the abdomen, which may eventually lead to abdominal distension.
Excessive alcohol consumption, an unbalanced diet, or long-term consumption of moldy food can all damage the spleen and stomach, leading to the internal generation of dampness, turbidity, heat, and toxins that accumulate in the middle jiao, thereby increasing the risk of this disease.
Although modern medical research has not definitively identified the cause of primary liver cancer, it is currently believed to be closely associated with viral hepatitis, cirrhosis, aflatoxins, and certain chemical toxins. In addition, water pollution, pesticides, as well as immune and genetic factors, can all lead to liver cancer.
II. Clinical Symptoms
Early-stage liver cancer does not present with obvious symptoms. Common symptoms include pain in the hepatic region, loss of appetite, weight loss, fatigue, abdominal distension, hepatomegaly, jaundice, and ascites. By the time symptoms become pronounced, the disease is often in its advanced stages, and death typically results from hematemesis, melena, or hepatic coma.
Therefore, early diagnosis is crucial. The most valuable diagnostic method is alpha-fetoprotein (AFP) testing. In addition, ultrasound can determine the size and location of the tumor; isotope scanning has a diagnostic positivity rate of 85% to 90%; selective celiac artery or hepatic artery angiography can reveal space-occupying lesions as small as 1 centimeter in diameter; and CT scanning, a newer method, also has a high accuracy rate.
Traditional Chinese Medicine (TCM) classifies primary liver cancer into four patterns based on pattern differentiation and treatment: Liver Qi Stagnation, Liver Blood Stasis, Damp-Heat Stagnation, and Heat-Toxin Injuring Yin. Each pattern presents with distinct symptoms.
III. Treatment of Primary Liver Cancer
TCM Pattern Differentiation and Treatment: Most cases are in the middle or late stages, and surgical resection is not feasible. After surgery, patients may undergo treatment with Chinese herbal medicine.
(1) Liver Qi Stagnation Type: Patients present with costal pain, abdominal distension, a bitter taste in the mouth, loss of appetite, an enlarged liver, a thin white or thin yellow tongue coating, and a string-like pulse. The treatment principle is to soothe the liver and regulate qi, as well as resolve stasis and soften hard masses. Chaihu Shugan San with appropriate modifications may be used, supplemented with Banzhilian and Baihuasheshecao.
(2) Liver Blood Stasis Pattern: Patients present with relatively severe costal pain, abdominal distension and fullness, marked hepatomegaly, loss of appetite, and fatigue. The tongue is dark purple with signs of blood stasis or ecchymoses, and the pulse is string-like, fine, or deep and涩 (thready). The treatment principle is to invigorate blood circulation, resolve blood stasis, soften hard masses, and disperse nodules. Hua Yu Tang with appropriate modifications may be used.
(3) Damp-Heat with Blood Stasis and Masses Pattern: The patient exhibits icterus of the sclera or generalized skin, which deepens daily, accompanied by flank pain, abdominal distension, hepatomegaly, scanty and reddish urine, dry stools, a red or purple tongue with a yellow, greasy coating, and a string-like and rapid or slippery and rapid pulse. The treatment principle is to clear and drain damp-heat, resolve blood stasis, and disperse masses. Treatment may involve Yinchen Decoction combined with Blood Stasis-Resolving Decoction, with appropriate modifications.
(4) Heat-Toxin Injuring Yin Pattern: Patients present with costal pain, hepatomegaly, low-grade fever in the afternoon, dry mouth, and restlessness. The tongue is red and dry, with little or no coating, and the pulse is fine and rapid. The treatment principle is to clear heat, resolve toxins, nourish yin, and resolve stasis. Yiguan Decoction with appropriate modifications may be used.
Surgical Treatment: Early diagnosis and early treatment are essential, followed by surgical resection of the tumor. According to statistical data, the 5-year survival rate for symptomatic liver cancer patients after surgical resection rarely exceeds 20%; in contrast, the 5-year survival rate for asymptomatic liver cancer patients detected through screening and treated with surgical resection can reach 60%. The surgical approach is determined based on the patient’s general condition, the degree of cirrhosis, and the size and location of the tumor.
Chemotherapy
(1) Systemic chemotherapy: 5-fluorouracil alone. Combination chemotherapy involves the use of several anticancer drugs.
(2) Local chemotherapy: Anticancer drugs are injected into the area surrounding the tumor.
Radiation Therapy: Radiation therapy may be used for patients with localized tumors that have not yet metastasized to distant sites but who are not suitable for surgical resection. This is applicable to patients in good general health with relatively normal liver function and no ascites or jaundice.
Immunotherapy: Treatment using BCG, autologous or allogeneic vaccines, and transfer factors.
IV. Prevention of Liver Cancer
Avoid extreme anger, as anger harms the liver.
Preventing viral hepatitis is extremely important, as there is a clear causal relationship between viral hepatitis and liver cancer. Some experts have proposed a three-step progression of liver cancer: hepatitis → cirrhosis → liver cancer.
Avoid eating moldy foods; in particular, do not consume moldy peanut butter.
Wash fruits and vegetables that have been heavily sprayed with pesticides thoroughly before eating, or peel fruits before consumption.
Early detection and early surgery are key to improving the 5-year survival rate.