We all know that liver cancer is a very serious disease that progresses rapidly. However, most people are not quite clear about how exactly it is severe. Here, I will introduce some relatively common and serious symptoms experienced by liver cancer patients.

1. Bleeding

Bleeding is one of the most dangerous symptoms in patients with liver cancer, usually manifesting as gastrointestinal bleeding with symptoms such as hematemesis and bloody stools.

The mechanism of gastrointestinal bleeding in liver cancer patients is similar to that in cirrhosis, typically caused by gastric hemorrhage due to esophageal or gastric varices. Increased vascular pressure and fragility can lead to vascular damage when consuming hard or indigestible foods. If the gastric bleeding is minimal, black stools may be observed; if bleeding is more significant, hematemesis may occur; and massive bleeding can be life-threatening.

As liver cancer progresses, the risk of bleeding increases. Therefore, family members should monitor the patient’s stool condition. Black stools indicate gastrointestinal bleeding, and timely communication with the attending physician is essential. If hematemesis occurs, it suggests substantial bleeding, and immediate hospitalization for emergency treatment is necessary.

Certain traditional Chinese medicines and proprietary Chinese herbal formulations, such as Yunnan Baiyao, Sanqi powder, and Shihui San, can help alleviate mild bleeding and are suitable for cases with minimal blood loss. In cases of significant bleeding, hemostatic agents may be administered first to control the bleeding, followed by immediate emergency medical care.

2. Fever

Fever is one of the common symptoms in liver cancer patients, mostly ranging from 37.5°C to 38°C, with some individuals experiencing temperatures above 39°C.

The causes of fever in liver cancer patients include infectious fever and cancerous fever, with cancerous fever being the primary cause. The reason for cancerous fever is generally attributed to rapid tumor progression, leading to insufficient blood supply and necrosis in the central area of the tumor. Another perspective suggests that the tumor itself acts as an endogenous pyrogen, and its presence triggers a non-specific inflammatory response, resulting in fever.

Fever in liver cancer patients can occur repeatedly and persistently. Infectious fever can be alleviated through anti-infection treatment; cancerous fever is often difficult to eliminate, as antipyretic drugs only provide temporary relief, and fever returns after the medication wears off. Therefore, the treatment of cancerous fever in liver cancer patients should focus on addressing the tumor itself. If the tumor is controlled, the fever will improve; if the tumor remains uncontrolled, the fever will not fundamentally resolve.

Traditional Chinese medicine attributes fever in liver cancer patients to fever due to internal injury, with patterns including qi stagnation fever, blood stasis fever, qi deficiency fever, blood deficiency fever, and yin deficiency fever, among which yin deficiency fever is most common. Commonly used traditional Chinese medicine formulas include Qinggu San and Qinghao Biejia Tang, which can alleviate fever symptoms over a prolonged period.

3. Ascites

Ascites is also a common symptom in liver cancer patients, and many patients are diagnosed with liver cancer only after undergoing tests due to the discovery of ascites.

Ascites is classified into three types: transudative, exudative, and hemorrhagic. Transudative ascites occurs due to factors such as portal hypertension and increased visceral vascular pressure, which reduce the reabsorption of tissue fluid and allow fluid to leak into the abdominal cavity. Exudative ascites results from portal hypertension combined with decreased albumin levels, leading to altered osmotic pressure and fluid seeping into the abdominal cavity. Hemorrhagic ascites is caused by increased vascular permeability or coagulation dysfunction, allowing blood to seep or leak into the abdominal cavity.

These three types of ascites can all be seen in liver cancer, therefore the ascites associated with liver cancer is typically quite severe and difficult to completely resolve. For patients with a relatively small amount of ascites, drainage or paracentesis is generally not recommended; methods such as diuresis, protein supplementation, and restricting water and sodium intake should be prioritized. When the ascitic volume is excessive, or when it affects breathing or causes intolerable abdominal distension, ascitic drainage therapy should be performed, but the amount of fluid withdrawn each time should not be excessive.

Traditional Chinese Medicine (TCM) refers to ascites as "drum distension" (鼓胀, Gǔ zhàng). Treatment often focuses on promoting qi circulation, resolving blood stasis, and fortifying the spleen to promote diuresis, while simultaneously emphasizing nourishing the liver, kidney, and spleen. Commonly used formulas include Wuling Powder, Shipi Yin, and Weiling Decoction. Drum distension is one of the "four major intractable diseases" in TCM. The condition is critical, often protracted and difficult to cure, but long-term relief can be achieved with appropriate medication. In the early stages, if healthy qi is still present, the patient may live for many years while managing the illness. However, if the disease progresses to a late stage, with the abdomen distended like a jar, protrusion of the umbilicus, and emaciation of the limbs, the prognosis is poor. The appearance of symptoms like vomiting blood, bloody stools, loss of consciousness, or convulsions indicates a critical sign.

4. Jaundice

Jaundice is a common complication of liver cancer. Some patients are diagnosed with liver cancer after jaundice is discovered.

Jaundice is generally classified into three types: hemolytic, hepatocellular, and cholestatic, with cholestatic jaundice caused by tumor obstruction being the most common. Since most liver cancer patients in China develop from chronic viral hepatitis, hepatocellular jaundice may also be observed.

For cholestatic jaundice caused by tumor obstruction, bile can be drained during the acute phase, combined with bilirubin-lowering medications such as adenosylmethionine and ursodeoxycholic acid. After bile drainage, treatment targeting the tumor is necessary. If the tumor obstruction issue is not resolved, jaundice may recur.

Traditional Chinese medicine attributes the cause of jaundice to damp-turbidity obstruction, which can transform into cold or heat patterns. Treatment primarily focuses on eliminating dampness and promoting urination, employing methods such as clearing heat and draining dampness or warming the middle and resolving dampness, depending on the pattern. Commonly used formulas include Yinchenhao Decoction, Yinchensiling Decoction, and Yinchenzhufu Decoction. Traditional Chinese medicine can help alleviate jaundice, but if the tumor obstruction cannot be removed, it cannot fundamentally resolve the issue of jaundice.

5. Hepatic encephalopathy

Hepatic encephalopathy is one of the main causes of death in patients with liver disease, often presenting with neurological or psychiatric abnormalities.

The occurrence of hepatic encephalopathy is due to the decreased detoxification capacity of the liver, which prevents the clearance of many toxic products from the intestines, allowing them to cross the blood-brain barrier and enter the brain. The ammonia toxicity theory is currently widely discussed, suggesting that when liver function fails, the liver's ability to synthesize urea from ammonia decreases. As a result, ammonia from the intestines enters the systemic circulation without detoxification, leading to elevated blood ammonia levels and causing ammonia toxicity.

After the onset of hepatic encephalopathy, neurological or psychiatric changes may occur, such as cognitive impairment, depression, euphoria, disorientation, behavioral disturbances, slurred speech, and personality changes. In severe cases, symptoms like drowsiness, confusion, or even coma may develop, which can be life-threatening if not treated promptly. Treatment primarily involves medication, such as lactulose to acidify the intestines and reduce ammonia absorption; rifaximin to inhibit excessive bacterial overgrowth in the intestines and reduce ammonia production; and branched-chain amino acids to correct imbalances in amino acid metabolism. Severe cases may require artificial liver support.

Based on its symptoms, hepatic encephalopathy can be classified in traditional Chinese medicine as conditions like "shenhun" (unconsciousness) or "dianzheng" (psychosis). Clinical emergency treatment focuses on clearing the mind and restoring consciousness, commonly using formulas such as Angong Niuhuang Wan, Zhibao Dan, and Zixue Dan. Hepatic encephalopathy is one of the severe complications of liver cancer, and any related symptoms should prompt immediate medical attention.

6. Tumor rupture and hemorrhage

Tumor rupture and hemorrhage is one of the most dangerous complications of liver cancer, characterized by acute onset, severe progression, and a high mortality rate.

The main causes of hepatocellular carcinoma rupture and bleeding include: tumor invasion causing obstruction of venous return and increased venous pressure, leading to vascular rupture; excessively rapid tumor growth causing the tumor capsule to be unable to stretch, resulting in surface ulceration; overly rapid tumor growth causing insufficient central blood supply, followed by necrosis, secondary infection, and subsequent tumor rupture; direct tumor invasion of intrahepatic vessels leading to vascular rupture; excessively large tumors or superficially located tumors rupturing due to external impact, among others.

Depending on the size of the rupture, the speed and volume of bleeding vary. With small amounts of bleeding, the condition may resolve on its own; with large amounts of bleeding, the patient's condition can rapidly deteriorate, leading to shock or even death. Emergency measures for liver cancer rupture and bleeding include liver cancer resection, hepatic artery ligation, liver suturing, and tamponade to stop bleeding. For smaller bleeding, abdominal band compression dressing can be applied to alleviate the bleeding.

Hepatic cancer rupture bleeding can be categorized within the scope of conditions like drum distension and blood syndrome in Traditional Chinese Medicine. For small amounts of bleeding, it can be managed through TCM hemostasis, commonly using medications such as Shi Hui San, Yunnan Baiyao, Sanqi powder, etc.; for larger amounts of bleeding, the emergency effects of TCM are poor, and hemostatic drugs can be administered first, followed by emergency transportation to the hospital for urgent care.

These are some of the common critical, acute symptoms and complications in liver cancer patients. When caring for liver cancer patients, it is essential to closely monitor any changes in their symptoms and seek medical attention promptly if any abnormalities occur.