Liver cancer symptoms: late and often unspecific
In the early stages of liver cancer, symptoms are rare – the disease can be asymptomatic for a long time. Those affected then notice nothing of the developing tumor in the liver. The first symptoms of liver cancer only appear once the tumor has progressed further. What’s more, these are usually non-specific (e.g. weakness, tiredness, loss of appetite) and can therefore have many other causes. This is why liver cancer is usually only discovered when it is difficult or impossible to treat.
First symptoms of liver cancer
The first symptoms of liver cancer include a feeling of weakness and tiredness: patients are noticeably exhausted quickly in everyday life, are constantly tired despite getting enough sleep and have reduced performance.
Loss of appetite and digestive complaints such as bloating, flatulence, constipation or diarrhea are also typical first symptoms of liver cancer. Some patients also develop an elevated temperature of unknown cause and report a general feeling of illness.
Another common symptom of liver cancer is unintentional weight loss: patients lose weight without this being explained by a change in lifestyle (e.g. more exercise, diet).
Late symptoms of liver cancer
In the advanced stage of the disease, liver cancer symptoms can occur that are due to the loss of function of the organ. This is because the further the malignant tumor spreads, the more healthy liver tissue it displaces – the functional capacity of the liver dwindles. In view of the organ’s many important functions, this has serious consequences:
As the disease progresses, the tumor impairs the functions of the liver more and more. The reduced excretion of bilirubin (the breakdown product of the red blood pigment haemoglobin) can lead to jaundice (icterus). If the tumor has already enlarged to such an extent that it is pressing against the liver capsule, the patient often feels pain in the right upper abdomen. Reduced protein production by the liver can also lead to water retention in the legs and abdomen and impair blood clotting.
Jaundice (icterus)
In liver cancer, the liver cells are often no longer able to sufficiently metabolize the breakdown product of the red blood pigment – the yellow-brownish bilirubin – and excrete it via the bile. It is then deposited first in the white part of the eye (sclera) and later also in the skin and mucous membranes, discoloring them yellowish. Doctors refer to this as jaundice. This is often accompanied by itching – presumably because bilirubin is deposited near sensitive skin nerves and irritates them as a result.
Water retention
The liver normally produces many important proteins. In the advanced stages of liver cancer, however, the organ can no longer produce certain proteins in sufficient quantities. This has several consequences – including the accumulation of water in the tissue (edema):
The reason for this is that the diseased liver can no longer produce enough albumin. This protein is responsible for binding fluid in the vascular system and maintaining blood pressure. This prevents fluid from accumulating in the tissue. However, the albumin deficiency in liver cancer causes water to leak from the vascular system into the surrounding tissue. Water accumulates in the legs (leg oedema) and in the abdomen (ascites).
However, such water retention can also occur in other diseases, such as heart failure.
Impaired blood clotting
Blood clotting also suffers from the cancer-related decline in protein production in the liver:
Blood coagulation is a complex system that only works if sufficient coagulation factors are present in the blood. These are certain proteins that are produced in the liver. Late symptoms of liver cancer can therefore be bleeding – the lack of coagulation factors means that the blood can no longer clot sufficiently (e.g. in the case of injuries). This is particularly fatal in combination with increased blood pressure in the portal vein (see below), as life-threatening bleeding can then occur in the oesophagus or stomach.
Increased blood pressure in the portal vein
Depending on its location, liver cancer can also affect the function of the so-called portal vein (vena portae). This is a large vein in the abdomen that transports oxygen-poor and nutrient-rich blood from the digestive organs (stomach, intestines) and the spleen to the liver.
Varicose veins of the oesophagus & Co.
Normally, the blood from the portal vein to the liver then flows via the inferior vena cava to the heart. However, due to the backlog in front of the liver in portal hypertension, the blood seeks alternative routes bypassing the liver: so-called portocaval anastomoses form – vascular connections between veins from the portal vein catchment area and veins that lead to the inferior or superior vena cava, both of which flow into the right atrium of the heart. In advanced liver cancer, these bypasses expand and are filled to bursting with blood. Possible consequences are, for example
- Varicose veins in the abdominal wall: The blood detour can cause the veins in the abdominal wall to enlarge and bulge – they become visible as tortuous, bluish shimmering varicose veins on the abdominal wall – doctors refer to this as “Caput medusae” (head of Medusa) in reference to the snakes on the head of the Greek mythological figure Medusa.
- Varicose veins of the oesophagus and stomach: The increased venous pressure in the liver can also cause varicose veins of the oesophagus (oesophageal varices) and stomach to form. Some sufferers report a feeling of pressure or fullness as a result. However, these varices do not necessarily cause symptoms.
Even if they do not initially cause any symptoms, varicose veins in the stomach and oesophagus are problematic. The veins here are very superficial and can easily be injured, rupture or burst and cause severe bleeding. Such bleeding can occur very suddenly and can be caused by swallowing or coughing.
In the case of bleeding from the esophagus or stomach, patients often vomit coffee grounds-like, brown-black blood. This is caused by the blood from the oesophagus or stomach reacting with stomach acid – it turns dark and grainy.
This bleeding is very dangerous because a lot of blood is lost in a short time – there is a risk of circulatory failure. The bleeding can usually be stopped during an esophagoscopy or gastroscopy. Preventive sclerotherapy of the varices is also possible.
Further effects
Toxins can also accumulate in other parts of the body, which the diseased liver can no longer break down. This leads to kidney failure.
Recognizing liver cancer symptoms
Recognizing liver cancer at an early stage is difficult – if symptoms appear at all at such an early stage, they are non-specific and can also have many other causes. However, you should always consult a doctor if you have a persistent feeling of weakness, unintentional weight loss and persistent digestive complaints such as bloating. These do not necessarily have to be symptoms of liver cancer, but early clarification is always advisable.
Liver cancer symptoms that occur later in the course of liver cancer are mainly the result of impaired liver function. They therefore also occur in connection with other liver diseases, such as cirrhosis or a chronic hepatitis infection. In order to be able to make a definitive diagnosis of liver cancer, a detailed diagnosis must therefore always be carried out, including imaging procedures such as ultrasound or computer tomography. This enables the doctor to clarify whether the symptoms are actually liver cancer symptoms.
