Carcinoma of the Liver.

Under this head are included cancer, sarcoma, and adenoma in the malignant class; and fibroma, angioma, and cystoma in the benign class.

Carcinoma of the Liver.

Etiology.—Cancer of the liver, especially as a primary lesion, is very rare, and occurs between the ages of forty and sixty. Primary cancer occurs more frequently in the male than in the female, due, no doubt, to the greater frequency with which males are affected with cirrhosis, malaria, and alcoholism, factors that predispose to cancer. Secondary cancer, on the other hand, is found with greater frequency in women, being- secondary to cancer of the uterus, ovary, and breast.

Traumatism, infectious processes in general, parasites, and heredity are regarded as predisposing factors in cancer of the liver.

Primary carcinoma of the gall-bladder is frequently associated with chronic irritation and obstruction from gall-stones, and probably accounts for the greater frequency of this affection in women than in men, the female being more frequently troubled with gall-stones. The same causes predispose to cancer of the biliary passages.

Pathology.—Three forms are recognized in primary cancer:

(a) The massive cancer; (b) the nodular cancer; and (c) the infiltration cancer.

The massive cancer may cause enormous enlargement, and weigh as much as twenty-five pounds. Beginning in the liver as a round tumor, it rapidly develops into a hard mass, involving the parenchyma of the liver. The healthy tissue is not cirrhotic. The capsule is not adherent to the peritoneal covering, although sometimes thickened.

Nodular Cancer does not show the enlargement of the above-mentioned variety, there being widespread cirrhosis, with contraction and induration. This variety resembles secondary cancer of the liver. The nodules vary in size and number, are grayish or yellowish, and distributed throughout the liver.

Infiltration Cancer.—In this form, cancerous masses are infiltrated throughout the parenchyma of the liver. The capsule is often thickened, and adheres to the peritoneum and other organs. The liver is uniformly enlarged.

Histologically, primary cancer cells do not differ from carcinoma of other parts, being epithelial in character, their shape being changed by pressure, some being polyhedral, others hexagonal. Giant cells are also found in the cancerous mass.

Secondary Carcinoma of the Liver.—This form is generally readily distinguished from the primary form by the enormous enlargement of the liver, and the presence of nodules projecting above the surface; also the tendency to degeneration of the nodule, causing its central contents to recede, and making many of the nodules umbilicated. The nodules, both on the surface and when cut, present a grayish-white or yellowish aspect.

So much of the organ may be involved that every trace of the parenchyma of the liver may disappear. Degeneration of the cancerous tissue may result in cavities or cysts, into which hemorrhages occur, and also into the gall-bladder and peritoneum. The hepatic cells atrophy, as the result of pressure of the cancerous mass. Cirrhosis is not an uncommon accompaniment, and areas of fatty degeneration are also found.

Histologically, secondary cancer does not differ from the primary form, save in the tendency to the various degenerations already mentioned. Cancer of the gall-bladder and bile passages may be primary or secondary, the latter often following cancer of the stomach, intestine, and pancreas.

Symptoms.—The symptoms of cancer of the liver vary, depending upon the location and stage of development. In the early stage, and when located in the interior of the liver, they are negative. When secondary to cancer of the stomach, intestine, rectum, uterus, ovary, etc., the symptoms are more pronounced than when the growth is primary.

Carcinomatous cachexia may be the first evidence of the lesion, and in some cases remains the chief feature to the end. Enlargement of the liver is usually pronounced, and palpation reveals the hard, nodular character of the organ, especially if the growth be near the surface. With the greater involvement of the organ there will be disturbance of the portal circulation, and consequent gastro-intestinal disturbances, such as nausea, vomiting, and sometimes hematemesis.

Pain is a common symptom, at times of burning, boring character; at other times it is darting and lancinating; although usually located in the right hypochondrium, it may extend to the right shoulder and scapular region.

Jaundice is present in most cases at some stage of the disease. Where the portal circulation is seriously compressed, ascites develops, and, when very great, obscures the physical examination. The temperature is usually normal or subnormal during a greater part of the disease; but in the advanced development, the temperature rises, end in some cases reaches 105°. The fever at this time is irregular or intermittent.

Progressive emaciation is characteristic, and the skin becomes dry, wrinkled, and icteric. In some advanced cases, where there is marked toxemia, there may be severe headache and delirium, followed by coma.

Diagnosis.—Where the liver is greatly enlarged, and the surface is nodular, the diagnosis is comparatively easy; but in the smoother forms, and when deep seated, it may be mistaken for other hepatic lesions. If, however, there is the cancerous cachexia, emaciation, pain in right hypochondrium, extending to the right shoulder and scapular region, and ascites, the diagnosis is positive.

Prognosis.—It is always unfavorable, the disease being progressive, usually terminating in death within a year.

While we do not pretend to cure cancer, there are a few remedies that tend to retard the development, allay the worst features of gastric disturbance, and render the patient comfortable to some degree. Echinacea neutralizes to some extent the toxemia generated in carcinoma, and should be given during the course of the disease. Dr. Webster thinks that it also lessens the pain. The dose will be from five to twenty drops four times per day. Hydrastis has long been considered by the Homeopaths as influencing carcinoma. Eclectics can testify to its influence in disorders of the stomach; and where there are gastric complications it should prove a valuable agent. Chelidonium and chionanthus influence hepatic tissue, and may assist in eliminating the bile and overcoming to some extent jaundice.

The diet should be nourishing, easily digested, generally fluid in form, and taken in small quantities. Milk, koumiss, whey, broths, and gruels will give the best results, although fruits and the more succulent vegetables, sometimes, can be taken. Anodynes will have to be used where the suffering becomes intense.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.