Carcinoma of the Liver.
Definition:—A development of malignant tissue in the structure of the liver, characterized by cachexia, emaciation and usually pain.
Etiology:—This is a disease of middle or advanced life.
It seldom occurs as a primary disorder, but follows as a secondary infection the development of cancer elsewhere within the body. It occurs more frequently in females, following cancer of the breast, or of the uterus or ovaries. The primary form is more common in men as the result of alcoholism or dissipation, chronic malaria or septic infection. The secondary form may result directly from cancer of the gall bladder, or from the transferrence of this infection from the pyloris, duodenum or from other portion of the gastro-intestinal tract.
Cancer develops in the liver as multiple growths which vary considerably in size, appear later as protuberances on the surface of the body of the organ, and have a nodular feel through the walls of the abdomen. In other cases the cancer may develop as a single round tumor, hard and resistant, involving the structure of the liver, which may increase in size until it becomes very large, weighing from fifteen to twenty pounds. In other cases there is an infiltration of cancer cells of rather slow development, throughout the structure of the liver, resulting in a thickening of the capsule and various adhesions, with uniform hypertrophy of the organ.
Symptomatology:—When the condition is primary, the first evidence which is at all pronounced is the cachexia, although there may be a sensation of uneasiness with fulness and some pain in the region of the liver. This soon occurs in the natural progress of the disease anyhow and becomes conspicuous. The nodular feeling or a smooth, hard enlargement are discoverable early and should arouse suspicions as to the real character of the disease. There may be no pronounced emaciation at first, and but little loss of strength, unless the severe pain appears early. The pain is an almost constant symptom. It is steady boring, or burning in character and is located in the entire right side, and under the shoulder blade or in the scapula. There are paroxysms of shooting or darting pain, which may be very severe, and may cause vertigo, nausea, and perhaps the vomiting of blood, with prostration.
Jaundice is usually present but is not often intense. There may be a simple conjunctival discoloration with a dusky sallowness of the skin; intense jaundice is present in not more than five per cent of the cases. The growth usually develops at a point of the liver, remote from the gall bladder and the ducts, and does not interfere with the escape of the bile until late in the course of the disease. Dropsy from compression of the portal vessels is a common accompaniment of cancer of the liver. The ascitic distention of the abdomen may increase slowly over quite a period of time until it becomes extreme.
In the early stages of this development there is no fever. As the disease progresses, and the vital forces are impaired, the temperature is apt to be subnormal and the pulse round, full and slow, but later when septic infection becomes general the temperature may rise as high as 104.5° or 105° F. for short periods, and finally the pulse becomes rapid, feeble and thready. The extreme abdominal enlargement, either from the growth or from ascites, presents a characteristic contrast to the emaciation of the body and especially to that of the extremities. These, with the cachexia, and the constant expression of pain on the countenance, give these patients a most pitiable appearance.
Diagnosis:—The diagnosis depends upon the conditions named. The cachexia is a confirmation of the character of the hardened tumor, which is progressing in size. The persistent local pain is also characteristic.
Prognosis:—The prognosis is always unfavorable.
Treatment:—Treatment should be directed to the specific indications with utter disregard to the fact that cancer is incurable. The patient may be kept in a reasonable condition of comfort, and life may be greatly prolonged by a persistent, careful attention to all conditions. Early in the case the carbonate of iron and hydrastis canadensis should be given. This may be combined with conium maculatum when the pain is not too severe. Hydrastis and conium act well together. I have obtained excellent results if hematemesis is present, indicating hemorrhage, from the addition of corn ergot. It controls pain in cancer and prevents engorgement, as well as retarding the hemorrhage. The tincture of belladonna may be given in drop doses every two hours for several days at a time. This antagonizes the engorgement of the capillary circulation and is to a marked degree soothing to the pain. With these from twenty to thirty drops of specific echinacea should be given every three hours for weeks at a time, with but little intermission. This antagonizes the toxic influence of the disorder, preserves to a marked degree the integrity of the blood, and prevents pus formation. It is often necessary to introduce antisyphilitic treatment also and echinacea, associated with other of our reliable alteratives, will antag onize this condition. The stomach and digestive apparatus must have careful attention, and digestion and assimilation must be sustained. I advise plain concentrated foods and I administer an artificial digestive after each meal, with a mild stimulant, as the one-fourth of a grain of capsicum, to promote the absorption of the food. Milk, buttermilk, whey, kumyss, and fresh meat with eggs, will be the diet upon which dependence can be placed. With this, selection should also be made from fruits and vegetables in season, as the stomach seems able to appropriate them.
Great pains should be taken in the early stage of carcinoma to control the pain without the use of opium or morphin, as the habit becomes quickly fixed upon a patient, and if life is prolonged this habit will make life a burden. In the final stages of the disease it may be a mercy to resort to these remedies, and if they have been used freely at the start, their influence will not be as satisfactory later on.
Sarcoma of the Liver will not have separate consideration. The conditions resemble those of carcinoma, except that it is apt to develop earlier in life, and the prognosis in all cases is bad.
In the treatment I would advise a symptomatic plan, as well as an observance of the conditions laid down for carcinoma. The adaptation of the measures to the conditions must be made in accordance with the very best judgment of the prescriber.