Jaundiee is present in about half the cases. It is usually slight at first, becom ing deeper tosvard the end. lt is usu ally due to pressure on the common bile duct in the transverse fissure by carci nomatous glands; it may be due to press ure on the branches in the liver by grow ing nodules, or if the primary growth is in the head of the pancreas it may press on the common bile-duct. It is important to remember that cancer of the liver is the most frequent cause of long-standing jaundice; it is permanent, and in the later stages may become extremely deep.
Case of cancer in which detached por tion caused symptoms of lithiasis; ob struction caused jaundice; glands of hilum gave rise to circulatory symptoms, while consecutive cirrhosis further com plicated the case. Gilbert, Claude (Ar chives Gen. de Med., May, '95).
Ascites occurs in some cases, and is caused by pressure on the portal vein or to extension of the cancer to the peri toneum. It is present in the cirrhotic form of cancer.
The superficial veins are enlarged. Some fever is not rare, continued or in termittent, especially when the disease runs a rapid course. It may occur in simple cancer, or may indicate suppura tion. Emmorrhages into the skin or from the mucous surfaces niay occur late in the disease.
Course and Duration.—Death usually results within a few months; it is rarely delayed beyond a year after the symp toms have declared themselves. Occa sionally the progress is delayed for some weeks at a time, during which some im provement may take place in the general condition. Death is usually due to progressive debility, with, in the last stage, some infection that closes the scene.
Diagnosis. — The occurrence of pro gressive loss of flesh and strength, of pain and tenderness in the hepatic region, and of rapid enlargement of the liver, with the formation of nodules, forms a fairly sure basis for diagnosis. Even with this symptom-group, difficulties may beset us.
Certain ease.,; of hepatic cancer closely resemble terminal stages of heart dis ease. But in latter slighter diminution of urea and albunfinuria present, whereas absent in cancer, — main differential points. Hanot, Fln (Jour. de Med. et de Chir. Prat., Aug. 19. '95).
Case in which cancer \vas only recog nized post-mortem, owing to absence of all usual symptoms. Dupont (Archives -ALCM. Belges, Sept., '95).
Enlargement of the spleen in cases of carcinoma of the liver is quite an un usual occurrence. There are, however, occasional exceptions to the rule, and carcinomatous tumors may bc found in the latter organ as well as in the liver. Enlargement of the left lobe of the liver, however, and the development of a, car cinomatous mass contiguous to, though not involving, the spleen may be mis taken for enlargement of the spleen, and thus assist in producing an erroneous conclusion respecting the condition of the la,tter organ. C. O. Hawthorne (Edinburgh Med. Jour., June, DOI).
Apparent enlargement of the liver may be due to hardened fames in the transverse colon, which. is tender, owing to the enteritis carised by the hard masses. Indurated puckered omentum and tumors of the stomach, kidney, and the abdominal wall may also simulate a large liver. The large cirrhotic liver may, in the early stage, be mistaken for cancer, as the liver is large and the jaun dice usually well inarked; but the liver is smooth and not tender and there is absence of the cachexia of cancer. The spleen is also large.
Syphilitic disease in which there is large amyloid liver with gummatous nodules may present some difficulties, as may also echinocoecic liver with large CVS1S. 111 1)0t11, 111e history is more longed and there is absence of cachexia and usually of jaundice. Ascites is strongly indicative of cancer. The early period of cancer with cirrhosis may be indistinguishable from atrophic sis; there is similar jaundice and ascites in both, but tater the cachexia is more marked in the cancerous form.
Melanosarcoma usually involves other organs as well. It may cause great en larsc_reinent of the liver. Secondary tumors may form in the skin. In many cases there is melanuria: a characteristic symptom. Great difficulty is often ex perienced in differentiating cancer of neighboring organs from cancer of the liver. especially if they are adherent to the liver.
The chief interest in tongue-like acces sory lobes of the liver is in connection with the diagnosis of abdominal tumors. Unless fully alive to the great variety, as to shape and position, in which the ac ee,sory lobes of the liver may present themselves, one will often be misled. MePhedran (Canadian Pract., June, '96).