It is well known that China is a high incidence of hepatitis B and primary liver cancer, and more than 50% of the world’s liver cancers occur in China. The prevention and treatment of hepatitis B and liver cancer has become urgent. At present, the national prevention of liver cancer is mainly a three-level prevention system. The prevention of liver cancer should focus on primary prevention and secondary prevention, i.e. etiological prevention and “three early” prevention (early detection, early diagnosis and early treatment).
The seven-word policy of “changing water, preventing mold and hepatitis” put forward by China in 1970s has been effective, and the incidence rate and mortality rate of liver cancer in some areas with high incidence of liver cancer have been significantly reduced by adopting primary prevention measures, but clinically, the overall incidence rate of liver cancer is still high. The incidence of liver cancer is still very high.
The main preventive measures are
1.To prevent hepatitis
Hepatitis B is the main disease in China, accounting for 10% of the population, while the proportion of hepatitis C is smaller. At present, hepatitis B can be prevented by hepatitis B vaccine, while no vaccine has been developed for hepatitis C so far. The use of hepatitis B vaccine to prevent hepatitis and thus liver cancer has become one of the most promising ways to prevent liver cancer. Not only should children be born with the hepatitis B vaccine, but adults who have not been vaccinated against hepatitis B and have not had hepatitis can also be vaccinated against hepatitis B. In addition to hepatitis B vaccination, both hepatitis B and hepatitis C are diseases transmitted by body fluids, so attention should also be paid to the control of other ways, such as diet, surgery, blood transfusion, injection, acupuncture, haircut and sexual life.
2.To prevent the consumption of moldy food
Can not eat moldy, mushy food, such food contains aflatoxin. Corn, peanuts, peanut oil, peanut butter, etc. are foods that are easily moldy, and these foods should be kept with care.
3, to pay attention to drinking water hygiene
To prevent drinking water contamination.
4.Avoid nitrosamine intake
Pickled food should be avoided as much as possible because it contains a large amount of nitrosamines, which can lead to various tumors, including liver cancer.
5.Appropriate vitamin and selenium supplementation
Vitamin C and vitamin E have the function of antioxidant and scavenging free radicals in human body, which can reduce oxidative stress damage in human cells and reduce genetic mutation. And selenium in human body has the function of cancer prevention.
6.Quit smoking and alcohol
Smoking and alcohol are harmful to the human body. The gastric mucosa in the stomach has a protective effect on the human body, alcohol can digest the gastric mucosa, the gastric mucosa is damaged, the toxic substances in food are easily absorbed by the stomach, causing alcoholic hepatitis, reducing the immune function of the liver and the immune function of the whole body, damaging the detoxification function of the liver. It can cause alcoholic cirrhosis, and part of the cirrhosis will be transformed into liver cancer.
Secondary prevention: that is, “three early prevention”. The main purpose of secondary prevention is to find small liver cancers in “healthy people”, focusing on “early detection, early diagnosis and early treatment”. There is a contradiction of “cost and benefit” in screening liver cancer in the natural population, so how to choose the scope and target of screening becomes the key to secondary prevention.
Experts have proposed the concept of “high-risk groups” for liver cancer and divided them into three categories.
1. Men aged 30-59 years old in areas with high incidence of liver cancer are the high-risk group.
2. In the first category, those who have one of the following five conditions are classified as the second high-risk group, which are: (1) HBsAg positive; (2) anti-HBe positive; (3) history of hepatitis; (4) cirrhosis; (5) family history of liver cancer.
3. Those with positive AFP detected in the second high-risk group but no liver occupancy detected by ultrasound, or those with negative AFP but substantial liver occupancy detected by ultrasound and temporarily unable to confirm the diagnosis are classified as the third high-risk group. In addition, patients with postoperative hepatocellular carcinoma should also be classified as the three high-risk groups. All three groups should be reviewed once every 2-3 months to facilitate early detection of liver cancer. Ultrasound, AFP, and enhanced CT or MRI or ultrasonography must be chosen for the three high-risk groups.
Tertiary prevention: The main purpose is to provide “aggressive, comprehensive and specific” treatment for liver cancer. At present, the treatment of liver cancer is individualized through comprehensive liver preservation, minimally invasive surgery, interventional surgery (vascular embolization + CT-guided local ablation), local radiotherapy (Y-knife, linear gas pedal, 3D conformal radiotherapy) and other treatment methods in specialized hospitals. Since different patients have different conditions and tumors, we cannot apply a one-size-fits-all approach as we did in the past, and have to analyze specific problems. For example, for patients with severe cirrhosis and small hepatocellular carcinoma with deep tumor location, surgical resection is not the best choice, but local treatment (local radiofrequency ablation, anhydrous alcohol injection) while strongly protecting liver and preventing cirrhosis complications such as ascites and hepatic coma can ensure treatment effect and reduce treatment risk, which is safer than surgery and microwave ablation. For large tumors, they can be shrunk after vascular embolization, and then microwave ablation, which is highly efficient for local treatment, but the treatment plan should also be selected according to the tumor growth site.