Currently, the potentially curative treatments for primary liver cancer are surgical resection (resection) and minimally invasive ablation (ablation). However, no one can say that 100% of the tumors are removed, not to mention that primary liver cancer is very prone to recurrence. Although most of the patients can have their fetoprotein reduced to normal after careful treatment, there is no shortage of patients who continue to have elevated fetoprotein after treatment, which feels like the tumor is playing hide-and-seek with the doctor, which is very distracting. 1.Inadequate radical treatment of intrahepatic tumor: large tumor, many lesions, close to large blood vessels or important organs still have residual after surgery, this kind is the most common. The most terrible thing is to encounter diffuse liver cancer and mistakenly consider the most prominent and typical part of liver cancer as nodular small liver cancer, so that there will be quite a lot of residual tumors after surgery. To use an analogy, it is like spreading fine sand on a white paper, among which there is a stone, who all went to pay attention to the stone, the stone was removed, and thought everything was fine, in fact, the white paper is full of sand, and elevated methemoglobin is an inevitable thing. There are also tumors with unclear boundaries, just like crabs, the crab shells are removed, leaving many claws, and the residual tumors can grow rapidly after the postoperative decline in body mass, especially liver cancer with high malignancy. In this case, the doctor should pay special attention to the patient’s portal vein and hepatic vein to determine the severity of the disease and inform the family as early as possible that it is advanced and the methemoglobin may be elevated after surgery. In addition, there must be those residual, invisible, cellular level hepatocellular carcinomas (due to tiny lesions, methemoglobin is mostly not high, but a source of recurrence). However, nowadays, they can be further eliminated by targeted drug therapy. 2. Rapid tumor growth and rapid rise of methemoglobin: There are some patients who have a tumor in the lower right lobe of liver, and one month after treatment, the methemoglobin is elevated, and the review CT can see that the tumor in the lower right lobe has been cleared, but a new tumor appears in the area of the upper right lobe where no tumor was originally seen. In some cases, the tumor in the right lobe of the liver has just been treated (2-3 months after surgery) and a new tumor appears in the left lobe of the liver. In addition to very few missed diagnosis (the imaging of major hospitals is very clear nowadays), it is because patients with primary liver cancer mostly have cirrhosis, low immunity, multi-centered growth of liver cancer, and intrahepatic metastases are not seen before surgery but grow out after surgery. 3. Atypical recurrent tumor lesions may easily lead to mistreatment or inadequate treatment: primary hepatocellular carcinoma with mainly hepatic artery blood supply is obvious on enhanced CT, but some hepatocellular carcinomas are mixed with bile duct cancer cells, or with mainly portal vein blood supply, or the images are not clear due to patients’ cirrhosis and fatty liver, even after hepatic artery embolization (inadequate iodine oil deposition), especially for Older patients with many previously treated lesions in the liver make it more difficult to detect recurrent or residual foci. The method found is PET-CT, but it is costly and sometimes still not found, but it is good for finding metastases (such as lung metastases, lymph node metastases, bone metastases, etc.). With the principle of considering the liver first, carefully compare the enhanced CT before embolization and after embolization, including the subtle changes in liver morphology (subperitoneal tumors can make the liver surface locally raised), review the surgical procedure to see if the problematic lesions were treated If there is any mislocalization, or even after re-treatment of the newly determined residual site, observe whether there is any decrease in methemoglobin, and if there is a significant decrease, it indicates that your new judgment and findings are correct. This also indicates that for such a difficult disease, a disease with frequently recurring elevated methemoglobin, a disease that requires close follow-up and repeated treatment, it is best to use minimally invasive treatment and to put recurrence prevention treatment in an important position, preferably under the same hospital and the same doctor who understands the condition for systematic treatment in order to compare, to discover the cause of elevated methemoglobin early and to control the progress of the disease with timely treatment. 4, because of the review time is too early, mistakenly thought that the methemoglobin is elevated: the thing is like this, suppose you are hospitalized before July 1 check methemoglobin for 600ng/ml, then you are hospitalized a week later, and wait for 3 days July 10 to do treatment, and before the treatment and did not recheck methemoglobin (maybe this time after 10 days methemoglobin has grown to 1000ng/ml), 3 days after surgery recheck If the fetoprotein rises to 800ng/ml, don’t be anxious at this time (in fact, it is still dropping), wait for another week, when the fetoprotein drops to 400ng/ml, you will be happy, that’s it, according to the experience of dropping half a week, after another month, it may be normal. Otherwise, according to my experience, in early stage liver cancer, 50% of recurrences will occur after one year, and in middle and late stage, almost 100% of recurrences will occur after six months. 5.Tumor metastasis to extrahepatic: This is a very simple and easy to understand problem, because tumor metastasis to extrahepatic is also the source of hepatocellular carcinoma, and elevated methemoglobin can be imagined. Here we tell you, as long as the metastases are not too many, it is still possible to break them one by one and treat them minimally invasively. 6.Cirrhosis and viral hepatitis can also cause elevated fetoprotein: during the treatment of hepatocellular carcinoma, surgery, radiotherapy and chemotherapy will make the immunity of the body decrease, and the hepatitis virus will easily replicate and enhance after surgery. Even some patients with no preoperative viral replication may have significantly higher HBV-DNA values, and even cases of liver failure due to viral outbreak. If post-operative elevated AFP is accompanied by elevated transaminases and enhanced viral replication, and enhanced CT shows complete tumor treatment without new or recurrent lesions, the possibility of elevated AFP caused by liver cell destruction and repair should be considered. At this time, even preoperative and postoperative routine antiviral therapy is necessary.