Primary liver cancer (abbreviated as liver cancer) is one of the most common malignant tumors in clinical practice. The global incidence rate is increasing year by year and has exceeded 626,000 people per year, ranking the 5th in malignant tumors, and the mortality rate is close to 600,000 people per year, ranking the 3rd in tumor-related deaths.
According to the statistics of Ministry of Health, there are about 2.3 million new cancer patients and 1.8 million deaths due to cancer in China every year.
2.Since the 1970s, liver cancer has been on a rising trend year by year. At present, the number of new cases of liver cancer exceeds 347,000 each year. Li Rui, Department of Acupuncture and Minimally Invasive Oncology, The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine
3.Liver cancer is the second most common malignant tumor after lung cancer, accounting for 19.3% of the total number of deaths due to cancer each year.
The pathogenesis of liver cancer is still unclear. It is related to hepatitis B, hepatitis C and cirrhosis caused by various reasons, as well as consumption of food contaminated by Aspergillus flavus and amyl nitrite and alcohol.
5.The infection rate of hepatitis B in China is 9.09%, and there are about 120 million hepatitis B virus carriers; the infection rate of hepatitis C is 3.2%, and there are about 40 million people; more than 90% of liver cancer patients in China occur on the basis of hepatitis B and or hepatitis C; liver cancer combined with cirrhosis is as high as 83.6%.
6.Don’t ignore the liver cancer that cannot be detected by imaging
(1) Microscopic liver cancer before blood vessel formation, which cannot be detected by imaging US/CT/MR/DSA etc.
(2) Cancer nest growth, when the diameter >1~5mm, after the tumor forms its own blood vessels and anastomoses with human blood vessels, imaging US/CT/MR/DSA and other examinations can partially detect the tumor.
(3) Tiny tumors of 1~5mm gradually develop into nodular, giant or diffuse tumors.
(4) More than 85% of liver cancer patients in China are multiple tumors.
(5) More than 80% of patients with liver cancer have recurrence of tumor after surgical resection.
7.The principle of RFA for tumor treatment
RFA is performed under local anesthesia or general anesthesia, using CT, US and other imaging guidance, and the RF electrode needle is directly punctured to the tumor site. The high frequency electromagnetic wave (200~500kHz) is radiated to make the local ions in the treatment area oscillate at high frequency and generate heat by mutual friction, which generates high temperature of 90~100℃ in the tumor area, and the temperature of RF treatment is monitored and regulated by the needle tip thermocouple in real time to ensure that the RF temperature is maintained at about 90~100℃, and the high temperature causes coagulative necrosis of the tumor tissue.
Ablation margin and complete ablation
(1) Ablation margin
Since satellite foci and invasive veins often exist around the tumor, radiofrequency treatment should ablate 1 cm of the peri-tumor area to obtain “ablation margin” and reduce the chance of local recurrence.
(2) Complete ablation
No enhancement of tumor and ablation margin on stage 3 CT/MR scan
New stage of liver cancer treatment: RFA + radioimmune-targeted drugs
8.Treatment process.
RFA/RFA adjuvant TACE-radioimmune treatment→follow up.
Macroscopic treatment: RFA/RFA adjuvant TACE for image visible liver cancer.
Microscopic treatment: radioimmune-targeted drug “Licartin” treatment. (microscopic liver cancer not yet detected by imaging)
Perioperative treatment: liver preservation, antiviral therapy, etc.
9.Liceptin radioimmune-targeted therapy for microscopic hepatocellular carcinoma
(1) Targeted killing: iodine [131I], killing cancer cells.
(2) Targeted molecular closure: blocking antigen function and inhibiting tumor cell invasion and metastasis.