Principles of treatment for liver cancer

  Early treatment is the most important factor to improve the prognosis of liver cancer. Early hepatocellular carcinoma should be surgically resected as far as possible.  (Early resection is the key to improve the survival rate. The smaller the tumor, the higher the five-year survival rate. The indications for surgery are as follows: 1. The amount of hepatic resection should not exceed 70%; for moderate cirrhosis, not more than 50% or only the left half of the liver can be resected; for severe cirrhosis, lobectomy cannot be performed and pathology confirms that more than 80% of hepatocellular carcinoma combined with cirrhosis is recognized to replace regular lobectomy with local resection and the postoperative liver function disorder is reduced and the surgical mortality rate is reduced. Ultrasonography is recommended to monitor recurrence.  Because of the close follow-up after radical resection, small hepatocellular carcinomas with recurrence in the “subclinical stage” are often detected and reoperation is preferred. Although liver transplantation is a treatment for liver cancer and has been reported more frequently abroad, its status in the treatment of liver cancer has not been confirmed for a long time, and patients often die of recurrence due to the application of long-term immunosuppressive drugs after surgery.  Palliative surgical treatment is suitable for larger tumors or scattered distribution or close to large blood vessel area or combined with cirrhosis which cannot be resected.  (2) hepatic artery chemoembolization (TACE) This is a minimally invasive tumor treatment method developed in the 1980s, which is recommended as the first choice of non-surgical treatment for hepatocellular carcinoma. LUF), gelatin sponge, sodium alginate microspheres, etc. Hepatic artery embolization chemotherapy should be repeated several times for better results. According to the data of one hospital, the one-year survival rate of 345 cases of inoperable hepatocellular carcinoma with hepatic artery infusion chemotherapy alone is only 11.1%, and the one-year survival rate of combined hepatic artery embolization therapy is increased to 65.2%, and 30 cases of tumor shrinkage are given the opportunity of surgical resection.  (c) Intratumoral injection of anhydrous alcohol Intratumoral injection of anhydrous alcohol into tumor by percutaneous liver puncture under ultrasound guidance is preferred for hepatocellular carcinoma with inoperable cirrhosis and tumor diameter ≤3cm or less.  (4) Radiation therapy Due to the advancement of radiation source radiation equipment and technology, the accurate positioning of various imaging examinations has improved the status of radiation therapy in liver cancer treatment, and the efficacy has also improved, radiation therapy is suitable for unresectable liver cancer whose tumor is still limited, and the efficacy is usually better if a larger dose can be tolerated. The total amount of stereotactic radiation is more than 40Gy (4000 rads capacity) for liver cancer radiation therapy, and the combined use of Chinese herbal medicines for qi and spleen can make the one-year survival rate reach 72.7% and the five-year survival rate reach 10%. Intrahepatic arterial injection of Y-90 microspheres, 131I-iodide oil or isotope-labeled monoclonal antibody can play the role of internal radiation therapy.  (v) Chemotherapy The most effective drugs for hepatocellular carcinoma are cisplatin (CDDP), fluorouracil (5-Fu), adriamycin (ADM) and its derivatives, mitomycin (MMC), etoposide (VP16) and methotrexate (MTX). It is generally believed that the efficacy of intravenous administration of individual drugs is poor. Hepatic artery administration and/or embolization and internal and external radiation therapy are more frequently used and have more obvious effects. In some cases of intermediate and advanced hepatocellular carcinoma, there is no indication for surgery and the main portal vein is obstructed by cancer thrombus. For patients who are not suitable for hepatic artery intervention and certain patients after palliative surgery, the common combination or sequential chemotherapy regimen can be used, which is cisplatin 20mg+5Fu750mg-100mg IV drip for 5 days, once a month, 3-4 times a month; Adriamycin 40-60mg on the first day, followed by 5Fu500mg-750mg IV drip for 5 days, once a month, 3-4 times a month. The effects of the above regimens have been evaluated differently. Often, during chemotherapy or intermittently, we use Fu Zheng class Chinese herbs to enhance the immunity of patients to strengthen the effect of chemotherapy.