Primary liver cancer (PLC) is one of the most common malignant tumors in clinical practice, with a global incidence of more than 626,000/year, ranking 5th among malignant tumors, and nearly 600,000/year, ranking 3rd among tumor-related deaths. It ranks second after lung cancer in tumor-related deaths. Therefore, liver cancer is a serious threat to people’s health and life in China.
China is the country with the highest incidence of liver cancer in the world
WHO, International Agency for Research on Cancer. GLOBOCAN 2008.
In the early stage of hepatocellular carcinoma, patients may not have any symptoms or signs. Only a few patients may have symptoms such as loss of appetite, epigastric distention, abdominal pain, weakness, loss of appetite, and some patients may have mild hepatomegaly, jaundice and skin itching. However, in general, these symptoms are difficult to be taken seriously, so 70-80% of liver cancer patients are already inoperable advanced liver cancer when they are diagnosed clinically.
As the treatment of inoperable advanced liver cancer is difficult, there is only one drug supported by high-level evidence-based medical evidence, which is the only drug recommended by NCCN guidelines (National Comprehensive Cancer Network (NCCN)) —- Sorafenib, but this drug is only suitable for patients with good liver function or moderate (Child grade A, B) patients and only prolonged 2.8 months (for European and American patients) compared to the placebo group, and for patients in the Asia-Pacific region, only prolonged 2.3 months compared to the placebo group.
The clinical development of integrated tumor treatment in our department has achieved good results. On July 11, 2012, Shenzhen Radio and Television Group’s urban channel “The First Scene” interviewed our department, and the link to the relevant report is as follows.
http://www.cutv.com/v2/2012-7-11/C16ghgggihjkigglklhdtc.shtml
Brief introduction of inoperable advanced liver cancer case
The patient was a 71-year-old female with a history of hepatitis B and cirrhosis; she went to a local hospital in February this year for “persistent vague pain in the right upper abdomen”.
Figure 1: Hepatocellular carcinoma of the left lobe of the liver
Figure 2: The main trunk and left and right branches of portal vein were completely filled with cancer thrombus
Figure 3: Ischemic necrosis of liver cancer tissue
He went to many hospitals for medical treatment, but was told that he was inoperable and there was no other good treatment method.
In early April 2012, he came to our department. At the time of admission, the patient had abdominal distension, abdominal pain, and was unable to eat normally for more than 40 consecutive days, relying on intravenous nutrition for maintenance and requiring oral pain medication daily.
Clinical diagnosis: hepatocellular carcinoma; portal vein carcinoma thrombosis; hepatitis B; cirrhosis; hypersplenism.
I. Case characteristics.
Main trunk and left and right branches of portal vein cancer embolism
Poor systemic condition and rapid deterioration
Large hepatocellular carcinoma and impaired liver function
Portal hypertension, hypersplenism
II. Treatment strategy
Whole-body conditioning and anti-tumor treatment at the same time
Local and systemic together
Multidisciplinary joint, rational and orderly treatment.
After two months of treatment, the MRI showed that the hepatocellular carcinoma tissue was ischemic and necrotic (see Figure 3 and Figure 4).
Figure 4: Ischemic necrosis of liver cancer tissue
Figure 5: Partial ablation of the main trunk of portal vein and the left and right branches of cancer thrombus, and the fibrous blood flow signal can be seen in them
After three months of treatment, the color ultrasound showed that intermittent blood flow signal was seen in the main trunk of portal vein and left and right branches, and the flow rate was 20 cm/s into the liver (see Figure 6).
Figure 6: Intermittent flow signals were seen in the main trunk of the portal vein and the left and right branch trunks, and the flow rate was 20cm/s into the liver.
The patient has now returned to normal life, with a return to normal mental, dietary and living conditions (as seen in the video), and is returning to the hospital regularly.