Follow-up and scientific review of liver cancer patients

  There are some liver cancer patients who think everything is fine after getting one treatment; as long as they have no symptoms, they do not go to the hospital for review; when they have symptoms and go to the hospital for examination, they find that the liver cancer has already recurred and the disease is so late that they have lost the chance to be treated again. It is regrettable that if the above-mentioned patients had a strong sense of follow-up and could go to hospital regularly for examination after treatment, when liver cancer recurred or newly developed, they could be detected and treated in time, and could have obtained satisfactory results.  Due to the vast geographical origin of China, the degree of knowledge popularization of medical disciplines needs to be further improved, and the habit of physicians to follow up liver cancer patients has not been fully established yet, there are few patients in the above situation, which to a considerable extent affects the level of liver cancer treatment in China. Both doctors and patients need to further improve their understanding of the importance of scientific follow-up of liver cancer patients, so as to standardize and institutionalize the follow-up of liver cancer patients and further improve the curative effect of liver cancer patients.  The occurrence and development of liver cancer are often multi-stage. One important characteristic of liver cancer is that it often grows polycentrically, that is, it occurs in two or more parts at the same time or successively. In patients, two or more liver cancer lesions may appear at the same time, and moreover, they may appear one after another. When the existing lesions are treated, another lesion or lesions will grow one after another.  Another characteristic of liver cancer in terms of pathological scope is that what is seen on ultrasound, CT and MRI is only a part of the liver cancer, i.e. the main cancer, which can also be regarded as the inner core of the liver cancer. Around the main cancer foci, there are also lesions that are difficult to be seen on imaging, including micro-venous infiltration areas of hepatocellular carcinoma and satellite metastases. In fact, the extent of lesions in hepatocellular carcinoma is much larger than the main cancer foci.  Therefore, unless the lesions are smaller in scope or liver transplantation is applied, which is a treatment method to “eliminate” all the cancer foci in the liver, it is often difficult to completely eliminate all the liver cancer foci at one time with common liver cancer treatment methods such as hepatectomy and radiofrequency ablation, and it is even more difficult to completely remove the cancer foci through arterial interventional embolization. Recurrence is almost inevitable after treatment.  The above two main characteristics of hepatocellular carcinoma determine that the occurrence and development of hepatocellular carcinoma are obviously multi-stage. Looking at liver cancer at one time point is like looking at a train through a doorway. The liver cancer in front of you is like one or several carriages seen in the doorway, which is only a part of the train, not the whole train.  II. Liver cancer treatment usually requires a course of treatment The multi-stage nature of liver cancer development determines that liver cancer treatment usually does not happen overnight, but like chemotherapy, it requires a course of treatment. In this course, multiple treatments are applied alternately and in combination to complement each other in order to achieve the best therapeutic effect. At one stage of liver cancer development or treatment, one tool is the best, while at the next stage of development or treatment, another tool may be the most appropriate.  For example, patients with recurrence of hepatocellular carcinoma after resection have less chance to be able to be resected again and can usually obtain satisfactory results through minimally invasive treatments such as interventional embolization or/and radiofrequency ablation; furthermore, for larger hepatocellular carcinoma that is not suitable for surgical resection, better results can be achieved through repeated and alternate application of interventional embolization and radiofrequency ablation.  Scientific follow-up is an important measure to improve the efficacy of liver cancer. After treatment, liver cancer will usually recur or reoccur. The early or late recurrence depends on both the malignancy of liver cancer and the thoroughness of treatment to remove liver cancer lesions. The higher the malignancy of liver cancer and the larger the cancer foci, the more the thoroughness of treatment cannot be guaranteed and the higher the possibility of recurrence, the earlier it will be. The vice versa is also true. After liver cancer treatment, if scientific follow-up and regular review can be conducted, liver cancer recurrence can be detected at an early stage.  The earlier the recurrence of cancer is detected, the smaller the lesion is, the easier the treatment is and the better the result is. It can be seen that scientific follow-up after liver cancer treatment is an important measure to enhance the efficacy of liver cancer, and it is an integral part of comprehensive liver cancer treatment that cannot be ignored.  ”After you are discharged from the hospital, I am still your doctor!” This phrase should become a verbal phrase in the communication between doctors and patients, and it is especially necessary for liver cancer patients. After a liver cancer patient completes a stage of treatment, the physician should design a follow-up plan according to the patient’s actual situation (such as the way of treatment, the possibility of residual or recurrence, etc.). Usually, liver function and methemoglobin should be reviewed monthly, and enhanced CT or MRI should be reviewed every 2 to 3 months, and PET-CT should be performed if necessary.  In conclusion, obtaining initial treatment for liver cancer is only the beginning of systematic treatment, never the end of treatment. Scientific treatment, usually, is only the foundation of curative effect; scientific follow-up is the guarantee of curative effect.  Caring for liver cancer patients and improving the efficacy of liver cancer treatment start from scientific follow-up!