Liver Cancer Treatment – The Pain of Choosing
Primary liver cancer is one of the common malignant tumors in China, and is often given the terrifying title of “the king of cancers”. In order to improve the treatment effect of liver cancer, doctors and scientists all over the world have been doing their best, and although the effect has been improved very obviously, in the past decade, it seems that all means have encountered the “ceiling” effect, and it is difficult to improve further. In my clinical work, I found that once someone has liver cancer, family members often go to many hospitals, see many specialists and go to various websites to learn, hoping to master the most comprehensive and latest knowledge about liver cancer treatment in a short time. I understand why: it is too difficult to choose! I am afraid that my wrong choice will delay the treatment of my loved ones, which is a matter of life and death. Unfortunately, the more you see, the more people you meet, the more you say, and in the end, you tend to be completely lost. I would like to talk about a little bit of my opinion in this article today, which is also the way I communicate with patients in my clinical work, just for your reference.
Can liver cancer be cured?
This is often the first question asked by patients’ families. As long as the patient still has vital signs, doctors can treat any disease! However, the purpose of treatment is different. There are two kinds of tumor treatment purposes: one is to strive for complete cure, that is, the patient will not die because of this tumor. The second one is to try to make the patient live longer (this is divided into different levels: for example, live for three to five years, or live for two to three years, or live for a few more months). Perhaps some people will say this who does not know, why do you need to write. But I found that in reality, due to the excessive and chaotic information collected by family members after the onset of the disease and the anxiety, some irrational family members are not thinking seriously about this simple issue and thus go to extremes. It is a great pity that those who should be treated, but think that the cure is not good enough to simply give up. There is another question similar to this one: to which stage? In fact, the purpose of the family asking this is to know how long the patient will live. While it is true that pre-treatment tests can distinguish between early and mid-stage patients, there is no way for a doctor to know exactly how long a particular patient will live, let alone assuming that you are going to receive treatment, which is even more impossible to say. If a patient’s family were to ask me, I would say: I am not saying the following like a doctor should, but it is a fact: Only God knows how long a patient will live! Because we found in our work that although liver cancer is detected early and the treatment effect should be very good, there are just a small number of people who do not necessarily live longer than patients with advanced liver cancer who receive proper treatment, and these things are indefinable. We can predict a population, but we cannot predict an individual precisely. This is the limitation of our understanding of the human body. But isn’t it true that we should just leave it to fate as I just said? No, there is another saying: people are doing what they are told.
How to treat liver cancer?
This is the key of this article. There are many methods of liver cancer treatment, which often include: surgery, intervention, ablation, drugs (including TCM), immunotherapy…. Because there are so many methods, patients and family members often don’t know how to choose, and even if you ask doctors in different fields, you will get different messages. For example, if I am a surgeon myself, I will definitely say that surgery is the best. But if you meet an interventionalist, you will definitely say that interventional effects are good and risky, not to mention the Chinese medicine that specializes in treating this terminal illness and is green and non-toxic. All experts, you can say there is wrong, are right, because it is called “academic debate”. For the layman, how to choose it? When the diagnosis is clear, the reason why the patient’s family is in a dilemma on the treatment method, is simply: efficacy and risk how do I choose! I only want efficacy, not risk! Although this is the ideal of all people, at present, the majority of tumor treatment is: high risk for high efficacy! You don’t need to ask around the world to find out the quickest and best way, your doctor will tell you the first time you go to the hospital! For example: gastrointestinal mesenchymal tumor, don’t hesitate, Gleevec treatment!!! If you find a bunch of treatment options, it’s a choice between efficacy and safety that must be made, requiring the patient or family to make a decision and tell the doctor, “I’ve decided to put up a fight and be efficacious”. Or, “Forget it, we’ve decided to focus on safety” so the doctor can quickly help you make a decision. (Add that even if you say you want efficacy, the doctor will not ignore patient safety.)
As a surgeon, here is my understanding of the various treatment options for liver cancer.
Surgery
The risk is the greatest, and in the worst case, even the situation of losing both money and people! However, the best efficacy is recognized worldwide! The basic principle is like the three major battles of the Liberation War: take out the enemy’s main force! Become the cornerstone of the final victory. A phrase I often explain: the biggest difference between surgery and other treatments is: the patient comes out of the operating room with the person on the push bed and the tumor in the basin. Whereas with any other treatment, the tumor is still in the body! When it comes to risk, I would say: No one knows for sure that they will win before the three major battles. If a soldier runs to the commander and says: Commander, do you tell me that we will win this battle for sure? Will I die in the battle? As a commander how do you answer? Some people were able to pass through Tiananmen Square on the 70th anniversary of the war this year, while others may have died in the early stages of the battle. This is how I go about explaining the meaning of surgery to my patients. Of course, it is not a good surgical effect, that no matter what the situation is going to do, it is like specific to each battle, it is not that regardless of the strength of the enemy, even if they only have a squad of troops, but also to go with the enemy a group of troops to fight, that is called a stupid sacrifice. But there is no absolute safety of the battle, that is to say, even if we are a group of troops, to fight the enemy a squad, there are killed by stray bullets. So how exactly do you choose? Doctors spell wisdom, families spell courage. The kind of stupid fight just now, the doctor will not recommend. Doctors propose surgery, often I am strong enemy weak, or the two sides of the military strength Qihu equal! Then you, as a soldier, go to war or not?!!!
Intervention and ablation
Intervention and ablation, these are the hotter advanced treatments available. Patients often receive the message that the risks are small and the results are good. I usually tell patients this, if it is really that easy, the world should ban surgery for liver cancer!!! Isn’t it unconscionable and foolish for doctors to let patients risk their lives and money to have surgery when such a good method is available? Unfortunately, surgery is still being pushed as the only way to achieve a cure, and surgery for liver cancer is still being done all over the world. What does this mean?
Intervention
I liken it to the siege of a city with no food plus poisoning the sewers. That is to say trying to besiege the enemy in one place, cutting off the main food supply (embolizing the blood vessels), and throwing a poison every now and then (administering chemotherapy drugs into the tumor vessels). I often say that if one day, intervention can really besiege the tumor with an iron barrel, it can really replace surgery. Unfortunately, the current intervention is similar to cardiac intervention, which can only block the blood vessels of certain caliber, just like only blocking the gates of the city. But the enemy (tumor) is not stupid, it will starve to death if it lacks food? No, he will also find a way: the main road is blocked to take a small road, the lower road is not available I will dig a tunnel. You have to know that although the main supply vessels of tumor are only a few, but in fact it is 360-degree seamlessly growing inside the liver, from which angle and can be new blood vessels, both to supply blood oxygen, but also to facilitate tumor metastasis (this place has no food and water still do not run, silly ah). This is the reason why intervention is defined as palliative care. It is true that intervention can shrink the tumor and prolong the life of some patients, but it is very difficult to remove it from the root, as its basic principle determines.
Ablation
Again, when it comes to ablation, there are many methods, the freezing method, the scalding method, and so on. I compare it to throwing bombs into the enemy pile. If there are some patients with smaller tumors, how would they like to do without surgery. I would usually recommend ablation in preference. The risk is small and the effect is immediate kill. Especially when there are not many enemies, maybe a few bombs really just take out all the enemies. Then you must ask, why do you still put behind surgery to recommend it? I think so: that is to say that the enemy is entrenched in a building (because the enemy is less, you can not use the city metaphor), surgery is: 50px from the perimeter of the building, even the house with the ground all to me completely shoveled! Ablation is: throw a bunch of bombs, the piece all to me, bombing and not to clean up the battlefield. So a comparison, ablation may still have one or two not be blown up, the resurgence of the dead. Of course, for too big to operate I personally recommend intervention, still grenades are too slow (because of the thermal effect, each ablation time is not infinite, too big tumors need to be divided), at this time the effect of food break is faster.
Chemotherapy and radiotherapy
The above treatments often have to be combined with drugs. Many people do not understand, I have taken such a big risk surgery, good not allowed to come over, why do we need chemotherapy again? Let’s talk about the war of liberation, after the three major battles will really be completely won? Even if the new China was founded, we still struggled with the infiltrators for a long time. Without these battles, the enemy is going to counter-attack. The main reason why the treatment effect of liver cancer cannot be raised now is that the problem of “the flame of a star can start a prairie fire” cannot be solved well. In fact, the medical community believes that there is no drug sensitive to liver cancer, and there is easily one (I will not say the name, not to do marketing), which can easily cost more than 100,000 yuan a year, but I will tell the patients that it is the longest one among the shorties! Then you must be asking again, if so why do chemotherapy? Planes, tanks, artillery and missiles are the best weapons of war, but now that the surgery is done, it’s like a tall weapon all used. You now have a basket of kitchen knives you use or not? You do not use, then there is no better way, there is quiet waiting for the results. You use, although not as good as the aircraft cannon, but maybe you can cut down the most critical one or two enemies. And these kitchen knives are not an unlimited supply, just a few, after throwing want to throw also ran out. Of course, that the most expensive drug is the kitchen knife, the others can only be considered fruit knives it.
In the past, it was thought that liver cancer was not sensitive to radiotherapy, but now it is considered to be moderately sensitive, and it is a method anyway.
Chinese medicine
I’m going to talk about herbal treatment. No matter the patient is in that stage, there will be patient’s family members who will professionally tell me one thing, adding Chinese medicine treatment is not better, not to mention the advanced stage patients. I’m not sure which tumor TCM can claim to have overcome, at least not at this point in time. I would position TCM as improving appetite regulating sleep, etc. My general advice is: take the treatment recommended by western medicine can be completed, you have money to eat. But one thing, it is recommended to eat the regular pharmaceutical companies out of the Chinese medicine, even if the effect is not as good as it should be, it will not kill you. Don’t take the secret recipe of private medicine, it may cheat your money and kill you. I have patients who died not from recurrence of liver cancer, but from drug-related liver failure. Some people may think what if they miss the competent Chinese medicine doctor, what a pity? I usually say: If there was such a prescription, this person would have been richer than Jack Ma or Bill Gates! Liver cancer is a worldwide problem, how much money must be made!
Immunotherapy
Then let’s talk about the recent hot cellular immunotherapy. Immunotherapy has always been the dream of medical practitioners because it is theoretically the most ideal treatment method. For patients and families, immunotherapy is also the highest in terms of name. However, for so many years, it has not been accepted by most clinical practitioners for the simple reason that the results are too poor! At present, there are two major categories of treatment each year: one is to stimulate the immunity of the body as a whole, such as thymidine and various herbal anti-cancer drugs, and this treatment is not specific. The other category is to draw out the immune cells of the body, process them through various stimulation, and then transfuse them back again. Such methods are considered to be specific for tumors and very specific.
The first type is commonly used by me in clinical practice, while the second type is rarely recommended. People who have done scientific research or follow scientific research know that tumor cells in vitro, will be easily killed by many things, so if you go to check the scientific literature, you will find that tumors seem to find should be attacked. But there are very limited drugs (even a little bit) that are really effective against tumors in the human body, so the progress of chemotherapy drugs for tumors that can be marketed is very slow. This shows: in vitro is completely different from in vivo! Then let’s look at the current immunotherapy method, which draws out the patient’s immune cells and then gives various stimuli so that he can recognize the tumor cells and kill them in vitro, this is no problem at all! But here comes the problem, the cells are alive!!! Cells will change with the change of surrounding environment, the environment of in vitro culture is simple, but from the moment the cells are fed into the blood vessel, it starts to receive a lot of cytokine stimulation in the patient’s body, these stimulated cells will undergo changes that we cannot control, how to ensure that they still retain their in vitro characteristics after a long journey to their destination? Let’s say there is a bad guy at the other end of the Great Wall of Congestion on the Fourth of July, and you train the security guards at this end, motivate their fighting spirit, say you believe me, that’s really a bad guy, you have to do justice, and then give them some equipment.
If the bad guy was right in front of you, a swarm of excited and heavily armed security guards would definitely solve the problem quickly and well, but unfortunately not. They had to traverse the whole section of the Great Wall from person to person, and then along the way there were people who said that actually the man was not bad, just an ordinary person. By the time this group of security guards reached their destination, they were already sleepy, some lost their armor and clothes and hats, and some simply knew who the bad guys were. The human body is a big dye bath, it is easy to assimilate foreign colors nothing can be seen. Of course, this does not mean that immunotherapy is ineffective, I personally believe that in the infinite future, the vast majority of disease eradication will rely on immunotherapy. Just like in the future humans will definitely move to an alien planet! But right now, only a very small number of people can turn around in space near the Earth, and we need to carefully distinguish the distance between dreams and reality. Immunotherapy has progressed again in the last 2 years! But there must be a big gap with the dream in the hearts of ordinary people. My suggestion is to meet the premise of conventional treatment and have sufficient funds to try it.
Other
In addition, there are many treatments for tumors, such as thermotherapy …… I am a surgeon after all, and those treatments don’t seem to have enough reasons to attract me to know about them, but still, it is possible to try them.
The Pain of Choosing
Finally I would like to talk about the pain of choosing a treatment for liver cancer. I think there are two types of patients that are better choices. One type is early stage liver cancer and in good physical condition. I would have to regret if they still give up the radical approach in this case. The other category is patients with advanced stage, as some methods are not effective but can be expensive as hell because of the high-tech hat on the head. Usually at this time I would suggest to the family to choose according to their financial ability, and the criterion is: ask for what you want! It is enough. If you just spell more money, Steve Jobs should still be opening Apple’s new product launch now.
The most difficult choice is the middle population, especially if the surgery is very risky and the doctors are hesitant! As you already know from the above analysis, surgery is effective but risky, and other treatments are safe but inferior. Families often say: I want my loved one to get the best results but not the risks. I am afraid that the choice I am making is wrong. I usually explain it this way: There is no right or wrong choice in this situation because no one knows what the future outcome will be. Although the doctor will have some judgment, doctors are not fairies who can pinpoint, especially in the current poor patient-prone relationship where decisions are almost always dependent on the family, especially the family with the biggest temper and the loudest voice. The only thing we can be sure of at this point is that everyone who is discussing the final decision, including the doctor and the family, is acting in the best interest of the patient! And we make decisions that are justified based on current knowledge and skill levels. Even if there is a bad outcome, as a loved one you should have a clear conscience. And as doctors can only do their best to not leave artificial regrets: the preparations that should be done are done, such as the tests that should be done, the consultations that should be requested, etc. The treatment of diseases is currently half on human and half on the sky! (again, not like a doctor’s words, but it is true). Even for a simple cold, we can’t control how many days it will take to get well, let alone surgery! When the risk is very high, surgery or give up, there is no right or wrong. It is often a decision to bite the bullet and stomp the foot. Although humans have gone to the moon, but in this regard, sometimes no different from gambling.