Cancer cells are abnormal proliferation of mutated cells in the body that, because of their rapid reproduction and highly invasive and metastatic nature, can easily cause lesions in tissues and organs, eventually leading to loss of organ function and life-threatening disease. In this article, we describe the most common type of liver cancer that occurs in adults, hepatocellular carcinoma (HCC).
First, there are several staging systems for liver cancer internationally, including the Barcelona Clinical Liver Cancer (BCLC) staging system, the TNM staging system, and others. According to the characteristics of Chinese patients, China also has its own liver cancer staging system. Let’s learn together about the four staging characteristics of liver cancer development, which are introduced by tumor extent, life expectancy, treatment options, recurrence rate and recovery.
I. Tumor extent
The extent of tumor progression and what to do next is a common concern of patients and families. Determining the diagnosis, based on the assessment of tumor extent, severity, and liver function, clinical staging, as shown in Table 1 below, is a very important basis for selecting the treatment modality and assessing prognosis. In general, stages I and II are early localized, stage III often refers to severe local infiltration, and stage IV usually has metastases.
Table 1 Tumor staging table
For further information on the liver function Child-Pugh rating and physical activity status PS score see the link:
II. Life expectancy
According to clinical data and experience, life expectancy depends on the patient’s physical fitness, severity of the disease, and state of mind. In general, if cancer cells are detected at an early stage and interventional treatment is carried out as soon as possible, patients have a relatively longer life expectancy. Therefore, if you find any physical abnormality, please seek medical attention as soon as possible, and even if unfortunately cancer cells are detected, you should not be afraid, but should actively adjust your mentality and physical condition, and actively cooperate with your doctor’s treatment, so that your life expectancy will be higher. Table 2 below compiles the life expectancy characteristics of the four stages of liver cancer.
Table 2 Life expectancy table
III. Treatment Options
When it comes to treatment, doctors are “following the guidelines”. The current mainstream guidelines are the NCCN guidelines in the United States and the CSCO guidelines in China, and the treatment recommendations for the four stages of hepatocellular carcinoma are shown in Table 3 below.
Table 3 Treatment recommendations for stage II hepatocellular carcinoma from US and Chinese guidelines
The “jargon” of the professional guide above is a bit hard to understand, so I’ll “translate” it for you.
Surgical
In early-stage patients, if the liver is functioning well and the body can tolerate it, doctors usually recommend surgery to completely remove the tumor and some of the surrounding liver tissue. It is also necessary to preserve liver tissue with good blood supply and blood and bile return to allow for postoperative liver function compensation and to reduce postoperative mortality and surgical complications.
Graftable
For patients with hepatocellular carcinoma with clinical portal hypertension and/or decompensated cirrhosis, physicians will consider liver transplantation. Prior to transplantation, some patients may require a period of transitional therapy, such as radiofrequency ablation, interventional chemotherapy, and targeted therapy, to control tumor growth.
Non-operable
If a patient has poor liver function or is physically unable to tolerate surgery, doctors have several local radical treatments, such as ablation, interventional and radiation therapy, which are also expected to cure the tumor.
Ablation: This involves inserting a probe or needle into the tumor under CT or MRI guidance and using the heat generated by an electric current, or the ultra-low temperature generated by a refrigerant (such as argon), to “scald” or “freeze to death”.
Interventional: A catheter is inserted into the hepatic artery that “feeds” the tumor and is infused with chemotherapy drugs and embolic agents to directly kill and “starve” the : A catheter is placed in the tumor-feeding hepatic artery and infused with chemotherapy drugs and embolic agents to directly kill and “starve” the cancer cells.
Radiotherapy: Radiotherapy can focus more precisely on the cancer, adapting to the shape of the tumor and releasing rays from multiple angles to the tumor, like an invisible “ray knife” that cuts the tumor cleanly for optimal The most effective treatment is to cut the tumor cleanly.
Targeted therapy: Targeted therapy can inhibit tumor cell proliferation and block tumor neovascularization, which is equivalent to blocking the tumor’s “food supply”. After taking targeted drugs for a period of time, most patients will develop “drug resistance” and their disease will deteriorate, requiring stronger targeted drugs or VEGFR2 antibody ramolutumab, or newer immune checkpoint inhibitors.
Systemic chemotherapy: Systemic chemotherapy, although slightly less effective than targeted therapy, is also effective in controlling disease and prolonging survival in patients with advanced disease. Guideline-recommended systemic chemotherapy regimens include the FOLFOX4 regimen (oxaliplatin + calcium folinate + 5-fluorouracil), XELOX (oxaliplatin + capecitabine), or arsenious acid.
Best supportive care (BSC) and palliative care (also known as palliative care): Specific treatments include analgesia, correction of anemia, correction of hypoproteinemia, and nutritional support therapy. For patients who develop complications such as ascites, jaundice, hepatic encephalopathy, gastrointestinal bleeding, and hepatorenal syndrome, the guidelines recommend symptomatic management to reduce patient suffering.
IV. Recurrence rate
Recurrence of hepatocellular carcinoma is still possible after radical surgical treatment in patients with stage I and II disease, with a recurrence rate of 70% 5 years after surgery and a peak recurrence rate of 1 to 2 years after surgery. One of the main causes of recurrence is hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, so antiviral therapy after surgery can effectively reduce recurrence.
V. Rehabilitation and care
In addition to antiviral therapy, patients in stages I and II must also be cognizant of alcoholic liver, fatty liver, hepatitis, viral infections, and unclean diet as risk factors for liver cancer. Therefore, a healthy lifestyle, such as abstaining from alcohol, eating properly, and exercising appropriately, is required after treatment. For patients in stages III and IV, it is not only important to adopt a healthy lifestyle, maintain an optimistic attitude, actively communicate with the doctor and especially need more support, care and comfort from family members.