China is a major country with liver cancer, and liver cancer ranks second in the list of deaths caused by tumors in China, with more than 100,000 people dying of liver cancer in China every year, which shows its great danger.
Usually, when people say “the king of cancers”, they refer to primary liver cancer. Many patients die less than 3 months after the diagnosis of liver cancer, and people call it “acute cancer”. Nowadays, it seems that these so-called “acute cancers” are actually late stage liver cancers, unlike early stage liver cancers, especially small liver cancers.
Liver cancer often starts insidiously and lacks typical symptoms in early stages. Liver cancer is often combined with hepatitis and cirrhosis. Early stage or liver cancer less than 5 cm in diameter can be asymptomatic for up to 2 years.
Early detection, early diagnosis and early treatment are the most important means to improve the prognosis of liver cancer, and some small liver cancers can be completely cured. It can be said that the prognosis of early stage and late stage of liver cancer are two very different days. In war, we often say that if we know ourselves and our enemy, we can never lose a hundred battles. In fact, in our fight with liver cancer, it is not the same.
Nowadays, with the popularization of medical knowledge, patients in general have certain knowledge about liver cancer. However, according to the survey, the more knowledge patients have, the more fears and worries they have. Therefore, it is better to get an oncologist to evaluate your condition. A random general practitioner who has little knowledge about liver cancer and its rules will often make inaccurate diagnosis and affect timely treatment. You should not listen to the experience of patients, and you should not draw a conclusion or “death sentence” for yourself. After all, liver cancer, especially early stage liver cancer, can be cured in part. The evaluation of liver cancer is divided into the following 3 aspects: early and late stage, benign and malignant, and prognosis.
I. Knowing each other: the liver cancer we face
1.Different sources
Liver cancer is divided into two categories with very different nature. One is primary liver cancer, which originates from the liver; the other is secondary or metastatic liver cancer, which initially occurs in other parts of the body and then spreads to the liver.
Some primary liver tumors are benign, such as hepatic hemangiomas, and they do not spread to other parts of the body. These benign tumors are usually small in size, may not have any symptoms, and are only occasionally detected during a physical examination, and usually do not require treatment.
Primary liver cancer originates from hepatocytes or intrahepatic cholangiocytes, in China, more than 90% are hepatocellular carcinomas, about 5% are intrahepatic cholangiocytes, and less than 5% are mixed carcinomas.
According to different origins, there are 3 main tissue types of primary hepatocellular carcinoma.
(1) hepatocellular carcinoma: the most common type of liver cancer, accounting for about 90% of this type in China, often combined with cirrhosis.
(2) Cholangiocellular carcinoma: better prognosis than hepatocellular carcinoma, accounting for about 5%.
(3) Mixed (hepatocellular and cholangiocellular) carcinoma: accounting for about 5%.
Fibrous lamellar hepatocellular carcinoma is a variant of hepatocellular carcinoma, mostly found in the West, rich in fibrous stroma, parallel arranged in a lamellar shape, commonly found in young people, single isolated nodule, slow growth, and better prognosis than general liver cancer.
2.Different traits
We classify hepatocellular carcinoma into mass type, nodular type and diffuse type.
Diffuse type: cancer nodules are small (from rice grain to soybean size), diffusely distributed and diffuse to the whole liver, easily confused with liver cirrhosis.
Massive type: The diameter of cancer nodules is larger than 5 cm, among which those larger than 10 cm are considered as giant nodules, which are prone to necrosis and cause liver rupture; common subtypes include single nodules, fused nodules and multiple nodules.
Nodular type: cancer nodules are usually smaller than 5 cm, and the common subtypes are single nodule, fusion nodule and multi-nodule type, which are often accompanied by cirrhosis.
3.Different stages
According to the course of the disease, liver cancer can be divided into early stage and advanced stage. If the diameter of liver cancer is less than 5 cm, there is no portal vein cancer thrombus and no lymph node or other organ metastasis, it is generally early stage, and vice versa is advanced stage. How long you can live with liver cancer mainly depends on the following 3 factors.
(1) the early or late stage of the disease.
(2) Whether the treatment is appropriate or not.
(3) the law of liver cancer itself.
The first two of them can be changed through subjective efforts of human. Early stage patients are mainly treated with surgery, and many of them have the hope of radical treatment. In conclusion, “early diagnosis” and “reasonable treatment” are the main deciding factors. Striving for early diagnosis and timely surgery means the hope of life!
4.Definition of small liver cancer
With the rapid development of imaging technology in recent years, the sensitivity of diagnosis has been greatly improved. For the diagnosis of small liver cancer, there are different standards at home and abroad. Generally, small hepatocellular carcinoma refers to hepatocellular carcinoma with diameter less than 3 cm, and has some characteristics as follows.
predominantly distensible, mostly with envelope formation
confined lesions.
Low incidence of cancer emboli and satellite nodules.
II. Mastering the general direction of treatment
Since there is no specific treatment for liver cancer, clinicians in China mostly advocate the use of integrated treatment of Chinese and Western medicine to obtain better results, and it is expected to reduce the chance of recurrence if radiation therapy, chemotherapy, biological therapy and Chinese medicine are used for patients after surgical resection. Organic use of embolization chemotherapy, traditional Chinese medicine and biological therapy for advanced liver cancer can improve patients’ survival quality and prolong survival period.
1.Maintain a good state of mind
People are higher animals with spirit, so they can have ideal and spiritual support is very important to overcome difficulties.
For a long time, people have deeply rooted cancer as an incurable disease, and often heard people say, “Don’t get cancer if you have any disease, for getting cancer is like a death sentence.” It can be seen that people are so afraid of cancer that they are “afraid of talking about cancer”.
Whether cancer can be cured or not depends not only on the treatment methods adopted by doctors, but also on the patient’s own attitude towards cancer.
Some patients often have fear and anxiety, lose confidence in life, lack the courage to continue to live, and even refuse to receive treatment. First of all, they collapse mentally, resulting in the organism’s ability to resist the disease are in an extremely low state, which is very unfavorable to treatment.
Once a healthy person is diagnosed with tumor, even a strong-willed person will have a serious psychological reaction. This is human nature, but there are some bad psychological reactions that will damage the body over time and need to be overcome at all times. The correct attitude is to have strong confidence in overcoming cancer and believe that you can overcome the disease. Cancer patients should see having cancer as a challenge to themselves, lift their spirits and make themselves happy. We should treat the process of having tumor as a challenge to overcome ourselves again, and actively cooperate with doctors for treatment with tenacity and perseverance.
2.Don’t avoid seeking medical treatment
Some people who suspect that they have liver cancer have the burden of thinking and are unwilling to go to oncology department to seek help from doctors, but turn to some non-oncology departments. In this way, sometimes misdiagnosis and omission may result in delaying the disease.
The advantage of specialized treatment is that it can enable you to find the specialist who treats the disease in the shortest time and get the most professional service that other departments cannot provide.
3.Stage treatment
Accurate staging of liver cancer before treatment is as important as figuring out the enemy’s situation before fighting a war. Only when there is a clear grasp of the size and scope of the tumor as well as the patient’s physical condition, can a reasonable treatment plan be formulated. The principle of staging is essential for liver cancer treatment, and the selection of treatment methods according to staging is more in line with the biological characteristics of liver cancer and can better avoid blindness and subjective arbitrariness of treatment.
Staging of hepatocellular carcinoma is very important to the formulation of treatment plan and prognosis. For surgical treatment, the staging of hepatocellular carcinoma can help determine the possibility of resection. In order to make accurate staging, a recent CT examination should be performed before surgery, which is more helpful to determine the degree of local invasion of tumor and whether there are metastases in lymph nodes.
Surgical resection provides the best outcome for patients with hepatocellular carcinoma. Lobectomy for large hepatocellular carcinoma can benefit some patients with hepatocellular carcinoma, and the 5-year survival rate increases to 30%. The 5-year survival rate for resection of small hepatocellular carcinoma, on the other hand, is 60 to 80 percent, and in some cases, even higher.
For multiple hepatocellular carcinomas, hepatic artery embolization chemotherapy is the best choice. For individual patients, even if there is cancer thrombus in the main portal vein, hepatic artery embolization chemotherapy can still be tried. For a small portion of unresectable hepatocellular carcinoma, if the tumor shrinks significantly, unresectable can be converted into resectable. For multiple hepatocellular carcinoma combined with cirrhosis and serious loss of liver function, only symptomatic treatment is appropriate.
4.Comprehensive treatment
The treatment of liver cancer has changed from mainly surgical to integrated and sequential application of multiple methods. According to the patient’s physical condition, as well as the pathological type, invasion scope (stage) and development trend of the tumor, the existing treatment methods are applied in a planned and reasonable manner, so as to increase the cure rate and improve the patient’s quality of life significantly.
Treatment of liver cancer by a single means has been proven to have great limitations. Any one treatment method has its unique therapeutic effects and all have different degrees of deficiencies. Therefore, hepatocellular carcinoma requires a multidisciplinary and comprehensive treatment.
Infiltration and metastasis of hepatocellular carcinoma are important reasons for the failure of local treatments such as surgery. Surgery, embolization chemotherapy, and radiation therapy are the three pillars of classical liver cancer treatment, and their organic combination may improve the efficacy. Some other treatments, such as biological therapy and Chinese medicine, can regulate patients’ immune ability and also have some anti-cancer effects. Since the above methods have different characteristics in terms of their targets, mechanisms of action and effects on liver cancer treatment, and their respective weaknesses, this has laid the theoretical and practical foundation for comprehensive liver cancer treatment. Combining these therapies organically and appropriately to form a multidisciplinary comprehensive treatment for liver cancer can prolong patients’ survival, reduce toxic side effects and improve survival quality.
5.Individualized treatment
Since each person has different strengths and weaknesses, different diseases originally suffered from, different types of tumors suffered from, different sizes, different organs invaded, and different complications produced, each person is different. Therefore, when determining the comprehensive treatment plan, it is important to give targeted treatment according to each individual’s specific situation, which is also called discriminative treatment in Chinese medicine.
In the research of liver cancer treatment, there is a perplexing question of why the efficacy and adverse effects of liver cancer patients with the same pathological type, the same stage and using the same treatment plan can be significantly different. The treatment outcomes achieved with the same liver cancer in different people with the same choice of treatment can vary widely. Now we have realized that these are related to the individual condition of the patient.
The principle of individualized treatment is to treat different patients differently, varying from person to person, from disease to disease, and from time to time, without making a one-size-fits-all approach. For example, although sometimes hepatic artery embolization chemotherapy of sufficient intensity is necessary, it is not very suitable for elderly patients and patients with cirrhotic basis.
6.Combined treatment of Chinese and Western medicine
In China, Chinese medicine has become one of the important means of comprehensive treatment for liver cancer. In treating liver cancer, TCM emphasizes on diagnosis and treatment. In treating liver cancer, it pays attention to the relationship between the local and the whole, paying attention to the local lesion of tumor and understanding the systemic changes caused by the tumor.
The combination of Chinese and Western medicine is the characteristic and advantage of liver cancer treatment in China. Although it has been gradually valued and applied, it is not yet common enough. Sometimes it is often applied by patients spontaneously when they receive western medical treatment. Some patients do not dare to cooperate with TCM treatment or carry out treatment secretly by themselves due to the prejudice and opposition of competent physicians, which makes it difficult to truly carry out comprehensive treatment in a planned and reasonable manner.
There is a great difference between Western medicine, which focuses on microscopic and local observation of the human body, and Chinese medicine, which focuses on macroscopic and overall. Therefore, TCM and Western medicine can be combined in a complementary way, and the way to combine them is that each can play its own strengths and make up for the other’s weaknesses in treatment.
The advantage of Western medicine in treating liver cancer is that it has powerful killing effect on tumor and can rapidly shrink tumor or remove tumor through surgery, thus controlling the development of disease and relieving symptoms. The disadvantages are the damage to human organ function and the decrease of human immune function, thus the recurrence and metastasis of tumor cannot be well controlled. While killing the tumor cells, it damages the anti-tumor function of human body itself, leaving potential danger for the recurrence and metastasis of tumor in the future.
The advantage of TCM in treating liver cancer is that it has strong ability to adjust and restore the function of human organs and enhance the immune function, so that the tumor cells in the body that are not killed by various western medical therapies can be removed by the body’s own immune system, thus achieving the purpose of curing tumor. The strengths of TCM are that it can enhance the efficacy of radiotherapy and chemotherapy and reduce the toxic side effects of radiotherapy and chemotherapy drugs. The disadvantage is that it does not have strong local therapeutic effect on tumors and cannot effectively control or shrink tumors.
Thus, the shortcomings of Western medicine are the strengths of Chinese medicine, and the weaknesses of Chinese medicine are the advantages of Western medicine. The superiority of combining Chinese and Western medicine in the treatment of tumors is certain. Chinese medicine treatment is an important part of comprehensive tumor treatment. Chinese medicine treatment and combined Chinese and Western medicine treatment are the characteristics of China and have been playing a unique advantage in anti-tumor treatment.