In China, the current medical market is rather confusing, and there is no professional and unified treatment standard for liver cancer treatment (what kind of treatment should be chosen for what stage of liver cancer) and strictly implemented in actual clinical work! Most of the treatment methods chosen by liver cancer patients are decided by the first department or doctor, which determines that liver cancer patients receive various kinds of treatment for the first time, including interventional, radiofrequency, resection, transplantation, Chinese medicine, radiofrequency knife, gamma knife or photon knife.
But in fact, “curable” and “curable” are two different concepts!
Different types of liver cancer have their most suitable treatment methods, and different treatment methods have their contraindications and indications.
1. Liver transplantation.
Liver transplantation is the only possible means to cure liver cancer, and liver transplantation solves three problems at the same time
(1) Liver cancer;
(2) cirrhosis of the liver;
(3) control of chronic hepatitis B. After liver transplantation, patients can resume normal life with high quality of life, but shortage of donors, long preoperative waiting time, high cost of liver transplantation and the need for long-term immunosuppressive drugs after surgery are its disadvantages. Indications: Liver cancer lesions are limited to the liver, no distant organ metastasis, and the function of other organs in the body can tolerate the surgery.
2.Hepatectomy for hepatocellular carcinoma: In the past, present and for a long time in the future, hepatectomy is the main treatment means other than liver transplantation. If the sclerotic liver still exists after resection, the recurrence or reoccurrence rate of liver cancer is higher, and the progressive development of cirrhosis may lead to liver function loss and complications of portal hypertension (upper gastrointestinal bleeding, hepatic encephalopathy, intractable ascites, etc.) and endanger the patient’s life.
3.Ablation therapy: It is a kind of treatment that directly kills tumor locally under the guidance of imaging technology, currently radiofrequency and microwave ablation and anhydrous alcohol injection are most commonly used. Indications: For single tumor with diameter ≤5cm or multiple nodules with maximum diameter ≤3cm, no vascular or bile duct invasion or distant metastasis, liver function Child-Pugh
A or B grade, radiofrequency or microwave ablation is the best alternative to surgery for early stage hepatocellular carcinoma patients.
4.Interventional treatment: including hepatic artery chemotherapy (HAI), hepatic artery embolization (HAE) and chemoembolization (TACE), simply giving HAI is not enough, and chemoembolization (TACE) is the main interventional treatment method at present.
Indications.
(1) Patients with intermediate to advanced primary liver cancer that cannot be surgically resected;
(2) Patients who can be surgically resected but are unable or unwilling to undergo surgery due to other reasons (e.g. advanced age, severe cirrhosis, etc.). For the above patients, radiation intervention can be the preferred method in non-surgical treatment.
5.Radiotherapy: Radiotherapy is one of the basic means of malignant tumor treatment, but before 1990s, patients with primary liver cancer seldom received radiotherapy because of its poor effect and large damage to the liver; after mid-1990s, modern radiotherapy techniques such as 3D conformal radiotherapy and intensity modulated conformal radiotherapy have gradually matured, providing new opportunities for the application of radiotherapy in liver cancer treatment. .
Indications for radiotherapy for hepatocellular carcinoma.
(1) The tumor is confined and cannot be removed surgically due to poor liver function, or the tumor is located in important anatomical structures and cannot be removed technically, or the surgery is refused.
(2) Those who have residual lesions after surgery.
(3) Local tumor management of the liver is needed, otherwise some complications will arise, such as obstruction of the hilar bile duct, tumor embolism of portal vein and hepatic vein. For patients with obstruction of the hilar bile duct, drainage can be performed first to relieve jaundice and then radiotherapy.
(4) Treatment of distant metastases, such as lymph node metastases, adrenal metastases and bone metastases, radiotherapy can reduce patients’ symptoms and improve the quality of life.
(6) Biological therapy and molecular targeted therapy: At present, most biological therapies or technologies are still in the stage of research and development and clinical trials, and a small part of them have been applied in the clinic. In recent years, molecular targeted drug therapy for liver cancer has become a new research hotspot and has received high attention.
They mainly include.
(1) anti-EGFR drugs, such as erlotinib and cetuximab;
(2) anti-angiogenic drugs, such as bevacizumab sorafenib and sunitinib, etc.
7.Chinese medicine treatment: It is believed that Chinese medicine can be used as adjuvant treatment for liver cancer, which can help reduce the toxicity of radiotherapy and chemotherapy, improve cancer-related symptoms, enhance the quality of survival and possibly prolong survival.
8.Systematic chemotherapy for primary liver cancer: Since as early as the 1950s, systematic chemotherapy has been used to treat primary liver cancer. Most traditional chemotherapeutic drugs, including adriamycin (ADM), 5-fluorouracil (5-Fu), cisplatin (PDD) and mitomycin (MMC), have been tried to treat hepatocellular carcinoma, but the single-agent efficiency is relatively low (generally <10%), reproducibility is poor, toxic side effects are obvious, and there is no improvement in survival time, so it has stagnated for many years, and there is no standard chemotherapeutic drug or program to date . At present, it is believed that systemic chemotherapy is better than general supportive therapy for patients with advanced primary hepatocellular carcinoma without contraindications, and it is still an optional treatment method.
Its main indications are
(1) Advanced patients with extrahepatic metastases;
(2) Patients with localized lesions but not suitable for surgical treatment or hepatic artery interventional embolization chemotherapy;
(3) Combined with portal vein trunk cancer embolism.
Patients should learn more about the treatment of liver cancer! Doctors should adopt the best treatment measures according to the specific conditions of different patients! The medical administration department should set up strict operation procedures according to the treatment protocols formulated by professionals.