What are the reasonable treatment modalities for metastatic liver cancer?

  Up to now, the treatment of metastatic liver cancer is not standardized, and many patients have lost their chance to be cured due to the lack of proper guidance, spending a lot of money but ending up with no money at all. It is also a pity that many patients give up seeking medical treatment and die prematurely because of the indiscriminate verdict of quack doctors. Based on our experience, we would like to make the following suggestions to patients with metastatic liver cancer for reference when seeking medical treatment.  1. If no signs of liver metastasis are found when the primary focus is diagnosed (especially tumors of gastrointestinal tract, biliary tract, pancreas, lung, breast, esophagus, etc.), regular liver examination (liver ultrasound is recommended at least once every 3 months) must be performed on the basis of effective treatment of the primary focus. Once signs of liver metastasis are detected, the diagnosis should be confirmed immediately by MRI/enhanced CT, etc.  2. If liver metastasis has already occurred when the primary focus is diagnosed, reasonable treatment should be chosen depending on the extent of the primary focus and liver metastasis. If both the primary focus and liver metastasis have the chance of radical surgery, and there is no extensive metastasis in other parts of the body, resection of the primary focus + liver tumor resection should be chosen. If the liver tumor is smaller, or the tumor is smaller but more in number (not more than 6), and the patient is old, in poor general condition, or unwilling to take surgery, the treatment of primary foci resection + radiofrequency ablation of liver metastases can also be chosen. If the tumor is well located, radiofrequency can also achieve similar effect as surgical resection, and the resulting systemic and liver damage is much lower than that of hepatectomy.  3. If liver metastases are found some time after radical resection of the primary focus, treatment modalities with radical potential should be adopted as much as possible. If the tumor is large (e.g., 7 cm or more) and eligible for resection, hepatic resection should be preferred. If the tumor is small and there exists little distance from the cavernous organs such as gallbladder and major bile ducts, radiofrequency ablation may also be preferred.  4.Systemic chemotherapy can only be used as adjuvant treatment because of its uncertain efficacy, but not as main treatment, unless the patient is unable to implement minimally invasive treatment such as hepatic resection or radiofrequency ablation. Chemotherapy over and over again without differentiating the specific situation will cause many patients who could have been cured to lose their treatment opportunities completely.  5. The efficacy of hepatic vascular interventions for metastatic liver cancer is limited, and the percentage of patients who achieve complete tumor inactivation through repeated interventions is very low. If the tumor still has the chance of minimally invasive treatment such as liver resection or radiofrequency ablation, it should be the first choice for treatment. Only after the conditions of surgery or minimally invasive treatment are not available should vascular intervention be tried.  6.Radiotherapy is also an optional treatment for liver metastasis cancer, provided that the patient cannot have liver resection or radiofrequency ablation and the number, size and liver function of the tumor are suitable. The disadvantages of radiotherapy are greater liver damage, inaccurate efficacy, long treatment time, and relatively high cost.  In conclusion, there are more treatment methods for metastatic liver cancer, and the key is whether to choose reasonably. Minimally invasive treatment such as liver resection or radiofrequency is always the first choice, followed by radiotherapy and vascular intervention as the last choice. Systemic chemotherapy can be combined with the above treatments, but it must be appropriate and not excessive. There is no one treatment that can be used all over the world. It is highly recommended that multiple treatments be applied in a rational, scientific and comprehensive manner.