Editor’s Note:
According to the latest cancer statistics for 2019, 3.93 million new cases of malignant tumors occur each year in China, and behind every cancer patient is a unique life of their own.
In the 26th National Cancer Prevention and Treatment Awareness Week, Tencent Medical Dictionary specially planned the topic of “Light of Life” to record the real stories under cancer, share the scientific knowledge of cancer prevention and treatment, and convey the power of “Light of Life”.
On January 15, 2020, a 13-hour “life-and-death tug-of-war” took place in the operating room of the Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital.
The surgery was performed by Professor Jianxiong Wu, chief of hepatobiliary surgery, on the operating table of a patient with very large central liver cancer.
After the “marathon” surgery, all the medical staff sat down, soaked to the bone.
The young doctors involved in the surgery said, “Although we all know this surgery is very risky and the patient could bleed easily, we are not afraid with Director Wu here!”
It all started with the patient who operated, Mr. Lin.
Man with a tumor in his liver as big as a rugby ball goes to Beijing for treatment
Mr. Lin is 61 years old and is from Fujian.
One day in November 2019, he suddenly felt severe pain in his lower back and abdomen, and when he went to the local hospital for a checkup, he found a 15-millimeter tumor on his liver, as big as a rugby ball!
And the imaging report showed that the tumor was malignant and stage III liver cancer.
After getting the results, Mr. Lin was instantly scared out of his mind. The company’s son, who was with him, was calm. After many inquiries, the son immediately flew his father to Beijing to seek medical help.
Wu Jianxiong, the director, saw Mr. Lin and found him to be overly anxious, and kept him calm and chatted with him on the way to the test. This may seem like a normal act, but it made Mr. Lin feel warm and confident in his treatment.
After getting the test results, Director Wu judged that Mr. Lin’s body was a highly malignant, rapidly growing giant hepatocellular carcinoma.
Patient’s preoperative imaging, where the earthy yellow part is the tumor and the greenish gray part is the liver
(Source: courtesy of the hospital)
If it is cut out surgically right away, it is very likely to cause recurrence of the tumor to metastasize.
So he had a joint multidisciplinary consultation with major specialists from other departments throughout the hospital, and a special surgical plan was developed for Mr. Lin’s unique situation:
1. The liver cancer cells were growing rapidly and could rupture at any time.
Rupture may also be triggered by external forces such as strenuous exercise or impact on the stomach, causing heavy bleeding. This can be life-threatening because the tumor tissue cannot be mended and the bleeding cannot be stopped.
To reduce the risk of rupture, Mr. Lin was given hepatic artery intervention to shrink the mass before surgery.
(Interventional treatment of hepatocellular carcinoma: hepatic artery chemo-perfusion embolization)
2. Intensify nutritional support therapy during the perioperative period and supplement with TCM modulation throughout the treatment process.
3. Adjuvant immunotherapy or targeted drug therapy as appropriate after surgery.
Tumor could rupture at any time, 13-hour surgery to remove “landmine”
However, one month after the hepatic artery intervention, the results of the review were unexpected: the tumor in Mr. Lin’s body grew wildly from 15 to 22 centimeters!
The risk of spontaneous tumor rupture became greater again.
“We can’t wait any longer!”
“We can’t wait any longer!” Mr. Wu suggested that Mr. Lin should have surgery immediately to remove this “mine” that could explode at any time.
Director Wu gestures with his hand at the size of this tumor
(Source: Courtesy of the hospital)
But by this time, Director Wu had arrived from Beijing to guide the department in the Department of Hepatobiliary Surgery at the Chinese Academy of Medical Sciences Cancer Hospital Shenzhen.
So Mr. Lin flew to Shenzhen again, shook Director Wu’s hand and said, “I’m fine with any surgical plan, I just trust you!”
Wu also reassured him, “If we work together, we will be able to cure it. There must be confidence, with a good state of mind emotionally to improve the stress capacity and immunity of the body.”
Director Wu was also aware of the high risk of surgery, but after weighing the pros and cons, this option was already the best choice for Mr. Lin, and the 5-year survival rate after surgery is about 40%.
To remove a tumor the size of a rugby ball, the surgical risks are very high. Some doctors may resort to conservative treatments such as radiation therapy, but extensive radiation therapy can cause a lot of damage to the liver and affect his entire body’s metabolic function later in life.
“I don’t want his tumor to be cured and his body to be wasted.”
It was already January, and after a rigorous and thorough preoperative consultation, Mr. Wu scheduled the surgery for Mr. Lin as soon as possible so that he could go home for the New Year. Everything was ready.
This extremely high-risk and difficult surgery was performed by Director Jianxiong Wu and Professor Xu Che, Director of Hepatobiliary Surgery at the Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital.
Director Jianxiong Wu (second from right), Director Xu Che (first from left) and team in surgery
(Source: Courtesy of the hospital)
The surgery has begun! The surgeons had to remove the very large central liver cancer while also repairing the ruptured blood vessels on the cut edge.
Comparable to a bomb disposal unit in a movie, a bunch of red and blue wires had to be cut to get the bomb out.
Because the 22-millimeter tumor involved almost all of the important blood vessels in each hepatic portal, the slightest misstep could cause a fatal hemorrhage!
This required the attending surgeon to be meticulous enough to move carefully around the blood vessels.
Adding to the long duration of the surgery, it is also an intense physical test.
The surgery lasted 13 hours, from 9 a.m. to 10 p.m.
Under the shadowless lamp, the edge of Director Wu’s blue cap was soaked with sweat and his eyes were bloodshot.
With the concerted efforts of the two greats, Mr. Lin’s surgery was very successful.
The huge tumor that was finally cut out looked like this:
Post-hepatectomy specimen
(Source: courtesy of the hospital)
On the first day after surgery, Mr. Liu started to eat; on the second day, he was able to walk on the ground; seven days later, he was successfully discharged from the hospital and returned to his hometown, accompanied by his son, to spend the Spring Festival with his family.
Patient with hepatobiliary surgeon before discharge
(Source: courtesy of the hospital)
Director Wu told Mr. Lin that after the surgery, he would need interventional therapy, targeted therapy, discretionary immunotherapy, and adjuvant therapy with Chinese medicine, hoping to improve the cure rate and quality of life through a reasonable combination of treatments.
For early detection of liver cancer, physical examination is more useful than looking at symptoms
In this case, Mr. Lin had hepatitis B for more than 20 years, which was the main reason he got liver cancer.
Human liver cells can continue to repair and regenerate after being damaged by the hepatitis B virus. But the regeneration process can form hard nodes of fibrous tissue, which can lead to cirrhosis in the long run.
In addition, some liver cells can become malignant during the repair process, and liver cancer can occur.
(Three Steps to Liver Disease)
The process of “hepatitis B – cirrhosis – liver cancer” is called the “three steps to liver cancer”. But not all patients with hepatitis B will develop liver cancer. There are other factors such as smoking, alcohol, and aflatoxin that play a role here.
Mr. Lin is a 30-year veteran smoker, and the carcinogenic effects of tobacco on many organs should not be ignored as well.
Why is it that Mr. Liu has just discovered that his stomach pain is advanced?
When the tumor becomes large and stretches the local liver envelope, the “pain in the liver” occurs, usually in the right abdomen, but later in life it can become a sharp stabbing pain, but then it is often in the late stages.
Mr. Lin’s son said his father had always seemed healthy, so he neglected his medical checkups. He didn’t expect to suddenly find advanced cancer, and he felt very self-conscious.
Here’s a warning for everyone, too:
Regular checkups are very important, so don’t be afraid to take the trouble.
Especially if you are a hepatitis B patient or carrier and are older, it is recommended that you get a physical exam every year, focusing on liver function, fetoprotein, liver ultrasound, and other items.
If you don’t get a physical exam during the week and wait for symptoms to appear before you go to the doctor, it’s too late!
Treating cancer, treating the disease more than the heart
“People are often not knocked down by disease first, but by a bad mind!”
“Don’t be sad, it will get better!”
“Don’t worry, we have many cures!”
These are the three words that Director Wu most often says to his patients.
Whenever a patient asks Director Wu for his phone number, he doesn’t hesitate to leave it for them.
Once these patients call or message, he tries to squeeze in time to respond, calm their emotions, and patiently answer their questions, except when they are in surgery or asking for a consultation.
He often tells young doctors:
“Cancer patients are often depressed and lack confidence in their treatment and enthusiasm for life. We must communicate more with patients to let them know they are always being cared for and to build more mutual trust between doctors and patients.”
I also hope that tumor patients will receive more warm encouragement and regain confidence in their recovery while seeking timely medical care and regular treatment!