There are various clinical treatments for liver cancer, each with different indications and very different effects.
They are briefly introduced as follows.
Liver resection for hepatocellular carcinoma: In the past, present and for a long time in the future, liver resection 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.
2.Liver transplantation.
Liver transplantation is the only means of possible cure for liver cancer, and liver transplantation solves three problems, simultaneously
(1) Liver cancer;
(2) cirrhosis of the liver;
(3) chronic hepatitis B.
After liver transplantation, patients can resume a normal life and have a high quality of life. However, the high cost of liver transplantation and the need for long-term immunosuppressive drugs after surgery are its disadvantages. Indications: liver cancer lesion is limited to the liver, no distant organ metastasis, and the function of other organs in the body can tolerate the surgery.
3.Interventional treatment.
It includes hepatic artery chemotherapy (HAI), hepatic artery embolization (HAE) and chemoembolization (TACE); HAI alone is not enough, and chemoembolization (TACE) is the main interventional treatment method.
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, radiological intervention can be the preferred method in non-surgical treatment.
4.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 patients with single tumor with diameter ≤ 5 cm or multiple nodules with maximum diameter ≤ 3 cm, without vascular or bile duct invasion or distant metastasis, and with liver function Child-Pugh grade A or B, radiofrequency or microwave ablation is the best choice other than surgery.
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 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 surgically removed due to poor liver function, or the tumor is located in important anatomical structures and cannot be removed technically, or surgery is refused.
(2) Those with 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: Most of the 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 and Brivanib;
(3) signaling pathway inhibitors, such as the mTOR inhibitor everolimus;
(4) multi-target inhibitors, such as sorafenib and sunitib, etc.
7.Chinese medicine treatment: Currently, 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.