With the gradual improvement of people’s living standard and the rapid development of modern medical technology, human life expectancy is gradually increasing, including the incurable cancer in the past, and today there are many treatment methods to greatly improve the survival of cancer patients.
The incidence of liver cancer is very high in China, and there are many ways to treat liver cancer, the common methods are;
1.Surgical treatment of liver cancer.
2.hepatic artery embolization chemotherapy treatment.
3.Radiofrequency ablation treatment for liver cancer.
4.Ultrasound knife treatment for liver cancer.
5.Combination therapy of Chinese and Western medicine.
Characteristics of various methods;
1.Surgical treatment of liver cancer; Surgery includes surgical resection and liver transplantation, the indications for surgical treatment of liver cancer are
(1) Clear diagnosis, estimated lesion is limited to one lobe or half of the liver, without invasion of the first and second hepatic hilum and inferior vena cava;
②Good liver function compensation, prothrombin time not less than 50% of normal;
(iii) No obvious jaundice, ascites or distant metastasis;
(iv) good cardiac, pulmonary and renal function, and able to tolerate surgery;
(⑤Post-operative recurrence with lesions limited to one side of the liver;
⑥After chemotherapy by hepatic artery embolization or hepatic artery ligation or intubation, the lesion is significantly reduced and it is estimated that surgical resection is possible. Problems to note after surgery; like all other malignant tumors, there are also problems of recurrence and metastasis after liver cancer surgery. Therefore, it is important to follow the doctor’s instructions and go to the hospital for regular checkups. Generally speaking, the examination mainly consists of two parts, namely imaging examinations such as ultrasound, CT, MRI and chest X-ray, and laboratory tests such as alpha-fetoprotein (AFP), CA19.9, liver function and blood picture. Usually, in the first two years after the operation, the examination is done once every three months; after two years, it can be changed to once every six months according to the situation.
2.hepatic artery embolization chemotherapy treatment; indications for hepatic artery embolization;
1.Application before hepatic tumor resection can make the tumor shrink and facilitate resection, and at the same time can clarify the number of lesions and control metastasis;
2.No serious obstruction of liver and kidney function, no complete obstruction of portal vein trunk, tumor occupancy rate less than 70%;
3.Small liver cancer;
4.Surgical failure or recurrence after resection;
5.Control of pain, bleeding and arteriovenous fistula;
6.Prophylactic hepatic artery chemoembolization after resection of hepatocellular carcinoma;
7.Recurrence of hepatocellular carcinoma after transplantation.
Indications for hepatic artery chemotherapy;
1.Primary or secondary hepatocellular carcinoma that has lost the chance of surgery;
2.Poor liver function or difficulty in super-selective cannulation;
3.Recurrence of hepatocellular carcinoma after surgery or postoperative prophylactic hepatic artery infusion chemotherapy;
4.The bone marrow suppression is corrected after treatment,
Radiofrequency ablation therapy for hepatocellular carcinoma; single tumor with maximum diameter ≤5cm; or number of tumors ≤3 with maximum diameter ≤3cm; liver function classification Child-Pugh A or B, or the standard is achieved by medical treatment; no vascular cancer embolism, adjacent organ invasion; single tumor >5cm in diameter or multiple tumors with maximum diameter >3cm that can be surgically resected, radiofrequency ablation can be used as palliative treatment or part of the combined treatment.
Ultrasonic knife treatment for liver cancer; Principle of high-energy focused ultrasonic knife treatment: Focusing high-intensity ultrasound on target tissues, the temperature of the target area suddenly rises 70 ℃~100 ℃ in a very short time, causing coagulative necrosis of tumor cells and directly inactivating tumor cells in the target area. High-energy ultrasound has short wavelength, strong penetration and good pointing performance, forming a focusing area of several millimeters in diameter in the target area, which can inactivate the target area precisely and achieve the treatment purpose.
It can treat patients with cancer embolism. Portal vein cancer thrombus is an important biological behavior of primary liver cancer, which is an important factor affecting the prognosis of patients with primary liver cancer, and its incidence and morbidity and mortality rate are high. The blood supply of liver nodules is 90%-95% from hepatic artery, and liver tumors are mainly supplied by hepatic artery, while the peripheral parts of tumors and fibrous envelope, extra-envelope infiltrated cancer tissues, subfoci and portal vein cancer embolus are mainly supplied by veins, which are the most active parts of tumor growth.
After hepatic artery embolization, the cancer nodules can be necrosed due to ischemia and the tumor volume can be reduced. At the same time, after hepatic artery embolization chemotherapy, the chemotherapeutic drugs can form a high concentration in the tumor for a short time, so as to kill the tumor cells to the maximum extent. Therefore, hepatic artery embolization chemotherapy is considered to be the preferred non-surgical treatment for mid- to late-stage primary liver cancer.
However, if combined with portal vein cancer thrombus, especially full-blown cancer thrombus with complete obstruction of portal vein trunk, if further hepatic artery embolization chemotherapy is performed, it will cause ischemic necrosis of normal hepatocytes, and the high concentration of chemotherapeutic drug stays in liver for too long, which will easily cause severe drug toxic hepatitis, thus leading to serious liver function damage or even liver failure until the patient dies.
Even the non-filled portal vein cancer thrombus which does not completely block the blood flow can still lead to different degrees of liver damage due to its different degrees of embolization, and the liver damage of a considerable number of patients is also very serious. Therefore, when hepatocellular carcinoma is combined with portal vein carcinoma embolism, hepatic artery embolization chemotherapy should be used quite cautiously. Portal vein cancer embolus is a kind of intravascular cancer embolus that grows by direct infiltration of liver cancer cells into the portal vein. Its biological characteristics are rapid growth and its site is consistent with the primary cancer foci, and once the portal vein is blocked, the disease will deteriorate rapidly. Without special treatment, its average survival is only 2~7 months.
The current treatment methods for portal vein cancer embolism are.
(1) Removal of the embolus during resection of the primary lesion, but it cannot be performed in non-surgical patients;
(2) Interventional chemotherapy, including intra-embolism anhydrous ethanol injection, which has very limited efficacy;
(3) Combined radiotherapy and chemotherapy, which often leads to rapid deterioration of liver function;
(4) percutaneous radiofrequency or laser ablation, which has achieved certain effect, but the long-term efficacy is not satisfactory. Therefore, there is no ideal treatment method for portal vein cancer embolism, and adopting negative methods or giving up treatment often leads to death of patients in a short period of time, which is one of the urgent problems in liver cancer treatment. The high-energy focused ultrasound knife developed in recent years has achieved promising results in the treatment of tumors.
Western medicine focuses on eliminating tumors, while Chinese medicine focuses on modifying tumors and the body. As for liver cancer treatment, TCM is suitable for patients who cannot tolerate surgery/interventional therapy as a palliative treatment to improve the quality of life and prolong survival with tumor; and as an adjuvant treatment for other therapies to promote recovery after treatment, reduce recurrence and metastasis, and prolong survival.
In conclusion, there are many different treatment methods for hepatocellular carcinoma in modern medicine. Patients should choose the treatment method suitable for them according to their conditions to improve the quality of life and prolong the survival period.