In the past three decades, the diagnostic and treatment methods for liver cancer have steadily increased. Various imaging developments have greatly assisted in the early diagnosis of liver cancer, like abdominal ultrasound, CT, MRI, PET-CT, and imaging techniques. The current treatment methods have also developed tremendously, including surgical resection of tumor, liver transplantation, TACE, radiofrequency, microwave therapy, anhydrous alcohol, molecular targeted drug therapy and other treatments.
Although the diagnosis and treatment methods have been greatly improved than before, still, more and more people die from liver cancer every year. So, how to prevent liver cancer and how to diagnose liver cancer? How to treat liver cancer? are our current concerns.
First, let’s understand who are the high-risk group of liver cancer?
(1) Age: Generally people above 35 years old. Survey data shows that in areas with high incidence of liver cancer, the incidence of liver cancer is higher among young adults, while in areas with low incidence of liver cancer, the incidence of liver cancer is higher among people aged 60 years or above. In other words, liver cancer in high incidence areas mostly occurs in young adults, while liver cancer in low incidence areas mostly occurs in middle and old age. The high incidence age of liver cancer in China is between 45-55 years old.
(2) Gender: There are more male liver cancer patients than female in almost all regions, and the ratio of male to female is about 2:1, and the ratio of male to female patients in high incidence areas of liver cancer is higher than 3:1.
(3) HBsAg positivity and history of chronic liver disease for more than 5 years: there is a close and specific causal relationship between hepatitis B virus (HBV) and liver cancer, and HBV is the second known human carcinogen after tobacco. All HBsAg carriers will eventually develop liver cancer if they survive long enough and do not die from other causes. more than 40% of those with persistent infection die in adulthood from liver cancer or cirrhosis.
(4) People with a family history of liver cancer: The results of studies have suggested that patients with certain genetic defects have an increased risk of developing liver cancer. There is family aggregation of liver cancer.
(5) Alcoholics: In many European countries, the United States and Australia, alcohol consumption is an important factor in chronic liver disease, and alcohol consumption is associated with an increased risk of liver cancer.
These are the 5 high-risk groups prone to liver cancer, because there are almost no signs and symptoms in the early stage of liver cancer development, liver cancer may be unpreventable. Liver cancer is an asymptomatic tumor. The clinical signs of primary liver cancer are extremely atypical, and its symptoms are usually not obvious, especially in the early stage of the disease process. Usually, about 70% of small liver cancers under 5cm are asymptomatic, and about 70% of asymptomatic subclinical liver cancers are also small liver cancers. Once symptoms appear, it means that the tumor is already large, and the progression of the disease is usually very rapid, usually presenting malignant quality within a few weeks and often failing and dying within a few months to a year.
The clinical signs are mainly two aspects of the disease.
(i) manifestations of cirrhosis, such as ascites, development of collateral circulation, vomiting of blood and edema of the limbs.
(ii) symptoms produced by the tumor itself, such as weight loss, peripheral weakness, pain in the liver area and enlargement of the liver.
Therefore, for this reason, regular screening should be done for high-risk patients, so what tests are performed? Regular screening is recommended for high-risk patients. monitoring tools for HCC, including abdominal ultrasound and a blood test for alpha-fetoprotein (AFP).
1. AFP, 2. Ultrasound or CT of the abdomen
Alpha-fetoprotein (AFP): AFP is a special protein, glycoprotein, produced by fetal hepatocytes, which is a normal component of fetal serum. Clinically, hepatocellular carcinoma cells are found to synthesize AFP, therefore, AFP is significantly elevated in the serum of patients with primary hepatocellular carcinoma, and recently, radioimmunoassay (RIA) is commonly used to quantitate Recently, radioimmunoassay (RIA) is commonly used to quantify fetoprotein, and the positive rate of liver cancer reaches about 60-70%. Its clinical significance is as follows: elevated fetoprotein is commonly found in.
(1) Primary hepatocellular carcinoma (except hepatic cholangiocarcinoma), the quantitative test is often greater than 500ng/ml. it is most meaningful to pay attention to dynamic changes.
(2) Chronic hepatitis and cirrhosis are mostly below 300ng/ml.
(3) Liver metastasis from other tumors.
(4) Normal pregnancy can be elevated from 12 weeks to 38 weeks, mostly within 40-540ng/ml.
(5) Occasionally elevated after acute blood loss.
(6) Germ gland embryoma.
Normal value of AFP: <;20ng/ml
Testing for AFP must be combined with diagnostic imaging and clinical presentation. For patients with abnormalities in these tests, evaluate with contrast-enhanced CT or MRI to determine if hepatocellular carcinoma has developed.
If the patient has symptoms, the pain is usually on the right side. Sometimes patients have episodes of severe pain, fever, nausea, rapid deterioration of health, weakness, swelling, and the presence of jaundice may also indicate HCC.
Once blood tests show elevated AFP levels or ultrasound of the lesion in the liver, the patient should undergo further evaluation to determine if it is hepatocellular carcinoma and to assess the size and number of tumors. The preoperative evaluation includes the lesion, determination of tumor staging and treatment options, diagnosis and localization.
Diagnostic imaging
It includes abdominal ultrasound, CT, MRI, PET-CT, selective liver angiography, laparoscopy and liver biopsy, etc.
1.Abdominal ultrasound, the most commonly used method for liver cancer diagnosis. There are four types of acoustic images of liver cancer, isoechoic, hypoechoic, hyperechoic and mixed type. For hepatocellular carcinoma of 2-3cm, the detection rate is 80-90%. In recent years, ultrasonography has been used as an effective imaging technique to diagnose liver cancer. It is performed by injecting sulfur hexafluoride microbubbles into the blood vessels to enhance the contrast of the vessels and improve the diagnostic technique.
2. CT of the liver, which has become a routine test for localization and characterization of liver cancer. It may include a four-stage computed tomography (CT) scan, including spiral CT scan in plain scan, hepatic artery and portal vein phase, and delayed phase. Hepatocellular carcinoma appears as hypodense on plain scan, hyperdense areas on arterial enhancement, and hypodense or isointense areas in the portal and delayed phases. If there is intra-portal cancer thrombus, it will be shown as low-density shadow within the fully enhanced vessels in the portal vein stage after enhancement.
3.hepatocellular carcinoma in MRI is manifested as low signal intensity in T1-weighted image, tumor necrosis and hemorrhage in mixed high and low signal. The lesions with more fibrous tissues show obvious low signal.
4.PET is helpful for the diagnosis of hepatocellular carcinoma, especially for whether there are intrahepatic and extrahepatic metastases, but it is expensive and inconvenient to promote, and is occasionally used.
Other laboratory tests and examination indexes are liver function, HBVM/HBVDNA, blood routine, abnormal prothrombin, etc.
How to treat liver cancer after early detection?
How to treat liver cancer, there are several methods as follows.
1.Surgery, 2.Interventional, 3.Radiofrequency ablation or microwave therapy 4.Molecular targeted drug therapy (Sorafenib) 5.Other treatments, deep heat therapy, thermal perfusion therapy, etc.
Surgical treatment
Traditionally, surgery is the preferred treatment for liver cancer, but not all liver cancer patients are suitable for surgery. Only patients with better cardiopulmonary function, more limited liver tumor and no metastatic conditions are suitable for surgery. In addition, most patients with liver cancer in China have a history of hepatitis and cirrhosis, and about 80% of them have been treated for various reasons.
About 80% of patients cannot be operated due to various reasons. There was a patient who was found to have a small liver cancer with a diameter of 3cm, but he was treated with liver cancer surgery ten years ago and is still alive today.
Liver transplantation is also an effective treatment for hepatocellular carcinoma, but only isolated hepatocellular carcinoma less than 5 cm in diameter or three hepatocellular carcinomas less than 3 cm in diameter without vascular invasion can be considered. At present, due to various reasons, only a few people can be treated with liver transplantation.
There are various non-surgical treatment methods for liver cancer, each of which has its own indications, and only the method suitable for the patient is the best one. Only the method that is suitable for the patient is the best one. The suitable treatment method should be selected according to the patient’s physical condition, liver function status, and tumor condition.
Interventional therapy
Interventional therapy is also a commonly used method, which involves entering the hepatic artery through a catheter and injecting chemotherapy drugs, iodine oil and gelatin sponge to destroy tumor cells. What are the limitations of this method? Liver cancer mainly relies on the hepatic artery for blood supply, but the cancer mass is surrounded by portal vein blood supply, so the cancer cells can “live and die”. Even if the operation is carried out smoothly, due to high pressure injection and other reasons, it may cause misembolism, shunt and inevitable micro-metastasis; some patients may have blockage of blood vessels after one treatment, which makes it difficult to operate again.
Disadvantages of interventional therapy.
1. The main blood supply of hepatocellular carcinoma depends on hepatic artery, but there is portal vein blood supply around the cancer mass, so the cancer cells can “live in peace”.
The catheter should be super-selected to enter the blood supplying artery for better treatment, but sometimes it is difficult to enter the hepatic artery. But sometimes it is difficult to enter the hepatic artery, while some hepatocellular carcinoma can be supplied by multiple vessels.
3. Despite the super-selective access, there are still obvious side effects, and the analysis of our hospital data shows that there are most reactions in the digestive tract.
4.People with existing portal vein cancer thrombus must consider or remove the cancer thrombus as appropriate.
5.Even if the operation is carried out smoothly with super selection, it may cause misembolism, shunt and inevitable micro-metastasis due to high pressure injection and other reasons.
6.It may still damage normal liver cells, and a few patients may even suffer from hepatic insufficiency.
7.The efficacy is not satisfactory for those with large cancer masses.
8.Some patients may have blockage of blood vessels after one treatment, making it difficult to operate again.
There are many advantages of liver cancer interventional therapy.
1. The efficacy of interventional treatment is exact. Successful treatment can see rapid decrease of AFP, shrinkage of lump and pain relief, etc.
2. Mechanistic science: the local drug concentration of interventional therapy is tens of times higher than that of systemic chemotherapy, and the blood supply to the tumor is blocked, so the two-pronged treatment is effective and less toxic than systemic chemotherapy.
3. Simple and easy to operate, safe and reliable.
4.It can be performed even for the old and weak and those with certain diseases, without general anesthesia and keeping awake.
5.The cost is relatively low.
6.It can be repeatedly performed, and the diagnostic imaging is clear and easy to compare.
7.For some hepatocellular carcinoma, it can be reduced in size and then resected in two steps.
8.It can be used as one of the important means for comprehensive treatment of advanced tumors.
and tumor. It is suitable for patients with hepatocellular carcinoma less than 5cm in diameter and accompanied by chronic liver disease or poor general condition which is not suitable for surgery.
Molecular targeted drug therapy: Currently, the more recognized one is sorafenib, which is a multi-target drug. The SHARP study in Europe and the ORENTAL study in Asia showed that it does have very good effect for advanced large hepatocellular carcinoma, which can indeed greatly extend the survival time of patients and can prolong the disease-free progression time. However, as far as the actual situation is concerned, it can only be used as an adjuvant treatment.
At present, the deep heat therapy and thermal perfusion therapy that our hospital is now able to perform are also very good adjuvant treatments for liver cancer, which belong to the third category of medical technology of the country.
Today, I have discussed with you the diagnosis and treatment aspects of liver cancer, and I hope to provide you with some help. Thank you, listeners.