Early liver cancer can be treated by liver transplantation, which can provide a cure opportunity; Secondly, choose tumor resection.
At present, there are many clinical methods to treat liver cancer, with different indications and different effects, which are briefly introduced as follows:
1. Hepatectomy for liver cancer: In the past, present and a long time to come, hepatectomy is the most important treatment besides liver transplantation. As long as the patient's general situation allows (the heart, lungs, kidneys and other organs are functioning well), liver cancer is confined to a leaf or a segment of the liver, and it is estimated that the remaining liver function after resection is enough to maintain the patient's life, radical resection can be carried out. The hardened liver still exists after resection, and the recurrence rate of liver cancer is high. The progressive development of liver cirrhosis may lead to decompensation of liver function and complications of portal hypertension (upper gastrointestinal bleeding, hepatic encephalopathy, intractable ascites, etc.). ) and endanger the lives of patients.
2. Liver transplantation: Liver transplantation is the only way to cure liver cancer at present, and it also solves three problems, (1) liver cancer; (2) liver cirrhosis; (3) Patients with chronic hepatitis B can return to normal life and have a high quality of life after liver transplantation, but the cost of liver transplantation is high, and long-term use of immunosuppressants after operation is its disadvantage. Indications: The focus of liver cancer is confined to the liver, and there is no distant organ metastasis. The function of other organs in the whole body can tolerate surgery.
3. Interventional therapy: including hepatic arterial chemotherapy, hepatic arterial embolization and chemoembolization. It is not enough to give HAI alone. Chemoembolization (TACE) is the most important interventional therapy at present. Indications: (1) patients with advanced primary liver cancer who cannot be surgically removed; (2) Patients who can be surgically removed, but are unable or unwilling to operate for other reasons (such as old age and severe liver cirrhosis). For these patients, radiation interventional therapy can be the first choice for non-surgical treatment.
4. Ablation therapy: refers to a treatment method that directly kills tumors locally under the guidance of imaging technology. At present, the most commonly used are radiofrequency and microwave ablation and anhydrous alcohol injection. Indications: For patients with early liver cancer whose diameter is less than or equal to ≤5 cm or whose maximum diameter is less than 3 multiple nodules, and whose liver function is Child-Pugh A or B, and there is no invasion of blood vessels or bile ducts or distant metastasis, radiofrequency or microwave ablation is the best choice besides surgery.
5. Radiotherapy: Radiotherapy is one of the basic methods to treat malignant tumors, but before the 1990s, patients with primary liver cancer rarely received radiotherapy because of its poor effect and great damage to the liver. Since the mid-1990s, modern radiotherapy technologies such as three-dimensional conformal radiotherapy and intensity modulated radiotherapy have gradually matured, providing new opportunities for the application of radiotherapy in the treatment of liver cancer. Indications of radiotherapy for liver cancer: ① The tumor is limited and cannot be surgically removed due to poor liver function, or the tumor is located in an important anatomical structure, which is technically impossible to be removed, or surgery is refused. ② Patients with residual lesions after operation. ③ It is necessary to treat local liver tumors, otherwise there will be some complications, such as hilar bile duct obstruction, portal vein and hepatic vein tumor thrombus. Patients with hilar bile duct obstruction can be drained to relieve jaundice before radiotherapy. ④ For the treatment of distant metastasis, such as lymph node metastasis, adrenal metastasis and bone metastasis, radiotherapy can relieve the symptoms of patients and improve their quality of life.
6. Biotherapy and molecular targeted therapy: At present, most biotherapy methods or technologies are still in the stage of research and development and clinical trials, and a few have been applied to clinic. In recent years, the treatment of liver cancer with molecular targeted drugs has become a new research hotspot and received great attention. It mainly includes: ① anti-EGFR drugs, such as erlotinib and cetuximab; ② Antiangiogenic drugs, such as bevacizumab and BuRivani; ③ Signal transduction pathway inhibitors, such as mTOR inhibitor everolimus (RAD 001); ④ Multi-target inhibitors, such as sorafenib and sunitinib.
7. Chinese medicine treatment: At present, Chinese medicine can be used as an auxiliary treatment for liver cancer, which helps to reduce the toxicity of radiotherapy and chemotherapy, improve cancer-related symptoms, improve the quality of life, and may prolong the survival period.
8. Systematic chemotherapy for primary liver cancer: As early as 1950s, systematic chemotherapy was used to treat primary liver cancer. Most traditional chemotherapy drugs, including adriamycin (ADM), 5- fluorouracil (5-Fu), cisplatin (PDD) and mitomycin (MMC), have been tried to treat liver cancer, but the effective rate of single drug is relatively low (generally
There are many treatments for primary liver cancer, but doctors should choose specific treatment or comprehensive treatment according to the specific condition to improve the quality of life and prolong life.