How to treat primary liver cancer non-surgically Non-surgical treatment methods for patients with advanced liver cancer

How to treat primary liver cancer non-surgically

Primary liver cancer is one of the most common malignant tumors in my country. According to statistics from the Ministry of Health, about 130,000 people die of liver cancer in my country each year, accounting for 40% of the total number of liver cancer deaths worldwide. Resection of small liver cancers only benefits about 10% of liver cancer patients, and about 90% of patients are already in the middle and late stages when they are diagnosed with liver cancer, and lose the opportunity for surgery. This article focuses on the current status of non-surgical treatment.

It is reported that about 115,000 people die of liver cancer in my country each year, accounting for 47% of the world's liver cancer deaths. The long-term effect of early resection of liver cancer in the subclinical stage can be particularly significant due to the monitoring of high-risk groups by serum alpha-fetoprotein (AFp) detection combined with ultrasound imaging. In addition, active comprehensive treatment has significantly improved the five-year survival rate of liver cancer.

Many people often ask if liver cancer can be cured? After a long period of exploration and practice, experts have made considerable progress in the treatment of liver cancer. Many liver cancer patients have achieved long-term survival after effective treatment. For example, in the Liver Cancer Research Institute of Fudan University alone, as of 2007, there were 1,511 liver cancer patients who survived for more than 5 years after treatment, and 415 who survived for more than 10 years. Some of them returned to work, and some got married and had children. It can be said that they have been cured. Therefore, it can be said that liver cancer can be cured.

At present, there are three traditional treatment methods for liver cancer: radiotherapy, chemotherapy, and surgery. All three methods have some disadvantages: First, the patient is in great pain, and the toxic side effects of radiotherapy and chemotherapy often make the patient miserable; second, the risk is high, and it is difficult to solve the problem of tumor recurrence and metastasis, resulting in 80% of patients dying in the recovery period. Third, tragedies continue, "overtreatment" leads to "cancer disappearance and death", causing the tragedy of "losing both people and money" to countless families. Therefore, traditional treatment methods can no longer effectively cure liver cancer, so are there any other methods to treat cancer patients? In recent years, with the rapid development of biomedical technology, cell immunotherapy has been more and more widely used in the clinical treatment of tumors, and is regarded as the fourth cancer treatment method after surgery, radiotherapy, and chemotherapy. It is also the most effective and newest treatment method for liver cancer.

Biological therapy is an emerging and effective treatment model for liver cancer. It is a new type of autoimmune anti-cancer treatment method. It uses biotechnology and biological agents to culture and amplify immune cells collected from the patient's body in vitro and then return them to the patient's body to stimulate and enhance the body's own immune function, thereby achieving the purpose of treating tumors.

So far, the technology of biological immunotherapy for liver cancer has matured internationally. Clinical trials of biological immunotherapy for liver cancer have shown that biological immunotherapy can effectively inhibit and kill tumor cells without adverse side effects. It plays an important role in clearing residual tiny metastatic lesions, preventing the spread and recurrence of cancer cells, and improving the patient's own immunity for tumor patients after surgery. The killing activity of liver cancer, kidney cancer, breast cancer, gastric cancer, colorectal cancer, ovarian cancer and other cancer cells is as high as 60%-90%. In addition, this therapy has no obvious toxic and side effects and risks.

Non-surgical treatment for patients with advanced liver cancer

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. According to relevant data, there are 626,000 new cases of liver cancer worldwide each year, of which about 55% are Chinese patients. At the same time, Chinese liver cancer patients also show the following characteristics: there are significantly more males than females, and most liver cancer patients are already in the middle or late stages when the disease is discovered, missing the best time for surgical treatment.

Introduction of the keynote speaker:

Expertise: Interventional treatment of hepatobiliary diseases. Employed as a reviewer for the Journal of Clinical Radiology and a lecturer for the Science Popularization Lecturer Group of the Guangdong Science Popularization Volunteer Association. Participated in the compilation of "Abdominal Surgery Imaging Diagnosis and Interventional Treatment", "Interventional Radiology Theory and Practice", and "Interventional Radiology" (Science Edition Textbook). In April 2009, he was invited to participate in the academic exchange project on new progress in the treatment of advanced liver cancer held in Italy. He has a comprehensive grasp of the new progress in the treatment and clinical research of liver cancer in the world.

Clinic hours: Monday afternoon 2:30-5:00

Consultation email:[email protected]

Treating liver cancer: our joys and worries

It is an indisputable fact that China is a country with a high incidence of hepatitis B. Although there is no necessary connection between hepatitis B and liver cancer, the pathogenic factors of liver cancer are more extensive, including hepatitis B, hepatitis C, alcohol, metabolic disorders, etc., but the pathogenic factor of most liver cancer patients in my country is hepatitis B.

According to the data from foreign peers, in the distribution of liver cancer incidence in the world, the number of Chinese liver cancer patients accounts for "half of the world's liver cancer patients". Therefore, there is such a "courtesy" - Western peers welcome Chinese doctors at seminars on liver cancer, because they believe that Chinese doctors have rich experience in liver cancer treatment and hope that Chinese doctors can share their clinical experience and understanding of liver cancer treatment.

Just as foreign counterparts expect, my country has abundant liver cancer case resources and rich experience in treatment. In fact, in recent years, Chinese doctors have made great efforts in the clinical diagnosis and treatment of liver cancer and have made gratifying progress. For example, the precise resection technology of liver cancer has been recognized and admired by foreign counterparts. For example, cryoablation and Hematoxylin and eosinophil surgery in the treatment of liver cancer were also first proposed in the world... All these show that Chinese doctors are not bad in the technical level of liver cancer treatment.

The high level of medical care and advanced medical equipment are the gratifying aspects of China's treatment of liver cancer. However, there are also worrying aspects: first, patients have misconceptions, and second, the configuration of doctors and patients' medical treatment channels are flawed, which delays patients' timely and effective treatment.

Treatment of advanced liver cancer ≠ hospice care

"Cancer" directly brings up fear

"Mid- to late-stage liver cancer" makes people think of death more directly.

Given the characteristics of liver cancer patients in my country—cancer is often discovered in the middle or late stages—many patients and their families have a misunderstanding: since it cannot be removed, it means there is no cure, and no matter how it is treated, it is just hospice care.

There are two reasons for this misconception.

First: Misunderstanding caused by lack of understanding of the staging principles of liver cancer.

At present, there is no unified staging and treatment standard for liver cancer treatment worldwide, and various staging systems and guidelines of various associations have limitations.

The guidelines of the National Comprehensive Cancer Network (NCCN) of the United States use the TNM staging system, the guidelines of the American Association for the Study of Liver Diseases (AASLD) use the BCLC staging system, the guidelines of the British Society of Gastroenterology (BSG) emphasize the diagnosis of patients with cirrhosis and hepatitis, and the consensus formulated by the American College of Surgeons (ACS) points out the treatment goals of liver cancer.

my country has not had its own liver cancer diagnosis and treatment standards or guidelines until 2009, when liver cancer experts in my country, referring to existing liver cancer diagnosis and treatment consensus and the latest foreign liver cancer treatment guidelines, developed the "Expert Consensus on Standardized Diagnosis and Treatment of Primary Liver Cancer" in line with my country's national conditions.

According to the Barcelona staging system, which is popular abroad, liver cancer can be divided into five stages, characterized by the number of nodules and tumor size: very early, early, middle, late and terminal stages. The corresponding survival rates are: 40%-70% for curative treatment (surgical resection, liver transplantation, local ablation therapy), 30%-40% for palliative treatment of middle and late stage liver cancer. For terminal liver cancer, the survival period is traditionally believed to be less than 3 months. With the emergence of new drugs (targeted drugs), the survival period has been significantly extended, and these have been proven by a large number of clinical controlled studies.

Therefore, different treatment plans should be selected for liver cancer of different stages, and the correct treatment choice may achieve the best treatment effect.

Second: Misunderstanding caused by lack of understanding of the treatment methods of liver cancer.

As surgeons' surgical skills continue to improve, cancer patients are increasingly advocating surgical treatment for cancer, believing that as long as the lesions are removed through surgery, the tumor can be eradicated completely, and that only by removing the lesions through surgery can treatment be expected.

Because of this, patients with advanced liver cancer are often desperate because their tumors no longer meet the indications for surgery, which means that they cannot undergo surgery. For this reason, they are frustrated that "there is no way to treat my liver cancer."

In fact, in addition to surgical treatment, the following treatment methods have been proven to have definite efficacy for advanced liver cancer through a large number of clinical studies:

1. Local treatment: radiofrequency ablation (RFA) + alcohol injection (pEI) treatment;

2. Treatment based on transarterial chemoembolization (TACE): can be combined with the above-mentioned local treatment;

3. Local radiotherapy and other adjuvant treatments;

Therefore, "middle and late stage liver cancer" does not mean "death sentence", and the treatment of "middle and late stage liver cancer" does not mean "hospice care". It is very necessary for patients with middle and late stage liver cancer to seek scientific treatment with a positive attitude and strictly follow the treatment rules.

Immunity, the light of hope for liver cancer patients

I believe most people will have a question: "Why when talking about the treatment effect of cancer, doctors do not say 'successful cure', but say what is the '5-year survival rate'?" Before answering this question, let's first look at a set of data -

Cold – 3 days

Pneumonia – 14 days

Tuberculosis – 1-2 years

Tumors – 5-7 years

This is a set of time required for the human body's immunity to return to normal and function under different disease conditions, and it is also the time required for general diseases to improve. Therefore, this also explains why the "5-year survival rate" is often used as an important indicator for evaluating the effectiveness of cancer treatment. In a sense, the key to treating any disease is to suppress and remove the pathogenic factors and restore the body's effective immunity to the disease. This also applies to liver cancer patients.

Taking surgical treatment of liver cancer as an example, relevant studies have shown that cellular immunosuppression is significantly aggravated one week after surgery, which is due to surgical trauma, fluid imbalance, tumor suppressor factors that have not yet been eliminated, and reduced complement synthesis. The literature generally agrees that immune function begins to recover one week after surgery, recovers fastest after two weeks, and returns to normal after four weeks; there are also studies showing that the immunity of patients with advanced liver cancer begins to recover two months after surgery, while some patients continue to be low. The length of this period (immunity recovery time) is significantly related to the metastasis and recurrence rate of residual tumors. Therefore, radical cure of liver cancer is relative. Surgery will inevitably leave a certain amount of tumor cells. If the body's immune function is normal, the residual cancer can be completely killed. Otherwise, it may recur.

Taking non-surgical treatment of liver cancer as an example, especially for patients with advanced liver cancer, it should be recognized that "non-radical surgery does not mean condoning the growth of tumors". Tumors can be regarded as a special chronic disease. In a sense, it is not more difficult to treat than chronic diseases such as hypertension and diabetes. The biggest problem of tumors is that they erode normal organs and cause functional failure of normal organs. Therefore, treating tumors is to remove tumors, curb tumors, and protect the functions of damaged organs. For patients with advanced liver cancer who cannot undergo radical surgery, palliative treatment is also an effective treatment method. The purpose of palliative treatment is to inhibit the growth of tumors, reduce the number of tumors, reduce them to a certain extent, and carry out immune support treatment to increase immunity, and finally achieve the purpose of curbing tumor recurrence. This process is a long process, and we must have the confidence to win this "protracted war". This is what we usually say "living with tumors".

How can patients with advanced liver cancer increase their immunity?

First: Active and appropriate treatment to control the growth of tumors, because tumors themselves are the greatest damage to immunity;

Second: protect immunity. Excessive chemotherapy is harmful to the body's normal immunity. Current clinical research results do not support chemotherapy after surgery for liver cancer patients, and chemotherapy for non-surgical patients is limited to some specific patients.

Third: drug combination. For cancer patients, the main thing is to improve cellular immunity. They can take relevant drugs that enhance cellular immunity under the guidance of a doctor. Currently, for liver cancer, the application of tumor-targeted drugs has also significantly improved the treatment effect.

Fourth: Chinese medicine conditioning, such as Ganoderma lucidum spores, ginseng, cordyceps and other Chinese patent medicines, have been verified by relevant clinical studies and have a certain effect on supporting the body's immunity and improving the quality of life of patients. However, it is not recommended for patients to choose some Chinese herbal remedies, because more and more studies have found that some herbal ingredients have a significant damaging effect on liver function.

Experts answer questions on site

Dr. Huang Yonghui: For patients with advanced liver cancer, their appetite is often the most important thing. This is because changes in appetite are closely related to liver function and the body's overall immune status. During outpatient consultations, doctors will ask patients about their recent appetite and food intake. If the patient's food intake is normal, we think the patient is in good condition and have greater hope. If the patient's food intake is poor and nutrients are not absorbed, the patient's immunity will also decline and the physical condition will become worse.

Dr. Huang Yonghui: It is inevitable to quit smoking and drinking. For patients with poor liver function, salt intake needs to be appropriately limited. In addition, special attention should be paid to not taking Chinese medicine that damages the liver. For example, people often think that mint is "cool", and poor liver function is always thought to be caused by "liver fire", but they don't know that mint is actually harmful to the liver, and people with liver disease should not take it.

Dr. Huang Yonghui: During the treatment of tumors, we emphasize the need to control the side effects caused by the treatment process, and fully consider how to protect related organs before treatment. For example, when using anthraquinone drugs, we use another drug to protect the myocardium in advance, so that the anthraquinone drugs will not affect the myocardium as much as possible, thereby protecting the myocardium; once bone marrow transplantation is found, we immediately use drugs to improve the hematopoietic function of bone marrow stem cells; for vomiting that may be caused by chemotherapy, there are many good antiemetic drugs now, and we let patients take these drugs in advance, so that the vomiting caused by chemotherapy is significantly reduced.

For patients with advanced liver cancer, non-surgical treatment does not cause major changes in their lives. For example, if patients with advanced liver cancer receive local treatment or transarterial embolization, the pain they endure during interventional treatment is very short, only one or two days, and the patient's quality of life is basically guaranteed after that, with no special impact.

Dr. Huang Yonghui: First, we must correctly understand the staging of liver cancer. Do not think that if you are in the middle or late stage of liver cancer, it is the terminal stage. You must have the confidence to accept treatment. Secondly, non-surgical treatment does not mean that it cannot be cured. Curative treatment is only defined in the short term, while non-surgical treatment is a long-term treatment process, which can also achieve the purpose of cure. Thirdly, patients must find the right way to seek medical treatment and do not blindly believe in medical advertisements that have no clinical basis.

Regarding the treatment of patients with advanced liver cancer, I personally feel very confident. From clinical practice, we can see that for patients without major vascular invasion and with relatively good liver function, the one-year survival rate of minimally invasive interventional treatment is over 40%, and the five-year survival rate is also around 30%, which is close to the effect of surgery for early liver cancer treatment.