Staging and treatment of liver cancer

Liver cancer staging.

There are two types of liver cancer staging, including pathological staging and clinical staging. Clinically, clinical staging is commonly used. Clinical staging: Those without symptoms or signs of liver cancer are classified as stage 1; those with jaundice, ascites, extrahepatic metastasis, or cachexia are classified as stage 3; and those in between are classified as stage 2. Most stage 1 liver cancer cases are discovered through screening, and more than 70% of these tumors have a diameter of less than 5 cm (small hepatocellular carcinoma). After active treatment, the overall 5-year survival rate exceeds 50%.

Staging and treatment of liver cancer
Staging and treatment of liver cancer

Treatment of liver cancer

Treatment principles of liver cancer: “early treatment”, “comprehensive”, and “active”. The smaller the tumor, the better the efficacy after radical surgical resection. Rationally and plannedly using a variety of methods together can significantly improve the efficacy. It has been proven that secondary treatments for recurrent and metastatic liver cancer, such as interventional therapy via the hepatic artery (such as infusion of chemotherapy drugs into the hepatic artery), multiple treatments with ethanol injection, microwave solidification, and focused ultrasound therapy, can further improve the efficacy.

With the improvement of the diagnosis and treatment level of liver cancer, the 5-year survival rate in China has increased from zero in the 1950s and 1960s to 72% for subclinical and small hepatocellular carcinoma (tumor diameter less than 5 cm) after surgical treatment in the 1980s, and 20% for large hepatocellular carcinoma after surgical treatment. Among the clinical patients with hepatocellular carcinoma, only a few can undergo surgical resection, and most patients still depend on various non-surgical resection treatment methods. The determination of the treatment plan for liver cancer depends on the size of the tumor, stage, liver function, and overall condition of the patient.

First, Surgical treatment

For early and middle-stage liver cancer, surgery is the preferred treatment. Common surgical procedures include:

  1. Regular liver resection: Suitable for tumors located in a specific liver lobe.
  2. Liver segment resection: Suitable for tumors located in a specific liver segment.
  3. Local liver resection: Suitable for tumors with small size and limited to the liver.

The following situations are generally not considered suitable for surgical treatment:

  1. Poor general condition, unable to tolerate surgery.
  2. Tumor invasion of the first and second liver gates.
  3. Obvious jaundice, ascites, and lower extremity edema.
  4. Inferior vena cava tumor thrombus, advanced liver cancer with distant metastasis.
  5. Severe liver function abnormalities, low albumin, and significantly abnormal coagulation time.

In 2009, the Chinese Academy of Medical Sciences reported that their hospital had adopted a series of new technologies to make liver cancer surgery resection without any forbidden area.

For liver cancer that cannot be surgically resected, the following treatments can be adopted according to the specific situation:

  1. Hepatic artery ligation or hepatic artery embolization: Inhibit tumor growth by cutting off the blood supply to the tumor.
  2. Chemical drug infusion: Kill tumor cells directly by giving anticancer drugs.
  3. Ablation therapies: Including radiofrequency ablation, focused ultrasound, argon-helium knife, etc., destroy tumor tissue through local high temperature, low temperature, or mechanical cutting.

Part of the patients can achieve secondary resection after the tumor volume shrinks. In the treatment process, individualized treatment should be adopted according to the specific situation of the patients to achieve the best efficacy.

Second, Radiotherapy

Primary liver cancer is sensitive to radiotherapy, but a better local control can be achieved only when the radiation dose reaches 4000 cGy (radiation dose unit) or more. Patients who come to the hospital for treatment have tumors that have grown to a considerable extent or have spread throughout the liver. During radiotherapy, large-scale or whole-liver irradiation is required, which severely limits the total dose of radiotherapy and directly affects the efficacy of radiotherapy. Because when the whole liver is irradiated, if the dose exceeds 3000-3500 cGy, radioactive hepatitis may occur in 3-4 weeks. If chemotherapy is used before or during radiotherapy, the tolerance for whole-liver irradiation decreases to about 2500 cGy.

Indications for radiotherapy:

  • Curative radiotherapy. Patients with a good overall condition, normal liver function, limited tumor lesions, and a radiation area of less than 100cm2 can undergo curative radiotherapy. Patients with early-stage liver cancer who are not suitable for surgical resection due to tumor location at the portal region, diaphragmatic surface, or between the two lobes can also undergo curative radiotherapy.
  • Palliative radiotherapy. Patients with larger tumors that have spread throughout the liver but have no distant metastases can undergo palliative radiotherapy as long as their general condition is good, without jaundice, ascites, and severe liver function damage.

Third, Chemical Therapy

The overall effectiveness of systemic chemotherapy for primary liver cancer is poor. In recent years, the use of hepatic artery catheterization and infusion chemotherapy has significantly improved the outcome. Commonly used drugs include epirubicin (EADM), mitomycin (MMC), 5-fluorouracil (5-FU), and calcium folinate (CF). The Chinese Academy of Medical Sciences summarized the efficacy of 132 cases of hepatic artery infusion chemotherapy and embolization from 1993 to 1997: 1-year, 2-year, and 3-year survival rates were 81.8%, 36.4%, and 18.2%, respectively; the survival rate of more than 6 months was 97.7%, with the longest survival of 10 years.

In 2007, a study was reported at the American Society of Clinical Oncology conference, which found that the application of sorafenib could significantly delay the time of tumor development in advanced liver cancer, and the overall survival of 44% of patients was improved.

Fourth, Other Therapeutic Methods

There are various other therapeutic methods for primary liver cancer, including anhydrous alcohol injection therapy, cryotherapy, microwave coagulation therapy, gene therapy, laser therapy, radiofrequency therapy, high-intensity focused ultrasound, and electrochemical therapy. Each method has its indications and can be used as one of the means of comprehensive treatment or adjuvant therapy. It is essential to choose the appropriate method based on the patient’s condition and disease stage.

Rehabilitation of Patients with Liver Cancer

To support the rehabilitation of liver cancer patients, consider the following tips:

  1. Maintain a positive attitude: Keep an open heart and try to maintain emotional stability, avoiding unnecessary anger.
  2. Family support: Family members should show concern and care for the patient in many aspects, providing more companionship and assistance.
  3. Nutritious diet: Prepare light, digestible, and nutrient-rich foods for the patient.
  4. Communicate with healthcare professionals: If the patient experiences any discomfort or pain, consult with healthcare professionals for appropriate treatment, aiming to alleviate pain rather than let the patient suffer.
  5. Engage in physical activities: Under the guidance of healthcare professionals, patients should participate in appropriate physical activities and social events to promote physical and mental recovery.

Remember that individual circumstances vary, and it’s essential to consult a healthcare professional before implementing any new treatment or activity. The main goal is to support the patient’s overall well-being and facilitate a smooth recovery process.

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