What is the standard of liver cancer cure?

Early clinical treatment is the most important factor to improve the prognosis of liver cancer. Early liver cancer should be surgically removed as far as possible. Multi-mode comprehensive treatment can also be used for unresectable large liver cancer. (1) Surgical resection is still the first choice for the treatment of liver cancer. Early resection is the key to improve the survival rate. The smaller the tumor, the higher the five-year survival rate. The indications for operation are: ① the diagnosis is clear, and it is estimated that the lesion is limited to one lobe or half liver; ② No obvious jaundice, ascites or distant metastasis; ③ The liver function compensation is good, and the thrombin time is not less than 5%; ④ Patients with heart, liver and renal function tolerance. In patients with normal liver function, the amount of hepatectomy does not exceed 7%; Moderate cirrhosis does not exceed 5%, or only left hemihepatectomy can be performed; Hepatic lobectomy cannot be performed in patients with severe liver cirrhosis. Surgery and pathology proved that more than 8% of liver cancer complicated with cirrhosis, and it was recognized that local resection instead of regular lobectomy had the same effect for no time, while postoperative liver dysfunction was alleviated and the operative mortality was also reduced. Because there is still a high recurrence rate after radical resection, AFP and ultrasound should be reviewed regularly after operation to monitor the recurrence. Because of the close follow-up after radical resection, small hepatocellular carcinoma with subclinical recurrence is often detected, and reoperation is the first choice, and the five-year survival rate after the second operation can still reach 38.7%. Although liver transplantation is a method to treat liver cancer, there are many reports abroad, but its position in treating liver cancer has not been confirmed for a long time. Patients often die of recurrence after long-term use of immunosuppressants after operation. For developing countries, it is still difficult to popularize in recent years because of the source and cost of donors. (2) Palliative surgical treatment is suitable for large tumors or those scattered in or near large blood vessels, or those complicated with liver cirrhosis and unable to be resected. The methods include hepatic artery ligation and/or hepatic artery intubation chemotherapy, freezing, laser therapy, microwave therapy, intraoperative hepatic artery embolization or ethanol injection, etc. Sometimes, the tumor can be shrunk and serum AFP can be reduced, providing opportunities for two-step resection. (3) Multi-mode comprehensive treatment is an active and effective treatment method for medium-term large liver cancer in recent years, sometimes turning unresectable large liver cancer into resectable small liver cancer. There are many methods, generally based on the combination of hepatic artery ligation and hepatic artery intubation chemotherapy, plus external radiotherapy as triple, such as combined immunotherapy as quadruple. The triple effect is the best. After multi-mode comprehensive treatment, the tumor shrinkage rate reached 31%. Because of the obvious tumor shrinkage, two-step resection was obtained, and the two-step resection rate reached 38.1%. The Institute of Hepatocellular Carcinoma of Shanghai Medical University has also studied hyperfractionated radiotherapy and targeted therapy. The combined therapy of hyperfractionated external radiotherapy and hepatic artery catheterization chemotherapy is: cisplatin (CDDP) 2mg per day for three consecutive days in the first week. In the second week, 2.5Gy(25rads) of local external radiation was given to the liver tumor area in the morning and afternoon for 3 consecutive days. Two weeks is a course of treatment, so three to four courses of treatment can be repeated alternately every other week. Directional therapy: 131I- anti-hepatocarcinoma ferritin antibody or anti-hepatocarcinoma monoclonal antibody or 131I-lipiodol was injected into hepatic artery catheter once every 1 ~ 2 months, and intra-arterial internalization of CDDP 2mg once a day for 3 ~ 5 days. It is better if the above treatment is combined with immunotherapy such as interferon, lentinan and interleukin -2. (4) Hepatic arterial chemoembolization (TAE) This is a non-surgical tumor treatment method developed in the 198s, which has a good effect on liver cancer and is even recommended as the first choice among non-surgical treatments. Lipiodol mixed therapy drugs, 131I or 125I-lipiodol, or 9Yttrium microspheres are often used to embolize the blood supply at the distal end of the tumor, and then gelatin sponge is used to embolize the hepatic artery at the proximal end of the tumor, which makes it difficult to establish collateral circulation and leads to ischemia and necrosis of the tumor focus. CDDP8～ ~ (2+) is commonly used as a chemotherapy drug, and 1mg5Fu 1mg Mitomycin 1 mg [or 4 ~ 6 mg Adriamycin (ADM)] is added, which is infused into the artery first, and then mixed with Mitomycin (MMC)1mg to embolize the distal hepatic artery. Hepatic artery embolization chemotherapy should be repeated for many times, and the effect is good. According to the data of radiology department of our hospital, the one-year survival rate of 345 patients with large liver cancer that can not be surgically removed was only 11.1%, and the one-year survival rate increased to 65.2% with hepatic artery embolization. The longest follow-up survival rate was 52 months, and 3 patients were given the opportunity of surgical resection. This method is taboo for patients with severe decompensation of liver function, and it is not suitable for patients with tumor thrombus in portal vein. (5) Intratumoral injection of anhydrous alcohol Ultrasound-guided percutaneous transhepatic injection of anhydrous alcohol into the tumor to treat liver cancer. Liver cancer with liver cirrhosis and inoperable tumor diameter ≤3cm and nodule number ≤ 3 is the first choice. It is possible to cure small liver cancer. The effect of ≥5cm is poor. (VI) Radiotherapy Due to the progress of radioactive sources, radiation equipment and technology, and the accurate positioning of various imaging examinations, the status of radiotherapy in the treatment of liver cancer has improved, and the curative effect has also improved. Radiotherapy is suitable for unresectable liver cancer whose tumor is still limited. Usually, if it can tolerate a large dose, its curative effect is also good. External radiotherapy has experienced whole liver radiation, local radiation, whole liver moving strip radiation, local hyperfractionation radiation, and the total amount of stereoscopic radiation exceeds nearly useful protons as radiotherapy for liver cancer. It has been reported that the one-year survival rate and the five-year survival rate are 72.7% and 1% when the total radiation exceeds 4Gy(4rads volume) combined with Chinese herbs for regulating qi and strengthening spleen. Combined with surgery and chemotherapy, it can kill residual cancer, and chemotherapy can also assist radiotherapy to enhance sensitivity. Intrahepatic arterial injection of Y-9 microspheres, 131I- iodized oil, or isotopically labeled monoclonal antibodies can play a role in internal radiotherapy. (VII) Targeted therapy It is one of the promising therapies to use specific antibodies and monoclonal antibodies or tumor-friendly chemicals as carriers, label nuclides or cross-link with chemotherapy drugs or immunotoxins for specific targeted therapy. The antibodies used in clinic include anti-human hepatoma protein antibody, anti-human hepatoma monoclonal antibody and anti-alpha-fetoprotein monoclonal antibody. In addition to 131I125I, 9Y has been tried for the "warhead", and cross-linked human monoclonal antibodies or genetically engineered antibodies of toxic proteins and chemotherapeutic drugs and antibodies are under study. (8) CDD[P] is the first choice for chemotherapy for liver cancer, and commonly used drugs are 5Fu, ADM and its derivatives, mitomycin, VP16 and methotrexate. It is generally believed that the curative effect of single drug intravenous administration is poor. Hepatic artery administration and/or embolization, as well as internal and external radiotherapy are widely used, and the effect is obvious. Combined or sequential chemotherapy can be used for some patients with advanced liver cancer who have no surgical indications and whose portal vein tumor thrombus is blocked, and some patients after palliative surgery. The commonly used combined regimen is cisplatin 2 mg+5 Fu 75 mg ~ 1 mg intravenous drip ***5 days, once a month, 3 ~ 4 times as a course of treatment. Adriamycin 4 ~ 6 mg on the first day, followed by intravenous infusion of 5 Fu 5 mg ~ 75 mg for 5 days, once a month for 3 ~ 4 times as a course of treatment, the above schemes have different effects. (9) biotherapy biotherapy not only plays the role of cooperating with surgery, chemotherapy and radiotherapy to alleviate the suppression of immunity and eliminate residual tumor cells. In recent years, due to the development of gene recombination technology, it is possible to obtain a large number of immune active factors or cytokines. The application of recombinant lymphatic factor, cytokines and other biological response regulators (BRM) in tumor biotherapy has aroused widespread concern in the medical field, and it has been considered as the fourth anti-tumor therapy. At present, interferon α and interferon γ have been widely used in clinical treatment, and natural and recombinant IL-2 and TNF have come out. In addition, the killer cells activated by lymphokines -LAK cells, tumor infiltrating lymphocytes (TIL) and so on have begun to be tried. The efficacy of various biotherapeutics still needs more practice and summary. Gene therapy provides a new prospect for biological therapy of liver cancer. (1) Traditional Chinese medicine Fuzheng anticancer is suitable for patients with advanced liver cancer and those whose liver function is seriously decompensated and can't tolerate other treatments. It can improve the general condition of the body and prolong life, and can also cooperate with surgery, radiotherapy and chemotherapy to reduce adverse reactions and improve the curative effect. To sum up, early liver cancer should be surgically removed sooner or later, and hepatic artery embolization chemotherapy is the first choice for those who cannot be removed. Intratumoral injection of anhydrous alcohol is suitable for small hepatocellular carcinoma with poor liver function and unsuitable for operation, which may have a radical effect. In the middle stage, large hepatocellular carcinoma should be treated by multi-mode therapy with hepatic artery intubation and ligation or hepatic artery embolization chemotherapy to kill tumor cells and reduce tumor load, and strive for two-step or sequential surgical resection after the tumor shrinks. Comprehensive treatment of advanced liver cancer with Chinese herbal medicine is expected to improve symptoms and prolong survival.