Liver cancer is a common worldwide cancer due to risk factors such as chronic hepatitis B and hepatitis C and aflatoxin exposure. Symptoms may include jaundice, upper abdominal pain, right scapula and weight loss. Doctors diagnose the condition using a combination of imaging tests and blood tests. Depending on the size of the tumor, liver cancer treatment options may include tumor removal, liver transplantation, targeted therapy, chemotherapy and sometimes radiation therapy.
When a tumor is found at an early stage and the patient’s liver is functioning properly, the treatment aims to try to eliminate the cancer. A care plan may also include treatment of symptoms and side effects, an important part of cancer care. When liver cancer is detected at a later stage or the patient’s liver is not working properly, patients and doctors should talk about the goals of each treatment recommendation. At this time, treatment goals may focus on slowing the growth of cancer and reducing symptoms to improve quality of life.
Overview of treatment for liver cancer
Different treatment options can be grouped according to whether they can cure cancer or improve survival, but may not eliminate the cancer.
Treatment options and recommendations depend on a number of factors:
- How much liver is affected by cancer
- Has the cancer spread?
- Interests and overall health of the patient
- Lesions in non-cancerous areas of the liver
Descriptions of the most common treatment options, both by disease direction and towards the management of side effects and symptoms, are listed below. Talk to your doctor about the goals of each treatment and what you can expect while receiving treatment.
Treatment is in the direction of elimination and is likely to cure HCC
These treatments are usually recommended when tumors have been found at an early stage. They may not be recommended to treat patients at later stages of the disease. These treatments include surgery, radiofrequency ablation, ethanol injection through the skin and radiation therapy.
Surgery is to remove the tumor and some healthy surrounding tissue during a surgery. It is likely to be the most successful treatment of the disease, especially for patients with good liver function and tumors that can be safely removed from a limited part of the liver. Surgery may not be an option if the tumor takes too much of the liver, the liver is damaged too much, the tumor has spread outside the liver or the patient has other serious illnesses.
Before surgery, talk to your doctor about possible side effects from surgery you may have.
Two types of surgery are used to treat HCC HCC :
Cut the liver
- When a part of the liver is removed, surgery is called a liver resection. Liver resection can only be done if the cancer is part of the liver and the liver is working properly. The remaining liver takes care of the functions of the entire liver. The liver can grow back to normal size within a few weeks.
- Liver resection may not be possible if the patient has advanced cirrhosis, even if the tumor is small.
- Side effects of liver surgery may include pain, weakness, fatigue, and temporary liver failure. The health care team will watch for signs of bleeding, infection, liver failure or other problems that require immediate treatment.
- Sometimes, a liver transplant can be performed. This procedure is only possible when the cancer has not spread outside the liver, an appropriate donor is found and very specific criteria are met for tumor size and number. These criteria are usually a single tumor of 5 cm or less or 3 or fewer tumors, all less than 3 cm. It is important to understand that the number of available liver donors is very limited, so transplantation is not always an option.
- After the transplant, the patient will be closely monitored for signs that the body may be rejecting the new liver or the tumor has returned. Patients must take medication to prevent rejection. These medications can cause side effects, such as puffiness, high blood pressure or increased body hair. Liver transplantation is at risk of serious complications, including death from infection or rejection of a donor liver.
- Liver transplantation is a particularly effective treatment for people with small tumors because the transplant removes the tumor and the damaged liver. However, very few donors and those awaiting a liver transplant may have to wait long before the liver is available. During this time, the disease may get worse. The transplant center will advise you on how long the waiting period may be and what rules are used to prioritize people on the waiting list.
Radiofrequency ablation (RFA)
- RFA and microwave therapy both use heat to kill cancer cells. They can be transmitted through the skin, through endoscopy or during surgery while the patient is sedated.
- A sedative is a medication that makes the medicine more relaxing, calm or sleepy. This treatment is also known as heat removal.
Administer ethanol through the skin
- Percutaneous ethanol injection is when ethyl alcohol is injected directly into the liver tumor to destroy it. Side effects include fever and pain after the procedure. In general, the procedure is simple, safe and particularly effective for a tumor smaller than 3 cm.
- However, if ethyl alcohol escapes from the liver, a person may have short but severe pain. This option is rarely used and has been largely replaced by RFA.
Radiation therapy uses high-energy X-rays or other particles to kill cancer cells. A doctor who specializes in radiation therapy to treat cancer is called a cancer specialist.
- Stereoscopic body radiotherapy (SBRT): SBRT is a term that describes a number of methods that give a high dose of radiation to the tumor while limiting the amount of radiation exposed to healthy tissue. This is important because healthy liver tissue may be damaged by radiation. SBRT effectively treats tumors about 5 cm or smaller. However, it is still considered research compared to RFA because there is not much information available on its long-term effectiveness.
Side effects may include stomach and lung damage. However, these side effects can often be prevented. Talk to your health care team about avoiding and managing possible side effects.
Treatments to help patients live longer
If the doctor feels that the cancer cannot be cured with the treatments listed above, he or she may recommend one of the following options to shrink the tumor and / or slow the progression. tumor growth. Although these treatments may not eliminate the cancer, they have been shown to improve a patient’s life time.
Chemotherapy and radiation
Chemotherapy is a type of chemotherapy treatment similar to hepatic artery infusion. Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer’s ability to grow and divide. In this treatment, the drug is injected into the liver artery, and blood flow through the artery is blocked for a short time so that chemotherapy lasts longer in the tumor. Blocking the tumor’s blood supply also destroys cancer cells.
In addition to being used as a primary treatment for HCC, chemotherapy may be used to slow tumor growth for people on the liver transplant waiting list.
Radiation is similar to chemotherapy, except that during radiation, a doctor places radioactive particles into arteries to supply blood tumors. Particles provide radiation directly into the tumor when they are trapped in the tumor’s small blood vessels.
Targeted therapy is drug therapy targeting specific genes, proteins of the cancer or tissue environment that contribute to cancer growth and survival. This type of treatment prevents the growth and spread of cancer cells while limiting damage to healthy cells.
For HCC, angiogenesis is the most common type of targeted therapy. Anti-angiotherapy is focused on preventing angiogenesis, which is the process of creating new blood vessels. Because a tumor needs the nutrients provided by the blood vessels to grow and spread, the goal of anti-angiotherapy is to starve the tumor.
- Sorafenib (Nexavar) is said to work through this process. Sorafenib is used to treat advanced HCC that cannot be completely removed by surgery. It is taken in the form of pills that are swallowed (orally). The side effects of sorafenib include diarrhea and some skin problems.
In April 2017, the U.S. Food and Drug Administration (FDA) approved the use of another targeted therapy, regorafenib (Stivarga), to treat people with previous HCC. Sorafenib treatment. Regorafenib also inhibits angiogenesis, and it has been used to treat colorectal cancer and gastrointestinal stromal tumors.
In August 2018, the FDA approved another anti-angiogenic targeting therapy, called:
- Lenvatinib (Lenvima). This drug was approved as the first treatment for HCC that cannot be removed by surgery. The most common side effects of this medicine include high blood pressure, fatigue, diarrhea, loss of appetite, joint and muscle pain, weight loss, abdominal pain, rash, redness, itching or peeling skin on hands and feet. , hoarseness, bleeding changes thyroid hormone levels and nausea.
Talk to your doctor about possible side effects for a specific medication and how they can be managed.
Other treatment options
Immunotherapy, also called biological therapy, is designed to increase the body’s natural defenses against cancer. It uses materials created by the body or in the laboratory to improve, target or restore immune system function.
In September 2017, the FDA approved an immunotherapy called:
- Nivolumab ( Opdivo ) to treat HCC. Nivolumab can be used to treat people who have been treated with sorafenib. Other immunotherapeutic drugs are still being studied in clinical trials.
Side effects of immunotherapy can range from very few side effects in many patients to dangerous autoimmune conditions in some patients. In autoimmune conditions, the immune system attacks normal parts of the body, such as the colon or lungs. Talk to your doctor about possible side effects for the immunotherapy recommended for you.
Other clinical trials
In addition to the treatment options described above, a physician may recommend participating in a clinical trial that is evaluating a new treatment for HCC. This is especially important for a disease like HCC, where the options for advanced disease treatment are very limited and there are many studies to find more treatment options.
Palliative care of side effects
Palliative care involves the treatment of symptoms of cancer and cancer treatments, rather than cancer.
Unlike cell care, palliative care can be used even for people with highly curable cancer. In addition to improving the quality of life, a 2018 study found that this type of care could improve outcomes for people with liver cancer.
A remission may be temporary or permanent. This uncertainty makes many people worried that cancer will return. Although many times remission is permanent, it is important to talk to your doctor about the possibility of cancer coming back. Understanding your risk of recurrence and treatment options can help you feel more prepared if the cancer comes back.
If the cancer returns after the initial treatment, it is called recurrent cancer. It may return in the same place called local recurrence, regional recurrence, or in another place, remote recurrence.
When this happens, a new test cycle will begin over to learn as much as possible about the recurrence. After this test is done, you and your doctor will talk about your treatment options. Usually the treatment plan will include the treatments described above, such as surgery and radiation, but they can be used in a different combination or given at a rapid rate. different degrees. Your doctor may suggest clinical trials that are investigating new ways to treat this type of recurrent cancer. Whichever treatment you choose, palliative care will be important to alleviate symptoms and side effects.
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called progressive or terminal.
The diagnosis is very stressful and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, interests and concerns. The healthcare team is always available to help and many team members have special skills, experiences and knowledge to support patients and their families. Ensuring a person is physically comfortable and painless is extremely important.
Patients with advanced cancer and expected to live for less than 6 months may want to consider a type of palliative care called cell care. You and your family are encouraged to talk to your health care team about cell care options, including home cell care, special hospice or other health care locations. . Nursing care and special equipment can make homework a viable option for many families
Reference Source for treatment of liver cancer:
- Source mayoclinic.org article Liver cancer – Diagnosis and treatment : https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664 , updated 4/5/2019.
- Source nhs.uk article Treatment – Liver cancer : https://www.nhs.uk/conditions/liver-cancer/treatment/ , updated September 24, 2019.
- A reputable source index-china.com summarizes the article Selecting a treatment method for liver cancer: https://index-china.com/treatment-for-liver-cancer/, updated 13/ 3/2020.
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Pharmacy.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.