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Liver cancer|Liver Cancer

1. Basic knowledge


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Hepatocellular carcinoma is cancer cells in which liver cells become malignant tumors. Even in the same liver cancer, the bile duct that has passed through the liver cancer is called "intrahepatic cholangiocarcinoma (cholangiocarcinoma)". A distinction is made between hepatocellular carcinoma and intrahepatic cholangiocarcinoma due to different treatment modalities.


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Usually, "liver cancer" means "hepatocellular carcinoma". Hepatocellular carcinoma usually recurs in the liver, and may also spread to the lungs, lymph nodes, adrenal glands, brain, bones, etc.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Metastatic liver cancer is cancer that has developed in organs other than the liver Symptoms metastasized to the liver. Distinguished from hepatocellular carcinoma and treated according to the site of pre-metastatic nuclear origin (first cancer occurrence).


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ The liver is known as the "silent organ", even with inflammation or Cancer has almost no subjective symptoms in the early stage. Hepatocellular carcinoma is often found incidentally during regular physical examinations in medical institutions, or when checking for other diseases. When abnormal liver function or hepatitis virus infection is found through medical examination, etc., be sure to see a doctor. When HCC continues to spread, some people may feel pressure and pain from a mass in the abdomen.


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Persistent infection with hepatitis B virus or hepatitis C virus (viral Infection caused by long-term persistence in the body). The hepatitis virus remains in the body, repeats inflammation and regeneration of liver cells over time, accumulates genetic mutations, and eventually turns into cancer.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Factors other than known viral infection include heavy drinking, smoking, diet Aflatoxins (a toxin produced by molds), obesity, diabetes and males. Recently, reports have shown that hepatitis is not a problem with viral infection, and the main factor for the increase in hepatocellular carcinoma is the influence of fatty liver.


​2. Treatment


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ The stages of liver cancer are classified according to tumor size, number and whether the tumor is in Intrahepatic or metastatic. There are many types of classification of disease stages, and most doctors use the Japanese "Clinical and Pathological Primary Liver Cancer Regulations (Japanese Society for Liver Cancer Research)" or the internationally used "TNM Classification of Malignant Tumors (UICC)" to describe the disease stage . According to different classification rules, the same disease period may appear but the content is different. Please rely on the judgment of the attending physician.


Liver Cancer Stage Classification in Japan (Japanese Society for Liver Cancer Research)


UICC Liver Cancer Stage Classification (Japanese Society for Liver Cancer Research)

Severity of liver damage, Child-Pugh classification:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ When choosing a treatment method, confirm the degree of liver damage (hepatic reserve : how much function the liver still retains). The degree of liver damage is divided into three stages A, B, and C according to the current state. In addition, in order to grasp the degree of liver cirrhosis, the Child-Pugh classification is used. Both classification methods are represented by A~C, and the degree of liver damage is higher when C is displayed.


​degree of liver damage


Child-Pugh classification

Treatment options:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ The treatment of liver cancer is liver resection, tumor radiofrequency ablation (RFA) , Hepatic embolization chemotherapy as the center. In addition, according to the state of the liver and the stage of the tumor, molecular targeted drug therapy, liver transplantation and radiation therapy are selected. Most patients with liver cancer also suffer from chronic liver disease. In addition to the classification of the disease stage, the degree of liver damage should also be considered in the treatment before making a choice.

liver_fig02 2.png

​ Treat after assessing the status of liver cancer and the degree of liver damage

(1) Surgery

Liver resection:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ is a treatment in which the cancer and surrounding liver tissue are surgically removed. In many cases, the cancer will remain in the liver, and if the number is less than 3, we will remove it. The size of the cancer is not particularly limited, even if it exceeds 10 cm, it is still possible to remove it. In addition, cancer of blood vessels and veins, even if it has spread to the bile ducts, in some cancers, can be treated with liver resection.


      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ However, if there is ascites, the liver will not be able to function after hepatectomy There is a higher risk of side effects (liver failure), and treatment other than liver resection is usually done.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Depending on the location of the cancer and liver function, the resection method is small to multiple Extensive resections of all regions are available. Laparoscopic surgery may depend on the location of the cancer and the procedure, there are limited cases where it can be done, and a laparotomy is usually performed. After liver resection, you can usually leave the hospital in about 1 to 2 weeks.


Liver Transplantation:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ All liver removed and transplanted from donor (organ provider) Liver treatments.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Liver transplantation for hepatocellular carcinoma

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_   (A) Spread to blood vessels, no metastases except liver

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_   (B) has a cancer cell below 5 cm

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_   (C) The number of cancer cells is less than 3 or within 3 cm

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Can be performed under standard conditions (Milan Guidelines). "Living donor liver transplantation" in Japan is mainly to provide liver relatives for close relatives.

side effect:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Leakage of bile from the surface of a resected liver (birth defect), Bleeding, liver failure, etc. Sometimes bile leaks are treated with reoperation, but usually symptoms are relieved by maintaining drainage. Bleeding requires reoperation for transfusion and hemostasis. Liver failure is a state in which liver function does not function at all, so we plan to leave enough liver at the time of surgery depending on the status of liver function, but in rare cases, serious complications such as liver failure may occur.

(2) Drug therapy

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Molecular Targeted Drug Therapy in Drug Therapy of Hepatocellular Carcinoma is standard treatment. It is a progressive hepatocellular carcinoma for which hepatectomy, liver transplantation, local therapy with aspiration, transarterial chemoembolization (TACE) and, if performance status and liver function are good, molecularly targeted therapy will be indicated.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ For primary treatment, use sorafenib or lenvatinib . If there is no problem of side effects after taking sorafenib treatment, it is suitable for Child-Pugh classification A, that is, the cancer reg of molecular targeted drugs, as the second-line treatment. Secondary therapy is still under consideration while lenvatinib is used as primary therapy.


side effect:

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Common side effects are numbness of extremities, hypersensitivity, swelling of extremities, pain, Rash, skin loss, diarrhea, anorexia, high blood pressure, fatigue, hair loss, nausea. Serious side effects, such as a decrease in white blood cells, may occur in some cases. If your condition worsens during your treatment, consult your doctor right away. Do not judge yourself, and follow your doctor's instructions to reduce or stop your medication.

(3) Puncture therapy

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Treatment performed locally with a needle pierced from outside the body. There are three types, Percutaneous Ethanol Injection Therapy (PEIT), Percutaneous Microwave Coagulation Therapy (PMCT), and Radiofrequency Tumor Ablation (RFA), which are less physically burdensome than surgery.       _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_           _cc781905 -5cde-3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136 bad5cf58d_   _cc781905-5cde-3194- bb3b-136bad5cf58d_           _cc781905- 5cde-3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136 bad5cf58d_   _cc781905-5cde-3194-bb3b -136bad5cf58d_       _cc7 81905-5cde-3194-bb3b-136bad5cf58d_   _cc781905-5cde -3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136bad5c f58d_   _cc781905-5cde-3194-bb3b- 136bad5cf58d_       _cc7 81905-5cde-3194-bb3b-136bad5cf58d_   _cc781905-5cde- 3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136bad5c f58d_           _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_           _cc781905 -5cde-3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136 bad5cf58d_   _cc781905-5cde-3194- bb3b-136bad5cf58d_           _cc781905- 5cde-3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136 bad5cf58d_   _cc781905-5cde-3194-bb3b -136bad5cf58d_       _cc7 81905-5cde-3194-bb3b-136bad5cf58d_   _cc781905-5cde -3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136bad5c f58d_   _cc781905-5cde-3194-bb3b- 136bad5cf58d_       _cc7 81905-5cde-3194-bb3b-136bad5cf58d_   _cc781905-5cde- 3194-bb3b-136bad5cf58d_     _cc781905-5cde-3194-bb3b-136bad5c f58d_      

side effect:

        Possible Complications of RFA

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●The fatality rate is less than two per thousand.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ● Pain, abdominal pain.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Slight fever.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Skin burns.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     Abnormal liver function.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Allergy to sedative/analgesics.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Bleeding: about 1% of those who need blood transfusion, vascular embolism or surgical treatment.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●About 1.5% of the tumor recurrence in the ablation and puncture route.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Cauterize damaged nearby organs (heart, lung, gallbladder, gastrointestinal tract, kidney/adrenal gland, nerves, etc.).  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Hepatic blood vessel/bile duct damage, resulting in abnormal liver function.

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Concurrent abscess, especially in diabetic patients, less than 1%.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     Sepsis.  

      _cc781905-5cde-319 4-bb3b-136bad5cf58d_   _cc781905-5cde-3194 -bb3b-136bad5cf58d_     ●Nervous cardiac and vascular abnormalities.


(4) Embolization chemotherapy

        Hepatic arterial embolization utilizes the different characteristics of blood supply between normal liver and liver tumor, and injects chemical drugs and embolization particles directly into blood vessels that supply nutrients to liver tumors. On the one hand, it can concentrate chemotherapeutic drugs in the tumor to improve the effect of treatment; on the other hand, it can block the nutrient supply of the tumor and accelerate its necrosis. This method can also greatly reduce the side effects usually caused by intravenous injection of drugs.


side effect:

        After transarterial chemoembolization (TACE), transarterial embolization (TAE) and transarterial chemotherapy (TAI), fever, nausea, abdominal pain, anorexia, hepatic insufficiency, and chest pain may occur. The degree of side effects depends on the size of the cancer, the degree of spread, embolism and liver function. In addition to listening to the doctor's full explanation of the expected side effects, you also need to rest for several hours to half a day after treatment.



3. Rehabilitation


     (1) Pay attention to balanced nutrition, the most important thing is to eat comfortably. In patients with chronic liver disease, alcohol should be avoided due to possible impairment of liver function. In addition, if you have swelling or ascites, you must control the salt in your diet. You can consult your doctor, nurse, nutritionist, etc. first.


     (2) One month after the operation, it is essential to slow down the pace. According to the recovery of physical strength, start with walking, etc., and gradually increase the amount of exercise. After consulting the attending doctor, you can do some intense exercise. After your physical strength recovers and your liver function stabilizes, you can gradually return to normal life.


     (3) There is no obstacle to sexual life, and contraception is required during treatment. If you are thinking of becoming pregnant or giving birth, you should consult your doctor first. Talk to your doctor when you use specific hormonal medicines, such as oral contraceptives.

For liver cancer-related drug information, please refer to the Medical Assistant Blog liver cancer

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