Many people mistakenly think that liver cancer is the patent of hepatitis B and C. In fact, all chronic hepatitis may lead to cirrhosis and increase the risk of liver cancer, such as fatty liver, excessive drinking, diabetes, smoking, overweight, or rare metabolic diseases (iron sink disease, Wilson's disease), so we should be vigilant and be careful to prevent "hepatitis, cirrhosis and liver cancer"
Because there are no obvious symptoms in the early stage of liver cancer, many patients with liver cancer are already in the late stage of liver cancer when they find it. The tumor may have invaded the portal vein of the liver, metastasized to lymph nodes, or metastasized to distant organs. Abdominal distension, abdominal pain, edema, weight loss and other symptoms may occur in the late stage of liver cancer.
At present, there are many therapeutic tools for liver cancer, but the residual function of liver must be considered in the treatment of liver cancer. The liver is the largest organ in the human body, and it needs to deal with many indispensable physiological functions. Because patients with liver cancer often have chronic hepatitis and cirrhosis, on the one hand, it is necessary to deal with liver tumors, on the other hand, it is necessary to preserve liver function as much as possible, which makes the treatment of liver cancer full of challenges.
Combined therapy, immunotherapy and anti-angiogenesis targeted therapy for advanced liver cancer
Clinically, Barcelona clinical liver cancer classification (BCLC staging) is often used to stage liver cancer. The BCLC stage will consider the general health status of patients, the number and nature of liver cancer tumors and the classification of liver residual function.
In Barcelona's liver cancer staging system, BCLC 0 is very early liver cancer, BCLC A is early liver cancer, BCLC B is intermediate liver cancer, BCLC C is advanced liver cancer, and BCLC D is end-stage liver cancer.
Early liver cancer can be treated by surgical resection, alcohol injection, arterial embolization and radiofrequency ablation. Patients with advanced liver cancer need systemic treatment because they have multiple tumors, which may have invaded the portal vein of the liver, metastasized to lymph nodes, or metastasized to distant organs. Traditional drug therapy has low efficiency and serious side effects, which have a great impact on residual liver function, and many patients may not be able to bear it.
At present, the combination therapy of "immunotherapy" and "anti-angiogenesis targeted drugs" has become the first-line treatment choice for advanced liver cancer.
Immunotherapy is the use of the human immune system to attack cancer cells. Japanese immunologist Tasuku Honjo discovered the immune checkpoint PD- 1 in the 1990s, and now immunotherapy has been applied to cancer treatment.
There is an immune checkpoint PD- 1 on T cells of the immune system. If there is PD-L 1 on cancer cells, it can dock with PD- 1 on T cells, thus inhibiting the immune response and making cancer cells escape the attack of immune cells.
Immunotherapy drugs can bind to PD- 1 on T cells and/or PD-L 1 on cancer cells, preventing PD- 1 from docking with PD-L 1, so the immune system will attack cancer cells.
On the other hand, when the tumor continues to grow, it will inevitably consume more and more oxygen and nutrients, so the tumor will secrete vascular endothelial growth factor (VEGF) to promote the growth of new blood vessels in the surrounding tissues, so as to obtain more abundant blood circulation.
The therapeutic mechanism of anti-angiogenesis targeted drugs is to combine with vascular endothelial growth factor VEGF to inhibit the growth of new blood vessels around tumors.
Immunotherapy combined with anti-angiogenesis targeted therapy combined with different mechanisms against liver cancer. Large-scale clinical studies involving 17 countries have found that combined therapy is helpful to prolong overall survival (OS), progression-free survival (PFS) and maintain quality of life.
If patients with stage C or D liver cancer in Barcelona need systemic treatment, they can consult with their doctors and consider the combination of immunotherapy and anti-angiogenesis targeted drugs.
A sweet little reminder
Early liver cancer is usually asymptomatic, and smaller tumors need to be found by abdominal ultrasound, computed tomography and other imaging methods.
In addition to hepatitis B and hepatitis C, there are people with smoking, fatty liver, excessive drinking, overweight, diabetes and other risk factors. It should be tracked and checked regularly in order to find it early. Remind you that not all liver cancers will increase the index of alpha-fetoprotein (AFP), so you can't just rely on blood tests!
In the face of refractory advanced liver cancer, the combination of immunotherapy and targeted therapy can be used for systemic treatment, and different treatment mechanisms can be used to fight cancer cells, which will help to prolong the overall survival and maintain a better quality of life.