1. The best choice for surgical treatment of liver cancer is surgical resection or liver transplantation. Partial hepatectomy: this operation will remove the liver tumor and some surrounding liver tissues, but it is only suitable for patients with single tumor, no vascular growth in the tumor and good liver function. Before this kind of operation, doctors usually ask patients for imaging examination to evaluate whether the operation can be cut cleanly.
2. Liver transplantation: For patients who can't operate, if they can find a suitable liver source, they can also choose liver transplantation. Patients who need a transplant usually have to wait a long time. During the waiting period, doctors usually use other methods such as ablation to treat it.
Ablation therapy in the treatment of liver cancer, ablation is mainly used for patients who are not suitable for surgery and have small tumor lesions. The best ablation effect is liver cancer less than 3 cm. For slightly larger liver cancer (3~5 cm), ablation therapy can be used together with chemical embolization (an interventional method). The commonly used ablation methods in the treatment of liver cancer are: radiofrequency ablation: this treatment uses high-energy rays to "burn" cancer cells, which is the most commonly used ablation method in the treatment of liver cancer.
Microwave ablation: This treatment uses the energy generated by electromagnetic waves to kill cancer cells. Cryoablation: This treatment method "freezes" cancer cells by gas such as liquid nitrogen. Alcohol ablation: In this treatment, the doctor directly injects alcohol (ethanol) into the tumor focus to kill cancer cells.
Embolization therapy Embolization therapy belongs to interventional therapy, which is to directly inject drugs into tumor blood vessels to reduce or block the blood supply of liver cancer lesions. This treatment method can be used for patients with liver cancer who are not suitable for surgery and have small lesions. For larger tumors (3~5 cm), embolization can be combined with ablation. The available embolization treatments for liver cancer include: Hepatic arterial embolization (TAE): During the treatment, doctors inject drugs into hepatic artery through a catheter to block the artery that provides oxygen and nutrition for the tumor. ? Arterial chemoembolization (TACE): This treatment process is similar to TAE. The drugs introduced are chemotherapy drugs, which can not only block the arteries that provide oxygen and nutrition for tumors, but also directly introduce chemotherapy drugs into tumors to kill cancer cells. The most commonly used chemotherapy drugs are mitomycin C, cisplatin and daunorubicin. Drug-eluting bead chemoembolization (DEB-TACE): Drug-eluting bead is a kind of bead with special structure, which contains chemotherapy drugs and can be transported into cancer focus for treatment through catheter. The most commonly used chemotherapy drugs are mitomycin C, cisplatin and daunorubicin. Radioembolization (RE) is an embolization therapy using radiopharmaceuticals.
3. Radiotherapy kills cancer cells by high-energy rays. In the treatment of liver cancer, radiotherapy is mainly used in the following situations: unresectable liver cancer. Liver cancer that cannot be treated by ablation or embolization. Patients with brain metastasis or bone metastasis of liver cancer. Cancer cells blocked the portal vein. External irradiation therapy (EBRT) is the main radiotherapy method for liver cancer. The commonly used radiotherapy methods are stereotactic radiotherapy (SBRT) and intensity modulated radiotherapy (IMRT). Targeted therapy Targeted drugs can treat cancer-causing mutations. In the treatment of liver cancer, targeted therapy is the first choice for advanced patients. Targeted drugs can be used alone or in combination with other treatments. At present, tyrosine kinase inhibitor (TKI) is a commonly used drug targeting liver cancer, which can block abnormal protein kinase caused by gene mutation in vivo and play an anti-cancer role. Commonly used targeted drugs for liver cancer include sorafenib, vartinib, gefitinib, nicarbatinib and ramorumab.
4. immunotherapy immunotherapy can affect the patient's own immune system, thus identifying and killing cancer cells more effectively. At present, in the treatment of liver cancer, the main immunotherapy drug is immune checkpoint inhibitor. The reason why the immune system does not attack the human body itself is because there is a "switch" called an immune checkpoint. Cancer cells "skillfully" use such a switch to escape the recognition and attack of the immune system. Immunocheckpoint inhibitors can resist this "switch" and are mainly used for patients who have failed chemotherapy. At present, in the treatment of liver cancer, the available immune checkpoint inhibitors are pabolizumab and Nivolumab. Chemotherapy Chemotherapeutic drugs can kill cancer cells or prevent cancer cells from growing. They can be taken orally or injected intravenously. In the treatment of liver cancer, chemotherapy is mainly used for patients with ineffective targeted drugs. Commonly used chemotherapy drugs for liver cancer are gemcitabine, oxaliplatin, cisplatin, daunorubicin, 5- fluorouracil (5-FU), capecitabine and mitoxantrone. Doctors usually combine two or more chemotherapy drugs to treat patients with liver cancer, such as gemcitabine+oxaliplatin and fol fox(5-Fu+ oxaliplatin+folic acid).