People with high risk factors must pay attention to healthy living and regular examinations.
Text | Shervin
Right now, the world is suffering from the covid-19 pandemic, and we are once again seeing the hideous face of infectious diseases. However, the global epidemic of infectious diseases has become a "rare event" in the past hundred years, and more often than not, the main health threats to human beings come from cardiovascular disease, cancer, chronic respiratory diseases, mental illness and so on.
Speaking of cancer, there is one cancer that is both familiar and unfamiliar to Chinese, and it is liver cancer. According to the data released by the National Cancer Center in 2020, the annual incidence of liver cancer in China is 410,000, ranking fourth among the top 10 cancers in all tumor incidence.
Today (March 18) is the "Love Liver Day", Professor Wang Kui, director of the Second Department of Hepatology of the Third Affiliated Hospital of the Naval Military Medical University, was interviewed by Xinmin Weekly to introduce the changes in the spectrum of liver cancer disease in China and the latest progress in liver cancer treatment.
Professor Wang Kui, Director of the Second Department of Hepatology, The Third Affiliated Hospital of the Naval Military Medical University
Professor Wang Kui introduced that the high-risk groups of liver cancer in mainland China mainly include the following: people with a background of hepatitis virus infection, people who drink excessively, non-alcoholic steatohepatitis, cirrhosis of the liver caused by various causes and people with a family history of liver cancer; especially men aged > 40 years old; and there are many people who have been gradually decreasing before, that is, people who have been exposed to aflatoxin-contaminated food for a long time. "Most liver cancer patients in the mainland still have chronic viral hepatitis, that is, people with a background of hepatitis B and C."
Liver disease is also a risk factor for liver cancer
Professor Wang Kui introduced that liver cancer mainly includes primary liver cancer and metastatic liver cancer, and the main types of liver cancer that originate in the liver are hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer. Among them, hepatocellular carcinoma accounts for 75%-85%, intrahepatic cholangiocarcinoma accounts for 10%-15%, and the remaining small part is mixed liver cancer.
The largest proportion of high-risk groups of liver cancer in mainland China is people with a background of hepatitis B virus infection, but with the popularization of neonatal hepatitis B vaccination, the incidence of hepatitis B has declined. Now, because excessive alcohol consumption and other reasons for cirrhosis have become a rising risk factor, the incidence of liver cancer in the background of alcoholic cirrhosis is gradually increasing, and some people with liver cancer caused by non-alcoholic steatohepatitis have also increased.
Although everyone thinks that liver cancer is particularly frightening, in fact, many people have various misunderstandings about liver cancer. "Some patients think that liver cancer is already advanced anyway, the treatment is also in vain and sinful, and finally end up with two people and money, so they do not actively cooperate with examination and treatment, which often delays the best treatment time window, resulting in a greatly shortened survival period." Professor Wang Kui said.
She said that if you adhere to healthy living habits and pay attention to health examinations, you can greatly reduce the incidence of cancer or reduce the occurrence of advanced cancer. At present, the early treatment of many cancers can already achieve the effect of curing, liver cancer is no exception, so it is still necessary to actively prevent, regular physical examination, early prevention, early detection, early treatment.
The number of "weapons" in the hands of doctors gradually increased
Professor Wang Kui is a surgeon, but nowadays the surgical treatment of liver cancer is far from being limited to major surgeries such as liver resection and liver transplantation, and doctors can also use various methods for local treatment and drug treatment.
She introduced that there are two local treatments in addition to surgery: one is interventional therapy, including traditional transarterial chemoembolization and transarterial perfusion chemotherapy, and the other is percutaneous ablation. Another type of topical treatment is radiotherapy. Drug therapy includes newly developed targeted therapy, immunotherapy, and chemotherapy.
Professor Wang Kui said that not every liver cancer patient must undergo surgery. "Surgery is just a means of treatment, a method of treatment. Our ultimate goal is to let the patient live well and live a long time, so it is not necessary to have surgery, but to see what stage of liver cancer is in, whether the tumor and the patient's condition are suitable for surgery. The so-called suitable surgery means that the best results can be obtained by surgery. ”
Clinically, although some patients are objectively suitable for surgery but they are not willing to operate, then there are other alternative methods of treatment, such as the above interventional, ablation treatment, etc., which can be used alone or in combination.
In recent years, the hotly discussed targeted therapy, immunotherapy, cell therapy and other technologies have gradually matured in the field of cancer treatment. Professor Wang Kui pointed out that in the field of primary liver cancer, targeted therapy and immunotherapy are more commonly used, and the efficacy is accurate. Cell therapy is still in the exploratory stage and is in the clinical trial stage.
In the field of targeted therapy, the first targeted drug sorafenib has been in the field of liver cancer treatment for more than ten years, and now there are currently three targeted therapy drugs in the first-line treatment plan for liver cancer, and the targeted therapy and immunotherapy in the combination therapy program are also included in the first-line program. Therefore, Professor Wang Kui believes that immunotherapy has entered the first-line combination therapy and second-line treatment plan for liver cancer, which is a very mature and verified treatment method.
The application of new drugs and good drugs needs to be regulated
In January this year, the "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)" was officially released by the National Health Commission. Experts commented that the new guidelines break the deadlock that has not been broken in the first-line treatment of advanced liver cancer for more than 10 years, and the inclusion of more innovative therapies will benefit more Chinese patients.
In the new guidelines, Roche atenizumab plus bevacizumab ("T+A therapy") was listed as the first-line recommended therapy for the first-line recommended therapy for antitumor therapy in advanced liver cancer system with evidence level 1 and recommendation A (the highest level of evidence type, highest recommended level). Up to now, "T+A" therapy has been approved for the treatment of advanced unresectable hepatocellular carcinoma in more than 80 countries and regions around the world, and has been recommended by many international authoritative clinical guidelines on oncology.
Professor Wang Kui explained that the new guidelines have been greatly updated on the use of drugs, and the previous systematic treatment was mainly single drugs. "The entry of immune combination targeted therapy into the first-line treatment of liver cancer is an epoch-making program. The protocol entry guidelines are based on the fact that it has yielded good results in Phase III clinical studies. Experimental data show that the median survival of patients with advanced liver cancer in China has reached 24 months, which is a very encouraging result. Professor Wang Kui said that many patients now know the "T + A" scheme and will take the initiative to ask doctors if they can use this treatment method when they seek medical treatment.
Professor Wang Kui said that in addition to the adjustment of first-line drugs for liver cancer, the new guidelines have also been adjusted for second-line drugs, adding domestic targeted and immunotherapy drugs. To put it simply, with the advent of new drugs and technologies, doctors have more "weapons" in their hands, and the new guidelines regulate medications and treatment methods, giving patients more chances of survival.
The new guidelines will also lead to an overall increase in the level of treatment at all levels of medical institutions. For example, Professor Wang Kui said that liver cancer patients with cancer embolus usually recommended surgery in the past, but the risk of recurrence after surgery is extremely high. The new guidelines clearly stipulate that most patients with cancerous thrombosis do not recommend surgical treatment as the first choice, but systemic treatment or combination of local therapy, such as targeted, immunotherapy, combined interventional therapy, perfusion chemotherapy, radiotherapy and so on. "For example, the T+A program, or another targeted drug plus an immunotherapy drug, or a combination of interventional and other local treatments, so that patients receive a comprehensive treatment plan, then the tumor will shrink, or the cancer suppository will shrink, or the cancer suppository will shrink, and sometimes the cancer suppository will shrink back into the tumor, or even disappear completely, so as to achieve the purpose of tumor hypotheses."
Professor Wang Kui believes that the new guidelines will have a profound impact on the overall level of liver cancer treatment in China.
Regular physical examinations healthy living
Because of the continuous improvement of treatment methods, many cancers are gradually becoming a "chronic disease", and the treatment of liver cancer has also revealed an exciting dawn.
Of course, for ordinary people, it is better to be healthy and not to get sick. When it comes to the prevention of liver cancer, Professor Wang Kui stressed the need to maintain healthy living habits, and if you know that you are a high-risk group, you must have regular physical examinations and find problems in the hospital in time.
"I've asked a lot of patients with a background in hepatitis why they don't have regular checkups. For example, some patients had hepatitis B 20 years ago, after the liver function returned to normal, he thought he was good, and he did not have regular physical examinations, and some even liked to drink, smoke, stay up late, and did not care at all or ignored their liver disease; some patients were afraid of avoiding medical treatment, afraid of finding out the disease, so they completely gave up the physical examination. Professor Wang Kui reminded that people with high risk factors must pay attention to healthy living and regular examinations.
In order to let more people learn the scientific knowledge of liver disease prevention and treatment, during the "Love Liver Day", the Department of Liver Surgery of the Third Affiliated Hospital of the Naval Military Medical University publicized the public through WeChat public accounts, short videos, science lectures and other forms. Before the epidemic, the hospital's old, middle-aged and young experts often went into the community, the grass-roots level, and the TV to carry out science popularization.
Professor Wang Kui said that the young doctors are influenced by the old dean Wu Mengchao and the older generation of experts and professors, and have been actively participating in science popularization and free clinic activities through various means for many years, hoping that there will be fewer and fewer liver cancer patients in the mainland.
Early diagnosis and early treatment of liver cancer Q&A
Q: Why is it so difficult to detect liver cancer in the early stages?
A: There are no typical symptoms in the early stage of liver cancer, if you wait until there are signs of liver pain, jaundice, cirrhosis, etc., most of them are intermediate and advanced liver cancer.
Q: Liver cancer is so dangerous, is there a way to find it early?
A: Regular treatment of liver disease and regular physical examination are the most important measures for early detection of liver cancer.
Q: Who are at high risk for liver cancer?
A: Hepatitis patients with hepatitis B/C, cirrhosis, family history of liver cancer, alcoholics, non-alcoholic steatohepatitis, middle-aged and elderly men, long-term exposure to aflatoxin-contaminated foods, etc. are at high risk of liver cancer.
Q: How should the average person and high-risk group do the medical examination?
A: Healthy people are screened once a year, and high-risk groups are screened twice a year. The easiest and most economical test is a blood test (blood biochemical test, alpha-fetoprotein, etc.) + abdominal ultrasound.
Q: What should I do if the physical examination is abnormal?
A: If abdominal ultrasound reveals a substantial mass (nodule) of the liver, be sure to consult a specialist if an enhanced MRI or CT test is needed to further confirm the diagnosis. Because sometimes AFP is elevated, B ultrasound reports liver nodules, not necessarily liver cancer; and AFP is normal, do not do imaging tests (B ultrasound, etc.), does not mean that there is no liver cancer. Therefore, once any problem is found, it must be further carefully examined and differentially diagnosed, and both doctors and patients need to maintain appropriate vigilance.
Part of this article with the picture: Oriental ic