What is the management of a broken liver cancer, high-risk group?
Jul 29, 2024
|
Hepatic cancer was summarized with the help of Shin Hyun-pil, a professor of gastroenterology at Gangdong Kyunghee University Hospital.
▶ Silent organ, almost no symptoms...pain at the end of the day
In the case of liver cancer, there are few or minimal symptoms felt by the patient not only in the early stages but also after some progression of the cancer. In some patients, there may be feelings of lethargy, fatigue, discomfort in the right upper abdomen, nausea, weight loss, and loss of appetite. When liver cancer progresses, jaundice may appear if pain is complained or the whites of the skin or eyes turn yellow. Severe pain may appear at the end of liver cancer.
▶ Hepatitis B and C virus is a major risk factor
Unlike other cancers, liver cancer is a relatively well-known disease with a relatively well-known risk factor. This is because liver cancer mainly occurs in people with chronic hepatitis B, hepatitis C, alcoholic liver disease, and cirrhosis. Only caution in people with these diseases can help prevent it. Among them, most of the liver cancer patients are related to the hepatitis B and C virus, and among them, hepatitis B virus is identified as a major cause of liver cancer, so we can see how important hepatitis B management is.
▶ 80% of liver cancer patients with cirrhosis
Cirrhosis is a disease in which chronic inflammation of the liver occurs and fibrous changes occur accordingly, making the liver hard and firm. Cirrhosis causes include hepatitis B and C, as well as drinking and non-alcoholic fatty liver. According to the Korean Association for the Study of Liver Diseases, about 80% of patients with total liver cancer are accompanied by cirrhosis. Virus hepatitis, cirrhosis, and non-alcoholic fatty liver, which cause chronic inflammation or fibrosis of the liver, can all act as risk factors for liver cancer, so caution is required.
▶ Regular ultrasound and blood tests of high-risk groups are important
Liver cancer is a disease that is difficult to detect early with only symptoms. Therefore, regular examination of high-risk groups is very important for early diagnosis and treatment. Along with periodic ultrasound, there is a serum alpha fetal protein test as a blood test. Liver cancer screening is conducted during national cancer screening with these two. However, another tumor marker, Fivka-Tu, is also helpful in diagnosing liver cancer, so it may be additionally performed in high-risk groups.
Liver ultrasound has the advantage of being able to observe changes in liver shape and local lesions. In some cases of obesity or insufficient ultrasound due to cirrhosis, tests such as CT or MRI can be performed at the same time.
▶ Virus carriers, excessive drinkers, and neglect of testing and taking medicine
Professor Shin Hyun-pil said "The problem is that chronic hepatitis B or chronic hepatitis C patients neglect tests, thinking they are health carriers when they are not taking drugs."However, it is difficult to know for yourself the progression of active hepatitis, which requires taking hepatitis drugs, and there is a problem that liver cancer can occur even though you are taking hepatitis drugs." However, hepatitis C can be cured, and hepatitis B can also suppress the virus through drugs that rarely develop resistance.
It is also important to detect liver cancer early through regular tests, and furthermore, it is important to take hepatitis drugs at an appropriate time to reduce the progression of cirrhosis and the risk of developing liver cancer, which cannot be known without testing. Whatever the cause, cirrhosis patients who do not function well due to solidification of the cause are more likely to develop cirrhosis-related complications in addition to liver cancer.
Professor Shin Hyun-pil said "There is a problem that the person who needs to be examined does not do because he may not know that cirrhosis has progressed even though he drinks a lot." Therefore, those who are infected with chronic hepatitis virus or who drink excessively must seek medical treatment.'
▶ Surgical treatment for complete liver cancer removal, resection and liver transplantation increase
In addition to surgery for liver cancer, the proportion of various treatments is high, and although there are treatments that show good results, the proportion of surgical treatments is increasing as the treatment results of liver resection improve. According to the Korean Liver Cancer Society's report on the liver cancer registration project, the proportion of liver resection was less than 20% before 2010, but now it exceeds 20%. Early detection of liver cancer, multidisciplinary treatment, and the development of surgical methods are enabling more active surgery. Patients with poor liver function and poor liver cancer progression can obtain normal liver function while removing liver cancer through liver transplantation.
▶ Early liver cancer detection works well with local treatment without surgery
If liver cancer is found early, topical treatments such as radiofrequency ablation are used. It is a method of necrosis of the tumor by placing a needle-shaped electrode in the tumor and applying heat. It has an advantage in that it is necessary to be hospitalized for a short period of time without general anesthesia, and if it corresponds to an appropriate indication, it shows a treatment effect equal to that of surgery. However, it cannot be applied to all liver cancer patients, and the liver function of the target patient is well preserved, and if the location, size, and number of tumors meet the conditions, the procedure will be performed.
▶ Block oxygen and nutrition supply of cancer cells, carotid artery chemical embolization
Although the proportion of treatments is decreasing somewhat, carotid chemoembolization is still the most commonly used treatment for early treatment of liver cancer. It is a treatment that finds the arteries that supply oxygen and nutrients needed for liver cancer to grow, administers anticancer drugs, and blocks blood vessels with embolized substances. Unlike surgery, several lesions can be treated simultaneously, normal tissues other than liver cancer can be maintained more, and hospitalization is often preferred because it has a longer hospitalization period than surgery, but recurrence is more common than surgery. Recently, various state-of-the-art treatments such as using drug-releasing microcells and radiation embolization have been performed depending on the progression of liver cancer and the patient's condition, including liver function.
▶ Active treatment with advanced cancer, immuno-cancer drugs, and targeted treatments
In the case of liver cancer involving major blood vessels or accompanied by extrahepatic metastasis, systemic anticancer drug treatment is considered to attack cancer cells. Since then, the introduction of molecular target treatments such as sorafenib, regorafenib, and renbatinib have been able to make a step forward in the treatment of liver cancer. These targeted treatments were convenient to take and led to an increase in survival rates, but there was still a burden of insufficient treatment effects and side effects. From 2022, atetzolizumab, an immune checkpoint inhibitor, and bevacizumab, a molecular target treatment, are the most commonly used combination treatments. It has a better therapeutic effect than previous anticancer drugs and is most often used in systemic anticancer therapy. Anti-cancer drugs are continuously being developed and the treatment response is improving through combination therapy, and multidisciplinary treatment with various treatments is helping.
Professor Shin Hyun-pil emphasized that `The key to liver cancer is to know the risk group and manage them properly to prevent liver cancer, and even if it occurs, detect and treat it early.' Even advanced liver cancer has various treatments that extend the survival period, but if you are at high risk for liver cancer, it is important to detect and treat liver cancer early through regular tests.
|
bellho@sportschosun.com
