Treatment of liver cancer, liver cancer incidence rate in primary liver cancer in China is low, while Europe is more than primary liver cancer. More common in patients 30-60 years of age.
(A) of the transfer pathway
1. Hematogenous metastasis
(1) portal venous system: such as esophageal cancer, stomach cancer, colon cancer, gallbladder cancer, membrane adenocarcinoma, ovary, prostate and bladder cancer, accounting for 30% -50%.
(2) hepatic artery portal triad: liver cancer, breast cancer, kidney cancer, thyroid cancer, nasopharyngeal carcinoma, malignant melanoma and so on.
(3) lymph node metastasis: gastrointestinal, biliary membrane, ovarian, uterine cancer, lymphatic vessels via the liver into the dry.
(4) direct invasion: the stomach, gallbladder, kidney, adrenal gland, infiltration of colorectal cancer can spread directly.
Treatment of liver metastases (b) Clinical manifestations and diagnosis
1. Generally have a history of cancer or other parts of the primary has a history of primary cancer surgery, some patients showed liver metastases were asked to find the primary cancer and before, even for a moment, can not find the primary tumor.
2. Complained of liver pain, nausea swelling, fever, weight loss, fatigue, anorexia and so on.
3. Check right upper quadrant mass, late yellow plague, ascites, cachexia.
4. Differential diagnosis of primary liver cancer to be identified, primary liver cancer more than a history of hepatitis, liver cirrhosis symptoms, HBsAg-positive, often solitary nodules, portal vein tumor thrombus and more advanced, 70% tested positive for AFP positive.
5. Imageology check the B-, CT or MRI, can be seen more than one class round liver lesions, 2cm or more, 98% can be detected.
(C) treatment
Metastatic liver cancer treatment 1. Surgical resection or hepatic arterial chemotherapy or embolization
(1) Indications: primary cancer may be removed or have been removed. metastatic liver nodules or limited single lobe. position to facilitate removal of tumor. extrahepatic metastasis, the patient can tolerate general condition is still good surgery.
(2) Contraindications: poor general condition of patients, the liver has been widely transferred or have extensive metastasis.
(3) surgical method: According to tumor size, number, location, selection of mode shape resection, lobe, half liver resection for patients who can not be removed or hepatic arterial chemotherapy (and) hepatic artery embolization. Such as gastrointestinal cancer is generally believed that intra-abdominal peritoneal metastasis, liver metastasis area of not more than 30%, limited to half the liver, the primary tumor can be removed, could be used for primary cancer cure liver cancer resection, preoperative After the use of chemotherapy.
2. Chemotherapy on both sides of both the liver metastasis, cancer chemotherapy according to the original decision. In addition to intravenous application, the conditions were set free MT hepatic artery or a drug delivery pump implanted subcutaneously placed beside the incision. Postoperative chemotherapy. Such as colorectal cancer liver metastases, intraoperative placement of pump, after the injection of mitomycin C, doxorubicin, fluorouracil little hospital can have a high killing effect, destroy the cancer cells inhibited tumor growth, slowing cancer development.
3. Percutaneous ethanol injection in hepatocellular carcinoma line indications as follows: metastatic liver tumor <5cm, foci <3. primary liver cancer recurrence after radical resection. general condition is still good.
4. Surgery plus chemotherapy for primary cancer resection plus resection of liver metastases, preoperative and postoperative chemotherapy was added, the preferred way of systemic intravenous chemotherapy, interventional therapy (chemotherapy or hepatic arterial chemotherapy pump set.) Primary tumor resection, survival after resection of liver metastases may be extended.
(D) prognosis
1. The number of liver metastases than the number of individual foci is good, better than a bilateral one side, extensive transfer often lose the chance of operation.
2. The limitations of surgical resection of liver resection, resection of small liver tissue than extended hepatectomy hepatic or safety.
3. Metastasis of time for the first time that primary tumor and liver metastases, five-year survival rate after resection of more than a few years after the first operation the recurrence of liver cancer resection.
4. Cancer biological behavior of mucinous adenocarcinoma, poorly differentiated adenocarcinoma and poor prognosis.
5. Treatments such as several years after resection of primary tumor metastasis to liver limitations, the primary tumor without recurrence, prolong survival after resection of metastatic cancer of 2-3 years. Such as the liver again, who used ethanol injection.
6. Resection rate of about 20% -25%.
Metastatic liver cancer treatment, 7. Hepatic arterial chemotherapy median survival of 15 months.