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Surgical resection is the first choice for tumor treatment, but if there is no chance of surgery at the time of diagnosis, can you regain the chance of surgery with medicine in the later stage and achieve clinical cure? How is liver cancer treated? Hepatitis B and C virus infections are recognized pathogenic factors for liver cancer
.
Liver cancer is also one of the common malignant tumors in China.
Surgery is the first choice for early liver cancer treatment and the most effective way to cure it
.
For patients who cannot undergo surgery, hepatic artery chemoembolization (TACE) and ablation are important options for mid-term patients, while for advanced patients, targeting is the main method before immunotherapy
.
Because liver cancer has a very high heterogeneity, that is to say, when sampling at different locations of the same tumor lesion, the detected gene mutations are different
.
This feature makes it difficult to have suitable targeted drugs for gene mutations of hepatocellular carcinoma.
At present, the targeted drugs for hepatocellular carcinoma are all anti-angiogenic mechanisms, such as sorafenib and lenvatinib
.
Later, the emergence of immunotherapy brought new options for the treatment of patients with hepatocellular carcinoma.
The combination of anti-angiogenic drugs and PD-1 inhibitors can often achieve better therapeutic effects, such as bevacizumab and PD-L1 A teplizumab inhibitor, erlotinib Lun cutting PD-1 inhibitors and Pabo Li daclizumab, apatinib Karui Li natalizumab and the like
.
Through these drug combinations, many patients with advanced hepatocellular carcinoma have achieved long-term benefits
.
In addition to targeted and immunotherapy, are there other options for inoperable liver cancer patients? Today, Cancer Degree will share with you a report that a patient with hepatocellular carcinoma who had no chance of surgery at the time of diagnosis was treated with lenvatinib for 12 months, and he was surgically removed and achieved clinical cure.
.
Advanced liver cancer: From "unresectable" to "resectable" A 61-year-old man was admitted to the hospital due to liver dysfunction.
This patient has not been infected with hepatitis B or C virus
.
The imaging examination CT revealed a large tumor of 10.
8 cm X 10.
2 cm in the liver, in addition to many small liver tumors, about 1.
6 cm in diameter
.
These liver tumors did not invade blood vessels
.
After testing, the patient’s alpha-fetoprotein (AFP) is 81.
6ng/mL (normal range: 0-10); vitamin K deficiency or antagonist-II-induced protein (PIVKA-II) indicators are also abnormal, which is as high as 112775 mAU/mL (Normal range 0-40)
.
AFP and PIVKA-II are important indicators for detecting liver cancer
.
Because the tumor is relatively large and the metastases are scattered, the patient cannot be surgically removed
.
He started using the targeted anti-angiogenesis drug lenvatinib at 8 mg per day
.
One week after the medication, the blood AFP and PIVKA-II began to decrease
.
After lenvatinib was used for four weeks, AFP decreased to 6.
2ng/mL, and PIVKA-II decreased to 4207mAU/mL
.
After four months of medication, the value of AFP has been completely normal, and the level of PIVKA-II is about 100mAU/mL
.
After the patient used lenvatinib for five months, the enhanced CT showed that the largest tumor shrank to 7.
1X6.
9 cm
.
There was no enhancement in the tumor lesions, and multiple small lesions in the liver on both sides disappeared completely
.
The patient was treated with lenvatinib for a total of 12 months
.
Figure 1.
Lenvatinib single-agent treatment of hepatocellular carcinoma achieved 12 months of benefit.
Due to adverse reactions such as diarrhea and loss of appetite, the patient stopped lenvatinib single-agent therapy
.
Two months after the drug was stopped, further CT imaging examination showed that the tumor did not continue to grow, and no new liver lesions were found
.
Ultrasound examination showed that the size of the main tumor lesion was 7.
3X5.
6 cm, and there was no blood flow signal in the tumor
.
The MRI revealed that the tumor lesion has a clear boundary, and there is a focal high signal on the diffusion-weighted graph
.
It is marked by the red frame in the figure below
.
Figure 2.
MRI examination before surgery, let it go, surgical resection Based on this, clinical oncologists performed surgical resection
.
The tissue examination after the operation revealed a capsule tumor
.
The tumor is infiltrated by a large number of lymphocytes and granulocytes, and there are no live tumor cells in the tumor lesion
.
After the patient was discharged from the hospital, no complications occurred
.
In this case, the patient's largest tumor foci shrank, there was no blood flow signal, and the small tumor foci disappeared
.
Although enhanced NMR showed high signal in local lesions, there may also be misjudgments
.
In addition, the patient's blood tumor markers AFP and PIVKA-II fluctuated, and more importantly, the patient stopped using lenvatinib due to adverse reactions
.
The combination of these factors prompted the doctor to give it a go, grab a precious window of time, and perform the operation on this patient
.
The results of the pathological examination after the operation are good, the live tumor cells are completely eliminated, and the patient has reached clinical cure
.
We can also get some enlightenment from it to help patients who have similar clinical situations make decisions
.
Figure 3.
There is no residual tumor live cells in the tumor lesion after surgery.
Choose surgery or continue observation? Most of the time, patients with advanced liver cancer are mainly treated with drugs and may achieve good results.
There are also a small number of advanced patients who seek surgical benefits.
However, liver cancer surgery is very invasive and has a high risk of recurrence
.
It is often difficult for doctors to decide whether or not to perform surgery on patients with advanced liver cancer
.
1.
Continue medication, systemic treatment
.
2.
Perform liver tumor resection or ablation surgery
.
3.
Observe closely and do not do any treatment
.
Does the aidu patient have the conditions for local surgical resection? When is the tumor removed? These all require very detailed and strict inspection and evaluation to make a decision
.
Tumor treatment is to help patients race against time
.
A study once reported a case of a patient with multiple hepatocellular carcinoma.
The patient achieved almost complete remission with lenvatinib alone, leaving only a small lesion
.
However, in the later stage, the tiny lesion began to grow out of control, and when it was noticed, the opportunity for surgical treatment had been lost
.
The patient has a tumor shrinkage during the medication and has a possible opportunity for surgery.
It is necessary to communicate with the clinician more and make a decision as soon as possible, because some opportunities are fleeting
.
As patients and their families, we must continuously improve our knowledge of the disease to prepare for emergencies
.
Everyone is welcome to download the Cancer App, and learn the professional knowledge of anti-cancer and anti-cancer
.
References: Hiroshi Shintani, et al.
, Hepatocellular Carcinoma Showing Pathological Complete Response to Lenvatinib Monotherapy, Case Rep Oncol 2021;14:772–777; click below to learn more about clinical trial projects in the past review slide to view more past content
.
Liver cancer is also one of the common malignant tumors in China.
Surgery is the first choice for early liver cancer treatment and the most effective way to cure it
.
For patients who cannot undergo surgery, hepatic artery chemoembolization (TACE) and ablation are important options for mid-term patients, while for advanced patients, targeting is the main method before immunotherapy
.
Because liver cancer has a very high heterogeneity, that is to say, when sampling at different locations of the same tumor lesion, the detected gene mutations are different
.
This feature makes it difficult to have suitable targeted drugs for gene mutations of hepatocellular carcinoma.
At present, the targeted drugs for hepatocellular carcinoma are all anti-angiogenic mechanisms, such as sorafenib and lenvatinib
.
Later, the emergence of immunotherapy brought new options for the treatment of patients with hepatocellular carcinoma.
The combination of anti-angiogenic drugs and PD-1 inhibitors can often achieve better therapeutic effects, such as bevacizumab and PD-L1 A teplizumab inhibitor, erlotinib Lun cutting PD-1 inhibitors and Pabo Li daclizumab, apatinib Karui Li natalizumab and the like
.
Through these drug combinations, many patients with advanced hepatocellular carcinoma have achieved long-term benefits
.
In addition to targeted and immunotherapy, are there other options for inoperable liver cancer patients? Today, Cancer Degree will share with you a report that a patient with hepatocellular carcinoma who had no chance of surgery at the time of diagnosis was treated with lenvatinib for 12 months, and he was surgically removed and achieved clinical cure.
.
Advanced liver cancer: From "unresectable" to "resectable" A 61-year-old man was admitted to the hospital due to liver dysfunction.
This patient has not been infected with hepatitis B or C virus
.
The imaging examination CT revealed a large tumor of 10.
8 cm X 10.
2 cm in the liver, in addition to many small liver tumors, about 1.
6 cm in diameter
.
These liver tumors did not invade blood vessels
.
After testing, the patient’s alpha-fetoprotein (AFP) is 81.
6ng/mL (normal range: 0-10); vitamin K deficiency or antagonist-II-induced protein (PIVKA-II) indicators are also abnormal, which is as high as 112775 mAU/mL (Normal range 0-40)
.
AFP and PIVKA-II are important indicators for detecting liver cancer
.
Because the tumor is relatively large and the metastases are scattered, the patient cannot be surgically removed
.
He started using the targeted anti-angiogenesis drug lenvatinib at 8 mg per day
.
One week after the medication, the blood AFP and PIVKA-II began to decrease
.
After lenvatinib was used for four weeks, AFP decreased to 6.
2ng/mL, and PIVKA-II decreased to 4207mAU/mL
.
After four months of medication, the value of AFP has been completely normal, and the level of PIVKA-II is about 100mAU/mL
.
After the patient used lenvatinib for five months, the enhanced CT showed that the largest tumor shrank to 7.
1X6.
9 cm
.
There was no enhancement in the tumor lesions, and multiple small lesions in the liver on both sides disappeared completely
.
The patient was treated with lenvatinib for a total of 12 months
.
Figure 1.
Lenvatinib single-agent treatment of hepatocellular carcinoma achieved 12 months of benefit.
Due to adverse reactions such as diarrhea and loss of appetite, the patient stopped lenvatinib single-agent therapy
.
Two months after the drug was stopped, further CT imaging examination showed that the tumor did not continue to grow, and no new liver lesions were found
.
Ultrasound examination showed that the size of the main tumor lesion was 7.
3X5.
6 cm, and there was no blood flow signal in the tumor
.
The MRI revealed that the tumor lesion has a clear boundary, and there is a focal high signal on the diffusion-weighted graph
.
It is marked by the red frame in the figure below
.
Figure 2.
MRI examination before surgery, let it go, surgical resection Based on this, clinical oncologists performed surgical resection
.
The tissue examination after the operation revealed a capsule tumor
.
The tumor is infiltrated by a large number of lymphocytes and granulocytes, and there are no live tumor cells in the tumor lesion
.
After the patient was discharged from the hospital, no complications occurred
.
In this case, the patient's largest tumor foci shrank, there was no blood flow signal, and the small tumor foci disappeared
.
Although enhanced NMR showed high signal in local lesions, there may also be misjudgments
.
In addition, the patient's blood tumor markers AFP and PIVKA-II fluctuated, and more importantly, the patient stopped using lenvatinib due to adverse reactions
.
The combination of these factors prompted the doctor to give it a go, grab a precious window of time, and perform the operation on this patient
.
The results of the pathological examination after the operation are good, the live tumor cells are completely eliminated, and the patient has reached clinical cure
.
We can also get some enlightenment from it to help patients who have similar clinical situations make decisions
.
Figure 3.
There is no residual tumor live cells in the tumor lesion after surgery.
Choose surgery or continue observation? Most of the time, patients with advanced liver cancer are mainly treated with drugs and may achieve good results.
There are also a small number of advanced patients who seek surgical benefits.
However, liver cancer surgery is very invasive and has a high risk of recurrence
.
It is often difficult for doctors to decide whether or not to perform surgery on patients with advanced liver cancer
.
1.
Continue medication, systemic treatment
.
2.
Perform liver tumor resection or ablation surgery
.
3.
Observe closely and do not do any treatment
.
Does the aidu patient have the conditions for local surgical resection? When is the tumor removed? These all require very detailed and strict inspection and evaluation to make a decision
.
Tumor treatment is to help patients race against time
.
A study once reported a case of a patient with multiple hepatocellular carcinoma.
The patient achieved almost complete remission with lenvatinib alone, leaving only a small lesion
.
However, in the later stage, the tiny lesion began to grow out of control, and when it was noticed, the opportunity for surgical treatment had been lost
.
The patient has a tumor shrinkage during the medication and has a possible opportunity for surgery.
It is necessary to communicate with the clinician more and make a decision as soon as possible, because some opportunities are fleeting
.
As patients and their families, we must continuously improve our knowledge of the disease to prepare for emergencies
.
Everyone is welcome to download the Cancer App, and learn the professional knowledge of anti-cancer and anti-cancer
.
References: Hiroshi Shintani, et al.
, Hepatocellular Carcinoma Showing Pathological Complete Response to Lenvatinib Monotherapy, Case Rep Oncol 2021;14:772–777; click below to learn more about clinical trial projects in the past review slide to view more past content
