Liver cancer is a relatively common liver disease. Its onset can significantly impact a patient's health, and in severe cases, it may threaten life, leading to fatal outcomes. Therefore, proper treatment is crucial, requiring the selection of appropriate methods. So, what is the best method for detecting liver cancer?
What tests are required for liver cancer screening?
1.Ultrasound (B-scan)
Ultrasound is characterized by its ease of operation and low cost. It can detect most liver masses and is the most commonly used method for diagnosing early-stage liver cancer. However, its accuracy is lower for smaller nodules (diameter <1cm). In such cases, other imaging tests like CT or MRI (magnetic resonance imaging) are needed to confirm the diagnosis.
2. Alpha-fetoprotein (AFP)
AFP is currently one of the most specific methods for diagnosing hepatocellular carcinoma. It plays a definitive role in diagnosis, assessing treatment efficacy, estimating prognosis, and preventing recurrence. It is often used as an adjunct to ultrasound and CT.When AFP levels exceed 200 μg/L, persistently elevated for over two months, and other conditions such as pregnancy, active liver disease, or germ cell tumors are ruled out, a diagnosis of liver cancer can be made in conjunction with imaging results.However, it is important to note that AFP cannot diagnose all hepatocellular carcinomas. Approximately 30%-40% of patients with hepatocellular carcinoma test negative for AFP. For these patients, additional tests such as ultrasound or CT scans should be employed. If necessary, diagnostic confirmation may require hepatic arteriography or ultrasound-guided needle biopsy.
3. Ultrasound Examination
Ultrasound serves as an early detection method for liver cancer with a high detection rate for hepatic lesions. It is characterized by ease of operation and relatively low cost.
4. Magnetic Resonance Imaging (MRI)
MRI has seen rapid advancement in recent years. With continuous technological improvements, scan times have become shorter and resolution higher, enabling more accurate assessment of small liver lesions. MRI is now a crucial method for early liver cancer detection.
Treatment Methods for Liver Cancer
1. Surgical Treatment
Surgical resection remains the primary treatment for liver cancer. Early resection is crucial for improving survival rates, with smaller tumors yielding higher five-year survival rates. Indications for surgery include:
① Confirmed diagnosis with lesions estimated to be confined to one lobe or half of the liver;
② Absence of significant jaundice, ascites, or distant metastasis;
③ Adequate hepatic compensation with prothrombin time ≥50%;
④ Sufficient cardiac, hepatic, and renal tolerance. For patients with normal liver function, resection volume should not exceed 70% of the liver; for moderate cirrhosis, not exceeding 50% (or limited to left hepatectomy); severe cirrhosis precludes lobectomy.Surgical and pathological findings confirm that over 80% of hepatocellular carcinomas coexist with cirrhosis. It is widely accepted that local resection yields comparable long-term outcomes to standard lobectomy while reducing postoperative hepatic dysfunction and surgical mortality. Given the persistently high recurrence rate after radical resection, postoperative monitoring with regular AFP testing and ultrasound imaging is recommended to detect recurrence.
Close postoperative follow-up after radical resection often detects "subclinical" recurrence of small hepatocellular carcinomas, for which reoperation is the preferred approach. Five-year survival after a second surgery can still reach 38.7%. Although liver transplantation remains a treatment option for hepatocellular carcinoma, with numerous reports from abroad, its long-term role in managing the disease has not been definitively established. The prolonged use of immunosuppressive agents postoperatively often leads to patient death from recurrence.For developing countries, donor availability and cost issues have hindered widespread adoption in recent years. 2. Palliative Surgical Treatment Suitable for larger tumors, diffuse distribution, proximity to major vessels, or cases limited by cirrhosis where resection is not feasible. Methods include hepatic artery ligation and/or catheter-directed hepatic artery chemotherapy, cryotherapy, laser therapy, microwave therapy,intraoperative hepatic artery embolization, or intra-tumoral injection of absolute ethyl alcohol. These approaches may sometimes induce tumor shrinkage and serum AFP reduction, creating opportunities for staged resection.
3. Multimodal Integrated Therapy
This represents an active and effective treatment strategy for mid-stage large hepatocellular carcinoma in recent years, occasionally transforming unresectable large tumors into resectable smaller ones.Multiple approaches exist, typically based on a dual-modality combination of hepatic artery ligation plus transcatheter hepatic artery chemotherapy, augmented by external beam radiotherapy for a triple-modality regimen, or combined with immunotherapy for a quadruple-modality approach. Triple-modality or higher yields optimal outcomes. Tumor shrinkage rates reached 31% following multimodal integrated therapy, with 38.1% of patients achieving two-stage resection due to significant tumor reduction.The Liver Cancer Institute of Shanghai Medical University has also investigated hyperfractionated radiotherapy and targeted therapy. The combined approach of hyperfractionated external radiation and hepatic artery catheter chemotherapy involves: Week 1: Intra-arterial chemotherapy with cisplatin (CDDP) at 20mg daily for 3 consecutive days. Week 2: Local external radiation to the liver tumor region at 2.5Gy (250rads) twice daily (morning and afternoon) for 3 consecutive days.One cycle consists of two weeks, and this alternating schedule can be repeated for 3–4 cycles. Targeted therapy involves intrahepatic arterial catheterization with 131I-labeled anti-hepatocellular carcinoma ferritin antibodies, anti-hepatocellular carcinoma monoclonal antibodies, or 131I-lipiodol, administered every 1–2 months. During treatment intervals, 20mg of intra-arterial CDDP is administered daily for 3–5 consecutive days.Adding immunotherapy such as interferon, shiitake mushroom polysaccharides, or interleukin-2 to the above regimen yields superior outcomes.
4. Transarterial Embolization Chemotherapy (TAE)
Developed in the 1980s, this non-surgical tumor treatment demonstrates excellent efficacy for hepatocellular carcinoma and is even recommended as the preferred non-surgical approach.Typically, lipiodol mixed with chemotherapy drugs, or 131I- or 125I-lipiodol, or 90Y microspheres are used to embolize the distal blood supply to the tumor. Subsequently, gelatin sponges are used to embolize the proximal hepatic artery supplying the tumor, preventing the establishment of collateral circulation and causing ischemic necrosis of the tumor lesion.Common chemotherapy agents include 80 mg CDDP plus 100 mg 5-FU, 1000 mg mitomycin C (or 40-60 mg doxorubicin), administered via arterial infusion. Subsequently, 10 mg mitomycin C is mixed into ultrasonically emulsified lipiodol for distal hepatic artery embolization. Repeated sessions of hepatic artery chemoembolization yield superior outcomes.Data indicate that among 345 cases of unresectable large hepatocellular carcinoma, the one-year survival rate for hepatic artery infusion chemotherapy alone was only 11.1%. Combining hepatic artery embolization increased the one-year survival rate to 65.2%, with the longest follow-up survival reaching 52 months. Thirty patients achieved tumor shrinkage, gaining eligibility for surgical resection.This method is contraindicated in patients with severe hepatic decompensation and is also unsuitable for those with main portal vein obstruction due to tumor thrombus.
5. Intratumoral Injection of Absolute Alcohol
Ultrasound-guided percutaneous transhepatic injection of absolute alcohol into the tumor treats hepatocellular carcinoma. It is primarily indicated for inoperable hepatocellular carcinoma with tumor diameter ≤3cm, ≤3 nodules, and cirrhosis. It may offer a cure for small hepatocellular carcinomas. Efficacy is poor for tumors >5cm.