[Famous Column] Hong Suqing / Abdominal pain emergency room shocked to see liver cancer! Pay attention to related symptoms, how late the pain occurs!

There are more than 10,000 new liver cancer patients in Taiwan every year, and one-third of them cannot be cured by local treatments such as surgery and electrocautery. They must rely on targeted drugs, immune drugs or radiation therapy. In recent years, “immune combination therapy” has made new breakthroughs! Multinational studies have shown that compared with traditional targeted therapy, the combined use of first-line immune drugs and anti-angiogenic drugs not only doubles the tumor response rate, but also reduces the risk of cancer death by more than 40%. choose.

A middle-aged man went to the emergency room because of severe abdominal pain. He thought it was appendicitis, but the examination revealed that it was liver cancer, and it was already at an advanced stage. The doctor pointed out that early-stage liver cancer can be treated with radical treatment such as surgery or electrocautery. If the tumor has metastasized or cannot be operated on, in addition to using targeted drugs or immune drugs alone, or with radiation therapy, immune combination therapy is expected to become the first. A new option for line therapy.

Studies have shown that compared with traditional targeted therapy, the combined use of immune drugs and anti-angiogenic targeted drugs in the first line not only doubles the tumor response rate, but also significantly improves the overall survival and disease-free survival of patients.

Dr. Chen Yanyang, director of the Department of Hematology and Oncology at Kaohsiung Chang Gung Hospital, pointed out that there are no nerves in the liver, but only on the surface of the liver. If the tumor in the liver does not invade the surface, there will be no symptoms of pain, and if the tumor is not large enough, or if it is not affected Influenced by external forces such as violent collisions, most patients have no obvious symptoms. Once patients develop fatigue, loss of appetite, weight loss, upper abdominal pain, abnormal liver function, jaundice, abdominal enlargement, and even upper gastrointestinal bleeding, vomiting and other clinical symptoms of liver cancer, most It is late.

Chen Yanyang pointed out, “If liver cancer is detected early, small tumors can be removed by surgical resection or electrocautery to burn off small tumors, and there is a chance to eradicate and cure.” There may also be an opportunity to block the blood vessels supplying the tumor with embolization, causing tumor necrosis. Otherwise, we must rely on targeted drugs and radiation therapy.

Chen Yanyang said that it was not until the publication of the first oral targeted drug literature in 2007 that targeted drug therapy was available for liver cancer. It is an inter-generational progress. But “Liver cancer is a highly heterogeneous tumor, there is no single mutation point, no single pathogenic mechanism, just like the cunning rabbit has three caves, you block a way, it has other places to escape, this is more difficult The traditional first-line targeted drug therapy for liver cancer has a response rate of about 10%, and it can remain stable for a short period of time, about three to six months.

After the advent of immunotherapy, it was initially used for liver cancer after the target was ineffective, and it was used alone. The response rate was about 20%, and the survival period was about 16 months.

In order to improve the effect, various combination therapy trials are started around the world. Chen Yanhao, a hematologist-oncologist at Kaohsiung Chang Gung Memorial Hospital, pointed out that last year, the results of a large clinical trial found that the first-line use of “immunotherapy PD-L1 inhibitors” combined with “anti-angiogenesis target drugs” combined treatment was better than the traditional first-line treatment alone. Compared with line-targeted drugs, not only the tumor response rate is improved, but the overall survival period is also improved. In this trial, the overall survival of the traditional first-line target was about 13 months, “and the overall survival of the combination therapy has not been results so far, because — more than half of the patients are still alive, so it can’t be calculated. “

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