Medical Resource

Primary liver cancer (the HCC) is our common malignancy. Liver cancer diagnosis, especially early diagnosis, and more dependent on the various examinations. In order to standardize procedures and facilitate the diagnosis of non-specialist doctors have, it is necessary to develop a diagnostic criteria.

Liver cancer is a progressive development of the disease, a different stage of the programme adopted by the different treatment, the prognosis is not the same, so there should be a stage on the standards. 1977 proposed by the author, such as a liver cancer diagnosis and sub-standard stages of liver cancer in the country, adopted at the research collaboration, the domestic use of the broad masses of medical workers. 1990 for a “national cancer diagnosis and treatment of norms” and 1997 for a “new cancer diagnosis and treatment of norms,” although a small number of textual changes, but the basic content has been extended by more than 20 years. 20 to liver cancer diagnosis and treatment have been making considerable progress, diagnostic criteria should be amended, the treatment of surgical indications the expansion of non-surgical treatment of liver cancer in stages so that the development of the standards required to make corresponding adjustments.

In recent years, some of the experts or magazine published by the diagnostic criteria of the main views is due to the development of diagnostic imaging, should no longer rely on a simple standard afp diagnosis of liver cancer, liver cancer afp the cases should be negative for other liver Cancer markers inspection. For liver cancer staging criteria are mainly the views of the past, the standard period of ⅱ the span is too big. Chien described, were not conducive to specific situations and should consider with the International Union Against Cancer tnm issued by the convergence criteria, such as. In 1977 of liver cancer in the diagnostic criteria did have a diagnosis of liver cancer afp simply rely on the standards, expressed as “afp> 400 μ g / l, sustained four weeks and can rule out the possibility of pregnancy, active liver disease, derived embryonic gonad Tumors and metastatic liver cancer, can be diagnosed with primary liver cancer. ”

To meet this standard is the time in large-scale census in the detection of liver cancer afp high concentration of cases established. Indeed, the truly meet the above criteria for the vast majority of cases of primary liver cancer, but it is not easy to implement, because of liver disease on activities not rule out the possibility. Moreover, the diagnosis of liver cancer should include the diagnosis and localization of two parts, even by the standards of the diagnosis of liver cancer, liver cancer can not be targeted but will not be able to carry out surgical resection, radiation therapy, such as local ethanol injection therapy. Diagnosis is the purpose of treatment, if unable to meet the needs of the treatment, diagnosis can not be regarded as perfect.

So in 1999, from November 29 to December 1 at the Fourth National Conference on liver cancer after a lively discussion approved in principle a new liver cancer diagnostic criteria (see “Chinese Journal of liver disease,” vol. 8 3 Article 135 of Countermeasures column). This standard is the first positive afp on the basis of the addition of the imaging examination of the characteristics of a liver cancer lesions. This in line with qualitative, positioning two requirements. Afp positive course also ruled out false positive, lesions need to have the characteristics of liver cancer, should be accurate. Afp on the second failed to meet the standards recognized by all, regardless of their normal or higher, are due two diagnostic imaging or two signs of liver cancer with a positive image of the evidence. In recent years, were found in clinical cases of negative afp growing, this one setting is essential. Afp have failed due to a strong positive diagnosis, so in diagnostic imaging should be looking for more evidence. Or to increase other markers of liver cancer diagnosis, but other markers of liver cancer diagnosis of specificity than afp, it required at least two more reliable marker of positive, the purpose of nature is to increase the reliability of diagnosis. Article 3 established for advanced cases, symptoms and signs of liver cancer has made clear, coupled with the transfer lesions, metastatic liver cancer is not unlikely to be the wrong. Liver cancer staging is designed to help choose treatment and prognosis.

Study all history, as early as 1971 in Uganda, Canberra, the topic of an international liver cancer had proposed a meeting with liver function and anatomical location-based standards in phases. Japan was the Austrian Tianbang male liver cancer patients in Japan under the characteristics of the other proposed a phased approach.

China’s 1977 proposed a phased approach is based on the early 1970s large-scale survey of liver cancer early detection of liver cancer a lot by the fact that, that is asymptomatic and signs of liver cancer ⅰ period for liver cancer, jaundice , Ascites, evil or quality of distant metastasis for one of ⅲ period, something in between for ⅱ period. Concise and applicable. Of course, ⅱ period span is too large, were not expressed with portal vein thrombosis, liver and abdominal lymph nodes door phased transfer of elements, and the International Union Against Cancer tnm issued by the staging of the much visited, it really should be amended. tnm staging of the tumor is t, n refers to the hilar lymph nodes, m refers to distant metastasis. t also on whether the tumor is greater than 2 cm, and the availability of vascular invasion, such as whether the leaf is subdivided into t1 ~ t4, then a different t, n, m combination ⅰ, ⅱ, ⅲ a, ⅲ b, ⅳ a, ⅳ b 6 Period. tnm very delicate stage, especially the staging of t t1 ~ t3 the stage depends on whether there are cancer-week invasion of the small blood vessels, it is actually a building in the pathological examination on the basis of the phases. As for surgical resection liver cancer can be few cases, a pathological examination of opportunities for small, it tnm phased in practical application, a lot of difficulties. In particular, tnm staging does not take into account the situation with cirrhosis, and liver cirrhosis of the liver function in a more restricted choice of treatment and prognosis of the important factors, the liver cancer in the Fourth National Conference, we compiled a number of experts Views put forward a phased standards.

The new standards should be phased broadly in line with our previous standards and tnm the same standards, so that they can use past data and participation in international academic exchanges.

For this standard are still different views, are:
(1) and the direct use of international standards tnm stage, do not have separate standards in phases.
(2) ⅰ period should be diameter <2 cm tumor as ⅰ a, ⅲ period should be of distant metastasis and liver function as a child c-ⅲ b.
(3) stages of liver cancer in not included in the standard classification of liver function, liver function can be in a separate classification. We believe that liver cancer will be conducted in phases to help choose the practicality of treatment programmes, and strict tnm in phases in order to establish after the operation, its usefulness poor. tnm only be phased in tumor size as <2 cm and> 2 cm, in fact a diameter of 3 cm and a diameter of liver cancer> 10 cm of liver cancer prognosis never the same, this has a lot of clinical practice in China confirmed by.

Therefore, to China for liver cancer clinical stage seems to be in line with China’s national conditions and generally consistent with international standards for good. Will diameter <2 cm of liver cancer ⅰ a separate period for the views of desirable, because of their prognosis, especially after surgical resection of the consequences better in the 2 ~ 5 cm in diameter of the liver, but also for ⅰ a separate phase are working with the staging of ⅰ tnm Phase match. Similarly, the distance will be to separate the transfer period with ⅲ b tnm ⅳ b phases of the match period.

Whether the grade of liver function should be separate » The issue raised is based on some very small tumors and no invasion or transfer, and liver function of how bad the difficulties. Another out that the advocates of such patients despite adverse liver function should remain within its liver cancer early. Who do not advocate a separate believes that the merger is cirrhosis of the liver cancer is different from other tumor characteristics. Liver function of the constraints of the treatment of choice, and the prognosis considerably. In serious adverse liver function on the basis that even small liver, lack of policies, poor prognosis, should remain with advanced as well. What should be how to deal with, the Chinese Anti-cancer Association of liver cancer around the hope that members of professional experts, to develop a common line with national conditions while broadly in line with international standards, practicality and feasibility of liver cancer are strong standards in phases.

Is a common digestive tract cancer, gastric cancer incidence rate after. In the age of onset and more between 30 to 60-year-old, male than female, if early detection of timely treatment, the better the prognosis. At present no clear cause, and rectal polyps, chronic inflammation and genetic factors. According to pathological changes can be divided into invasive, and cauliflower type of ulcer. Its way to directly transfer the spread of lymphatic metastasis, blood transfer and abdominal cultivation.

[Clinical characteristics]
1, changes in bowel habits diarrhea or constipation, defecation not sense stool sexual thinner, a late Lijihouchong.
2, blood in the stool for the common symptoms of colorectal cancer. The early stage of 50 per cent of the cases have blood in the stool and started bleeding less, found in feces surface, with infection after Nongxue it.
3, chronic intestinal obstruction, abdominal swelling, Chang Ming-hyperthyroidism and paroxysmal colic.
4, the body of the evil of advanced cancer patients in anorexia, weight loss, fatigue, anemia, jaundice, ascites, and so on.
5, rectal examination can reach mass, gloves, stick bloody mucus.
6, abdominal distention advanced liver, ascites, cause abdominal distention.
7, sigmoid colon, rectum cancer examination can be observed that the shape, color, location.

A clear diagnosis

Clearly the meaning of at least 2.

The first is whether the judgement in the end had liver cancer;
The second is clearly the scope of liver cancer.

Clear diagnosis of very simple, the first is to determine you are indeed suffering from liver cancer, rather than advanced inspection equipment to your “lying”, only really suffering from liver cancer to accept the treatment of liver cancer is the scientific, If not suffering from liver cancer and liver cancer according to the treatment, it wrong;
Second, to liver cancer on the size, location, scope, level of respectability, a series of metastasis, and so on a clear, only to the above aspects of a master in order to formulate a scientific treatment, the patient can also Get the best treatment.

Since the doctor told patients suffering from liver cancer, why the need to be further confirmed this » This is because the current clinical diagnostic methods commonly used, sometimes a misdiagnosis, solely on the basis of individual inspection conclusion is even more prone to misdiagnosis of this situation. For a typical clinical features, the typical image examination or more typical liver, a single B-ultrasound, CT or MRI, liver angiography or two or more of them combined with the correct diagnosis rate of close to 100% Such a clear diagnosis of liver cancer almost no problem.

Of the rule is often misdiagnosed and misuse in clinical and imaging examination are not typical of the liver lesions. For these diseases, often the lack of a clear clinical performance, and the use of imaging examination of these lesions are often has been difficult, even the combination of two or means, the correct diagnosis was yet to be further improved. Clinical misdiagnosis on the cause of the error and its governance often have the following:

① will be more diffuse range of fatty liver tumor misdiagnosed as liver cancer, will embolization treatment;
② will adenomatous hyperplasia liver nodules, and other benign disease misdiagnosed as liver cancer, surgical resection;
③ small liver cancer misdiagnosed as hemangioma, the time delay treatment;
④ no clear diagnosis on the rush for governance, the omission of the lesions, or only some of the main lesions were removed, resulting in after poor results.

Second, develop treatment programmes
After a clear diagnosis, treatment plan is developed liver cancer patients receiving treatment before the important part. Liver cancer treatment is a big family, currently used on the main clinical including surgical resection, embolization treatment, drug catheter chemical treatment, tumors in the ethanol injection, radiofrequency ablation treatment with multiple warheads, biological therapy, Chinese medicine treatment. Over the treatment of liver cancer means have advantages and disadvantages, also have their own indications, the choice of treatment options, should give full consideration to the tumor location, extent, the growth rate, liver function status, age and economic sustainability, and other factors, Develop the best effect, at least side effects for patients and economic situation in the comprehensive treatment programme, all play the comprehensive advantages of treatment.

In short, if this is suffering from liver cancer, you must be calm, cool, calm again, do not rush to doctors, not Luantou Yi, the conditions should be better, stronger, more professional treatment of the hospital for medical treatment, so as soon as possible Clear diagnosis, formulate scientific and rational treatment, you accept the scientific, effective treatment.

Introduction of proprietary Chinese medicines commonly used liver cancer
1. Inaction Consumers film oral cancer, a 8-10 tablets a day three times. Anti-cancer, anti-inflammatory. Mainly for the treatment of esophageal cancer, stomach cancer, liver cancer, lung cancer, cardiac cancer, colon cancer, cervical cancer, leukemia and other malignancies, but also with radiotherapy, chemotherapy and post-operative treatment.

2. Kim grams (Huaier particles) granules 1 per bag, three times a month, Chongfu. A month for a course of treatment. Fuzheng have the effect of promoting blood circulation, suitable for the adjuvant treatment of liver cancer.

3. Muji compound granule bags per 1, three times a day, after meals Chongfu. Indications hepatitis, cirrhosis, liver cancer.

4. Compound deer Xiancao particles per 1 package, three times daily, oral, 30 days for a course of treatment. Chinese Shugan Jieyu, activating blood detoxification. Liver depression and stagnation for gas, drugs stasis Transimpedance caused by the primary liver cancer.

5. Ruanjian Oral Liquid, three times a day, every two, oral, 30 days for a course of treatment. Huayu, detoxification, Yiqi. Apply to the treatment of liver cancer.

6. Compound cantharidin every two capsules three times daily, oral, 30 days for a course of treatment. Indications of primary liver cancer, lung cancer, colorectal cancer, malignant lymphoma, and other gynecological cancer.

7. Kangai injection dosage use of slow or intravenous drip, on the 1st 1 to 2 times daily 40 ~ 60 ml, 30 days for a course of treatment, Yiqi centralizer, enhance immune function. For primary liver cancer, lung cancer, esophageal cancer, colorectal cancer, malignant lymphoma, gynecological cancer

1. Proliferation of esophageal cancer within the wall of water next to the bottom of epithelial cells into cancer or carcinoma in situ, on the surface spread of cancer is one way. Esophageal cancer is also often no inherent reactive submucosal layer membrane of the lymphatic invasion.

2. Directly adjacent organ invasion of esophageal cancer can be intrusive on the throat, trachea and neck soft tissue, and even penetrated bronchial, fistula formation of a bronchial; can also be invasive thoracic duct, Ki vein, hilar and lung tissue, and some can be invasive aortic formed Esophagus - aortic fistula, caused massive hemorrhage and Zhi Yuan. Lower esophageal cancer often involving cardiac and pericardium.

3. Lymphatic transfer of the more common, accounting for cases of 2 / 3. Middle of esophageal cancer often transferred to the next or hilar lymph nodes, can also be transferred to the neck, and gastric cardia around the left side artery lymph nodes. Esophageal cancer often lower esophagus can be transferred to the next, next cardia, left gastric artery Pangji abdominal lymph nodes, and so on, even to the last mediastinal lymph nodes and neck. Lymphatic were transferred to the Department of Run at, abdomen, next to trachea and trachea, bronchial hilar and next.

4. Blood transfer more common in patients with advanced. The most common transferred to the liver (about 1 / 4) and lung (about 1 / 5), followed by other organs of bone, kidney, adrenal gland, pleura, the omentum, pancreas, heart, lung, thyroid and brain, and so on.

First, esophageal function of the inspection:
1) esophageal motor function tests:
A) of esophageal pressure, apply to the suspected patients with esophageal motor disorders;
B) remove acid test for the determination of esophageal body ruled out the acid creeping efficiency.

2) of gastroesophageal reflux:
A) infusion of esophageal acid test;
B) 24-hour esophageal pH monitoring;
C) lower esophageal sphincter pressure test.

Second, Imaging Diagnostic:
1) X-barium examination: a diagnosis of cancer of the esophagus and cardia one of the important means, for the study and provide a reliable early esophageal cancer, esophageal combination of cytology and Endoscopy, can improve the accuracy of diagnosis of esophageal cancer. Esophageal cancer barium X-ray examination not only to determine the lesion site, length and obstruction of the need to judge whether the invasion of esophageal lesions and outside the scope of transgression.

2) CT examination: CT scans can clearly show esophagus and the neighbouring mediastinal organs, but found it difficult early esophageal cancer. CT and X-ray to check the integration of esophageal cancer diagnosis and help raise the level of phases.

Third, esophageal shedding cytology:
Esophageal shedding cytology method is simple, easy to operate, security, patients suffering small, the accuracy rate of more than 90 percent, esophageal cancer is an important method for large-scale census. But for esophageal bleeding and hemorrhage, or associated with esophageal varices should be taboo for esophageal net cytology; of esophageal cancer X-ray on a deep see esophageal ulcers or with hypertension, heart disease and late pregnancy, should Shenxing esophageal net loss of checks on the general situation of poor, too frail patients should first improve the general condition of patients after the examination; merger of the upper respiratory tract and acute upper gastrointestinal inflammation, infection control should be further checks. With barium X-ray inspection can be used as basis for the diagnosis of esophageal cancer, the majority of patients suffering from esophageal endoscopy. However, a narrow esophageal obstruction, so that this method can not be carried out esophageal endoscopy.

4, esophageal endoscopy:
Fiber-esophageal already widely used in the diagnosis of esophageal cancer. Esophageal endoscopy can directly observe the tumor size, shape and location for clinical doctors to provide the basis for treatment, but also in the lesion for biopsy or brush-examination. Esophageal endoscopy shedding cytology and the integration of esophageal cancer is the ideal method of diagnosis.

5, differential diagnosis:
In addition to the differential diagnosis of esophageal cancer history, symptoms and signs, to a large extent depends on the X-ray and endoscopy, and the final diagnosis to be confirmed by pathological diagnosis. To be benign esophageal cancer and esophageal cancer and other differential.

The results showed that: beer or liquor severe alcoholics the risk of colorectal cancer in a significant increase in alcohol than those who drink or a small amount was nearly double. And a small amount of drinking red wine to the risk of colorectal cancer in a significant reduction for the half of alcohol.

When the study will be limited to advanced colorectal cancer, this correlation still exists. Another study also found that the incidence of colorectal cancer risk include the elderly (more than 60 years old), smoking, high body mass index.

The researchers pointed out: Long-term drinking laws are in the risk of colorectal cancer significantly improved, general practitioners and gastrointestinal disease doctors should pay special attention to this crowd. Should be of concern in the daily cited at least a cup of beer or spirits are.

Anderson and others on a routine colonoscopy 2291 of patients with colorectal cancer were alcohol intake surveys to study the incidence of alcohol for colorectal cancer risks. Authors from the United States Stony Brook University’s Joseph C. Anderson said: alcohol colorectal cancer is one of the risk factors, lifestyle and genetic factors in the incidence of colorectal cancer plays an equally important role. A U.S. study concluded that: intoxicating liquor or beer can increase the risk of colorectal cancer, and red wine can reduce the risk of colorectal cancer. The results published in September’s “American Journal of Gastroenterology” (Am J Gastroenterol 2005; 100:2049-2055).