Pencegahan kanker ati
Nyegah kambuh deui kanker ati, nyegah kambuh deui kanker ati sanggeus dioperasi, kumaha nyegah kambuh deui kanker ati, kumaha nyegah kambuh deui kanker ati
Liver cancer is the second leading cause of cancer death in the world, of which hepatocellular carcinoma (HCC) is the most common type of liver cancer. Globally, nearly half of new cases of liver cancer occur in China. The treatment options for patients with advanced hepatocellular carcinoma are very limited. The currently approved treatment options have a tumor progression-free survival of about 3-7 months and a total survival of about 9-13 months
Tingkat salamet lima taun kanker haté
The five-year survival rate of patients with kanker haté is low, according to data from the US ASCO official website:
44% pasién didiagnosa kaserang kanker hati tahap awal sareng tingkat salamet 5 taun na nyaéta 31%.
Upami kanker ati parantos nyebar ka jaringan atanapi organ sakurilingna sareng / atanapi simpul limfa régional, tingkat salamet 5 taun nyaéta 11%.
Upami kanker parantos nyebarkeun jauh tina awak, tingkat salamet 5 taun nyaéta 2%.
Nanging, sanaos kanker katéang dina tahap anu langkung maju, sagala rupa pangobatan tiasa dianggo pikeun ngabantosan penderita kanker ati manjangan umur hirupna. Bedah mangrupikeun pilihan pangobatan anu pangsaéna pikeun penderita kanker ati. Kaseueuran pasien mikirkeun reseksi bedah heula, tapi aranjeunna masih nyanghareupan résiko kambuh saatos reseksi operasi.
Kumaha carana sacara efektif nyegah kambuh kanker ati?
Tinjauan périodik
Compared with malignant tumors such as breast cancer and bayah cancer, the recurrence rate of liver cancer is relatively high: Generally, the recurrence rate after three years is about 40% -50%, and the recurrence rate after five years is 60% -70% .
Kusabab kitu, perlu ditinjau sacara teratur sareng nuturkeun paréntah dokter, sanaos aya tanda-tanda awal metastasis dipendakan, masih aya kasempetan pikeun disebarkeun deui sacara operasi. Upami sakabeh metastasis awak dipanggihan kusabab ngalalaworakeun tinjauan, pangobatan bakal hésé pisan.
Barang anu kedah diparios pikeun marios kanker ati rutin kalebet:
Tés fungsi ati
Liver function tests are generally the most capable of detecting the current state of the liver for diseases and inflammations, but they often fail to detect the presence of cirrhosis and liver cancer, and they cannot detect whether they are infected with various hepatitis viruses.
Fetoprotein alfa
Upami alfa-fetoprotein positip sateuacan operasi turun janten normal saatos operasi dipiceun kanker ati, teras ningkat deui, teu aya katerangan pikeun panyakit ati aktif kronis, anu nunjukkeun yén kanker ati parantos ngulang.
Pikeun penderita alfa-fetoprotein négatip sateuacan reseksi kanker ati, alpha-fetoprotein tiasa positip nalika kambuh, sareng alpha-fetoprotein kedah tetep dituturkeun saatos operasi.
Ultrasound dina beuteung
B-ultrasound ngagaduhan kaunggulan sénsitip, genah, sareng béaya rendah. Mangrupikeun cara anu penting pikeun ngawaskeun kanker kanker ati. Ultrasound beuteung mangrupikeun tés anu penting
Radiografi dada
Sababaraha lesions kambuh mimitina lumangsung dina bayah, jadi dada Sinar-X diperlukeun pikeun ngawas dada pikeun kambuh.
CT, PET-CT
When the doctor is still not sure whether to transfer after the B-ultrasound, CT scan should be done in time. If there is any other metastasis in another part, then a whole body PET-CT check is performed. Conditioned liver cancer patients can have a PET-CT examination once a year to detect tumors larger than 2mm in the whole body at one time, reducing the complexity and uncertainty of many tests.
Ngarobih gaya hirup
Leupaskeun alkohol, kaluar alkohol, kaluar alkohol, hal penting anu disebutkeun tilu kali, anjeun kudu kaluar alkohol. Ogé, ulah ngaroko, ulah kaleuleuwihi, sareng tetep bahagia.
Latihan anu pas, 2-3 bulan saatos dioperasi, anjeun tiasa ngalakukeun latihan anu lembut, sapertos leumpang, sareng laun-laun ningkat tina 15 menit dugi ka 40 menit; Anjeun ogé tiasa latihan qigong, Tai Chi, latihan radio sareng latihan hipu anu sanés.
Perhatian khusus kedah diperhatoskeun dina diét, tong tuang kadaharan kapang, barbecue, bacon, tahu sareng tuangeun sanés anu ngandung nitrit, sareng henteu tuang ubar tradisional Cina sareng produk kaséhatan.
Diét paséa operasional utamina énténg, sareng asupan protéin kualitas luhur sapertos endog bodas sareng daging langsing leres-leres ningkat. Diét pasca operasi umumna transisi tina cai, bubur, susu, endog dikukus, lauk, daging langsing kana diet biasa.
Coba tuang tuangeun anu gampang dicerna, nyingkahan gajih, lada, ngaganggu, heuras, caket sareng tuangeun anu sanés, tuangeun saimbang, tuang langkung seueur, sareng henteu kedah pinuh.
Kumaha carana nyegah kambuh kanker ati saatos operasi?
At present, the main treatment options for liver cancer include liver transplantation (liver replacement), liver cancer resection, transcatheter arterial chemoembolization, radiofrequency ablation / microwave ablation, high-intensity focused ultrasound (HIFU), absolute alcohol injection, molecular targets To drugs, etc., while radiotherapy, chemotherapy, and immunotherapy mangrupakeun perlakuan adjuvant, umumna lain salaku rencana perlakuan utama.
Bedah bersih
The most ideal method for liver cancer treatment is to remove tumor lesions to achieve the goal of radical cure. If the surgical criteria are met, all tumors can be removed surgically.
Upami aya sababaraha lesi, daérah invasi relatif ageung, atanapi metastasis jauh, reseksi tumor tiasa dipilih numutkeun kaayaan. Dina kasus yén kauntungan bedah henteu dijamin, padika pangobatan anu sanés tiasa dipilih.
Perlakuan invasif minimal
Perlakuan invasif minimal mangrupikeun padika unik pikeun pangobatan kanker ati, kalebet tilu di handap ieu:
1. Chemoembolization artéri transcatheter
Lebetkeun tabung tina arteri femoral tina anggota badan handap atanapi artéri radial tina anggota awak luhur kana ati, sareng meungpeung arteri anu tuang tumor, sareng tumor bakal ngalaman nekrosis iskemik. Dina waktos anu sasarengan, ubar kemoterapi disemprotkeun kana tumor anu nganggo lipiodol. Dina kasus mangaruhan jaringan ati normal di sakurilingna, sél tumor tiasa langkung tiwas.
2. Ablasi kimia
Biasana dina panungtun ultrasound B atanapi CT, suntikan alkohol mutlak kana situs tumor ngajantenkeun sél tumor gancang dehidrasi sareng protéinna dématur sareng koagulasi, sahingga maéhan sél tumor, tapi cara ieu ayeuna kirang dianggo.
3. Ablasi fisik
Kalebet radiasi ablasi radiofrequency sareng gelombang mikro ablasi, ogé dina panungtun ultrasound B atanapi CT, sél tumor tiwas ku pangaruh thermogenic tina jarum tusukan.
Radioterapi dina kanker ati
Radiotherapy biasana dianggo salaku perlakuan pelengkap. Pikeun kanker ati di tempat-tempat khusus (sapertos intravaskular, saluran biliary, atanapi véna ageung caket), pangobatan invasi minimal henteu tiasa kahontal, atanapi pangubaran anu minimal invasif henteu tiasa dilaksanakeun kalayan bersih. Radiotherapy tiasa dipilih.
Terapi proton dina pangobatan kanker ati
Radiotherapy mangrupa perlakuan adjuvant pikeun loba penderita kanker ati sanggeus bedah. Sanajan kitu, dina radiotherapy tradisional, sinar-X atawa sinar foton anu inevitably dikirimkeun ka situs tumor jeung jaringan sehat sabudeureun. Ieu bisa ngaruksak jaringan sehat caket dieu sarta bisa ngabalukarkeun efek samping serius. Terapi proton sampurna tiasa nyingkahan efek samping ieu.
Kontrasna, terapi proton nganggo iradiasi sinar proton sareng tiasa mampir di tempat tumor tanpa ngantepkeun dosis radiasi di balik tumor, janten anjeun
nlikely to damage nearby healthy tissue. Some experts believe that proton therapy is safer than traditional radiation therapy. Cancer patients have low immunity, high-intensity radiation exposure can easily cause damage to normal organs, cause serious adverse reactions, and bring a serious burden to the already weak body. Especially for liver cancer, tumor lesions are next to many important organs, such as lung, heart, esophagus, etc. There are also common brain metastases. Choosing proton therapy can effectively avoid damage to surrounding healthy tissues and achieve tumor-killing like traditional radiotherapy effect.
Perawatan médis kanker ati
1. Kémoterapi
Kémoterapi kalebet kémoterapi sistemik sareng kémoterapi lokal. Kémoterapi lokal nyaéta chemoembolization artéri transcatheter anu didadarkeun di luhur. Éféktivitas kémoterapi sistemik kirang ti 10%, sareng efek sampingna serius. Kaseueuran pasién moal milih.
2. Terapi sasaran
Targeted drugs approved for liver cancer at home and abroad
| kaping | FDA nyatujuan ubar target kanker ati | tandana | Persetujuan domestik |
| November 2007 | Sorafenib (Sorafenib, Nexavar) | Pikeun pengobatan karsinoma hepatosélular atanapi kanker hati anu teu tiasa dirawat | Listing sareng kalebet asuransi kasihatan |
| Agustus 2018 | Lenvatinib (Levatinib, Lenvima) | Pikeun pangobatan lini kahiji tina karsinoma hépatosélular anu teu tiasa dirawat | Buka umum |
| April 2017 | Regorafenib (Sigvarga) | Perlakuan garis kadua pikeun kanker ati anu tahan sorafenib | Listing sareng kalebet asuransi kasihatan |
| September 2017 | Nivolumab (navumab, Opdivo) | Perlakuan garis kadua pikeun kanker ati anu tahan sorafenib | Buka umum |
| November 2018 | Pembrolizumab (Keytruda) | Perlakuan garis kadua pikeun kanker ati anu tahan sorafenib | Buka umum |
| Januari 2019 | Cabozantinib (Cabometyx) | Perlakuan garis kadua pikeun kanker ati anu tahan sorafenib | Buka umum |
| bisa 2019 | Ramucirumab (Rimolimumab, Cyramza) | Monoterapi pikeun penderita karsinoma hepatosélular sareng alfa-fetoprotein (AFP) ≥400ng / ml sareng sateuacan diubaran ku sorafenib | Teu daptar |
Pilihan pangobatan garis kahiji pikeun kanker ati
(1) Sorafenib
A number of clinical studies have shown that Sorafenib has certain survival benefits for patients with advanced liver cancer in different countries and backgrounds with different liver diseases (level of evidence 1).
Pamakéan anu disarankeun biasana nyaéta 400 mg oral, dua kali unggal dinten. Tiasa dianggo pikeun pasién Kelas-B atanapi Kelas A atanapi B anu ngagaduhan fungsi ati. Dibandingkeun sareng fungsi ati Child-Pugh B, Child-Pugh A benefit survival pasién langkung jelas.
Kudu merhatoskeun pangaruhna kana HBV sareng fungsi ati, sareng ngamajukeun ngatur panyakit dasar ati dina prosés ieu. Réaksi ngarugikeun anu paling umum nyaéta diaré, leungitna beurat, sindrom leungeun jeung suku, baruntus, iskemia miokardial, sareng hiperténsi, anu biasana kajantenan dina 2 dugi 6 minggu saatos mimiti ngubaran.
(2) Lemvatinib
Lenvatinib cocog pikeun penderita anu teu tiasa didésépsi sareng tahap IIb, IIIa, IIIb, fungsi ati Anak-Pugh Kangker ati, sareng pangobatan lini kahiji na henteu kalah ka sorafenib. Kanker ati anu patali sareng HBV ngagaduhan kauntungan Survival anu langkung saé [185] (tingkat buktina 1).
Lenvatinib parantos disatujuan pikeun dianggo dina Child-Pugh A penderita kanker ati kalayan kanker ati anu maju. Pamakéan: 12mg, lisan, sakali unggal dinten kanggo beurat awak ≥60kg; 8mg, lisan, sakali unggal dinten kanggo beurat awak <60kg. Réaksi ngarugikeun umum nyaéta hiperténsi, diare, turun napsu, kacapean, sindrom kaki-kaki, proteinuria, lieur, sareng hypothyroidism.
(3) Kémoterapi sistemik
The FOLFOX4 (fluorouracil, calcium folinate, oxaliplatin) protocol is approved in China for the treatment of locally advanced and metastatic liver cancer that is not suitable for surgical resection or local treatment (level of evidence 1).
Sababaraha studi tahap II parantos ngalaporkeun yén kémoterapi sistemik sareng oxaliplatin digabungkeun sareng sorafenib tiasa ningkatkeun tingkat réspon objektif, manjangkeun salamet bébas kamajuan sareng salamet sacara umum, sareng nyayogikeun kasalametan anu saé (tingkat bukti 3).
Pikeun pasién anu ngagaduhan fungsi ati anu saé sareng status fisik, terapi kombinasi ieu tiasa dianggap, tapi studi dikontrol sacara acak sacara klinis masih diperyogikeun pikeun nyayogikeun bukti-bukti médis dumasar-tingkat tinggi. Salaku tambahan, trioxide arsenic gaduh pangaruh perlakuan paliatif tangtu dina kanker ati maju (tingkat bukti 3). Dina aplikasi klinis, jaga kedah diawasi sareng nyegah karacunan ati sareng ginjal.
Perawatan barisan kadua kanker ati
(1) Regorafenib
Regorafenib disatujuan pikeun dianggo dina pasién kanker tahap IIb, IIIa, sareng IIIb CNLC anu parantos diubaran ku sorafenib (tingkat buktina 1). Pamakéanna nyaéta 160mg sakali unggal dinten salami 3 minggu sareng lirénna salami 1 minggu.
Di Cina, dosis awal tiasa 80mg atanapi 120mg sakali, sakali sapoé, sareng laun ningkat numutkeun kasabaran sabar. Kajadian ngarugikeun umum nyaéta hiperténsi, réaksi kulit kaki-tangan, kacapean, sareng diaré.
(2) Navumab sareng Paimumab
The US FDA has approved the use of Navulinu monoclonal antibodies (Nivolumab) and Pabrolizumab monoclonal antibodies (Pembrolizumab) in patients with liver cancer who have progressed or cannot tolerate sorafenib after previous sorafenib treatment (level of evidence 2).
Ayeuna, sambetan péso imunologis sacara mandiri dikembangkeun ku perusahaan Cina, sapertos antibodi monoklonal Carellidizum, antibodi monoklonal Treplepril, sareng antibodi monoklonal Xindili, parantos aya dina panilitian klinis. Kombinasi imunoterapi sareng ubar anu ditujukeun, ubar kemoterapi, sareng pangobatan topikal ogé teras-terasan digali.
Imunomodulator séjén (sapertos interferon α, timosin α1, jsb.), imunoterapi sélular (sapertos terapi sél T reséptor antigén chimeric, CAR-T, and cytokine-induced killer cell therapy, CIK) all have certain antitumor effects. However, it is yet to be verified by large-scale clinical studies.
(3) Pilihan pangobatan kadua anu aya di Amérika Serikat
Salaku tambahan, US FDA nyatujuan cabozantinib pikeun penderita kanker ati anu parantos maju saatos terapi sistem lini kahiji (tingkat buktina 1), sareng nyatujuan panggunaan antibodi monoklonal Lemorex pikeun pangobatan linién kadua anu ngagaduhan tingkat AFP ati ≥400ng / mL (tingkat buktina 1)). Nanging, dua ubar ieu henteu acan dipasarkeun di Cina. Panilitian klinis kandaraan alit-molekul anti-angiogenesis nargétkeun apatinib ubar pikeun linién kadua pikeun penderita kanker ati masih lumangsung.
