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Liver cancer and radiation therapy

I. Incidence

According to the 91st National Cancer Registry report of the National Health Service of the Executive Yuan, the Department of Health of the Executive Yuan, the incidence of liver cancer among Chinese people is the third highest, and the mortality rate is the highest among the top ten cancers. Liver cancer ranks first in the rate and mortality rate. The majority of liver cancer patients in this country are men, about three times more than women. The age of onset is concentrated in adults aged 40-50 years. In Taiwan, the main cause of liver cancer is hepatitis B and C. Alcoholic hepatitis is also prone to cirrhosis, which indirectly increases the risk of cancer.

Common symptoms

Liver cancer has almost no symptoms at an early stage. As the tumor grows and the disease progresses, the following symptoms may appear:

Discomfort in the right upper abdomen: Usually it is "swelling" or "soreness". This uncomfortable feeling is usually limited to the right upper abdomen, but sometimes it also extends to the upper back or shoulders.

  Jaundice: The remaining normal liver cells cannot exclude bilirubin from the bile, which causes jaundice; if the tumor invades or compresses the bile ducts and causes bile duct obstruction, the bile can't be smoothly discharged, which can also cause jaundice.

  Lower extremity edema and ascites: The main causes of ascites are increased pressure in the liver and portal vein, poor liver function, and the inability of the liver to produce enough albumin, allowing the water in the blood to leak out of the vessels, causing ascites and edema.

  Intra-abdominal hemorrhage: The liver cancer is too large to rupture, and blood flows into the abdominal cavity causing abdominal pain or even shock.

  Hematemesis: Increased portal vein pressure may cause esophageal venous tumors and rupture and bleeding.

  Others: fever, general burnout, loss of appetite, weight loss, etc. 

Third, the treatment

The treatment of cancer needs to determine the diagnosis and cancer stage, and then select the treatment method according to the stage. The main treatment methods are as follows:

   Surgical treatment: Resection of liver tumors is the most effective method for treating liver cancer, but not all patients are suitable for surgery. Whether they can be operated depends on liver function, tumor location, size, and number. Ask the general surgeon for details.

   Vascular embolization treatment: The growth of liver tumors mainly depends on the nutrient supply of the hepatic artery. Therefore, vascular embolization treatment is to inject embolic substances and anti-cancer drugs into the hepatic artery, plugging the arteries supplying liver cancer nutrients, and necrosis the cancer cells. If you encounter a large tumor, you may need to do a few more times to kill the cancer cells. Ask the radiologist, gastroenterologist or general surgeon for details.

   Radiation therapy: If the patient cannot receive surgery or vascular embolism, radiation therapy is another option; usually it is suitable for smaller tumors, or palliative radiation therapy can be performed when severe abdominal pain occurs. In addition, the radiotherapy team of our hospital found that if a patient's liver tumor invades or oppresses the hepatic portal vein, making vascular embolization impossible, he can use radiotherapy to open the portal vein of the liver, and then let the patient receive vascular embolization. Ask your radiation oncologist for details.

   Chemotherapy: The efficacy of most chemotherapeutic drugs for liver cancer is not good; currently there are some new drugs being studied, the effect is about 10% -20%. Whether it is worth a try, the liver function and overall condition of the patient should be considered It depends. Ask your colorectal surgeon or hematologist for details.

   Other treatment methods: including alcohol injection, cryotherapy, radiofrequency ablation, liver transplantation, etc.

4. Possible side effects and precautions of radiation therapy 

 During radiation therapy, radiation must pass through the normal liver before it can reach the tumor location. Therefore, during radiation therapy, liver function changes due to the radiation of some normal liver tissue. Common side effects during the course of treatment include nausea, vomiting, loss of appetite, weight loss, etc. The corresponding ways are:

1. You can drink light and cold beverages. Eating foods with strong acidity and saltiness can reduce symptoms. When severe vomiting, you can take antiemetics according to the doctor's prescription.

2. Avoid foods that are too sweet and greasy; avoid eating hot and cold foods at the same time, otherwise it will easily stimulate vomiting.

3. Eat dry food before and after getting up and before exercising.

4. Few meals to avoid fasting; drink preferably 30 ~ 60 minutes before meals, and it is advisable to suck with a straw.

5. Avoid eating within 2 hours before receiving radiation therapy to prevent vomiting.

6. Pay attention to the balance of moisture and electrolyte.

7. If you feel tired, rest for a while and eat after the physical strength is restored, try to cook the greasy food by the patient as little as possible, otherwise it will affect appetite.

The occurrence of other advanced side effects is related to the dose of radiation and the amount of radiation to normal tissues, which has rarely occurred under the current advanced radiotherapy technology. There may be gastrointestinal bleeding, biliary bleeding, duodenal stenosis, etc.

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