I am a liver cancer patient. On 18th January,2006. I did a regular body examination and found that there was a space occupying lesion in my left lobe of liver ,so i accepted the resection surgery immediately, the pathology showed that it was cholangiocellular carcinoma.After the surgery ,whether i should do the radio? Someone suggested me just did like usually do to accept the radiation. I refused and accepted a long-term immunotherapy.
Other two cancer patients who are my friends also have cholangiocelluar carcinoma and they both accepted the hepatectomy, and had the smooth operation. One of them is a general manager in a public company from Henan province,after his surgery, he also accepted the chemo and radiation. The later of 4 months, his tumor recurred again and found the liver, kidney and bone metastases. The tumor constricted spinal nerves and caused a great pain. Then he came to accept some comprehensive treatments which could remit pain in Guangzhou. Finally, he died for the hepatic failure;Another cancer patients is a lady from Shandong province, had the operation of hepatectomy in Shanghai, for consolidating the curative effect, she accepted the radiation and chemo. During her chemo, found the liver,lung and bone metastases in her body, when she came to the Guangzhou, she suffered more from jaundice,anemia and bleeding.Except the symptomatic treatment for her, we can not bring her any particular treatment.both of my friends’ survival were not more than 1 year.
The same cancer with them, why i am so lucky that have survived about 8 years without any disease symptom, however, both of them passed away in less than one year？Just like the general manager said：for your tumor accepted the “manual operation”treatment, and mine is for “stylized line” treatment; The husband of the lady from Shangdong spoke a point that: “whether do the radiation and chemo or not after the surgery, the doctors have different advice. But we always think the more treatments she gets the faster she cured, now,it proved its wrong for us.”they are both upset and said to me: it would be better if we go with you for the same treatment.
Face the challenge
Cancer therapies are faced with challenge: First, though the surgical resection is the main treatment to treat cancer, but “ radical cure” not equal to “healing”. Just like my two cancer friend s i mentioned above, they were “radical cure”, but there were several metastases and recurrent tumors after the surgery. We always to say “5-year survival rate was 50%, 60%, what about the cancer patients with 50%, 40%? They died?; second, when the cancer found, 70% of them lost the chance with surgical treatment. How to treat these patients? can we prolong their life? Third, chemo and radiation are the most generally used cancer treatment, but most of the patients can not live longer.
Why cancer will recur after the “Radical surgery”? Because cancer is a systemic disease, tumor just a part of them,even in the early stage, cancer cells may also exist in external bleed and marrow, these cancer cells often exist in the form of “cancer stem cells”and go into “ sleep” state,once it reaches the right time, the cancer cells will wake up and grow rapidly to be new tumor,this is “metastasis”. Cancer metastases are the main reason to kill the cancer patients.Chemotherapy is kind of treatment to use the chemical medicine to kill cancer cells. The malignant disease like leukemia,lymphoma are mainly depend on chemotherapy.
But less cancer patients are healing by chemo, someone estimated only 7% cancer patients can be healing, and may be effective to the other 15% of cancer patients.Though chemo is widely used for most of cancer patients,what is the great effect from chemo? Our famous chemotherapist and academician Sun Yan said: radiation and chemo are not all-powerful for everything, for some advanced cancer patients, radiation and chemo will increase their pain, which should be used vary seriously.In the process of treatment, should pay attention to the chemotherapy moderation, prevent its excessive use. Famous oncology Zhao Yuntang said:chemotherapy is a double-edged sword. After chemo the cancer cells will produce drug resistance so far as to increase residual cancer’s level of malignancy. The current molecular targeting treatment is like a “magical bullet”of molecular level, but it may also increase the ability of survival cancer cells and the metastases.
The present abused chemo to be a serious problem, the patients could not bear the pain and side effect from chemo have been done the chemotherapy. The medical college from Harvard University found that nearly 10% of advanced cancer patients accepted the chemo in the last two weeks of death ,also in 1999,the number increase to nearly 12%.Domestic incomplete statistics found that 15% of terminal cancer patients who were in the excessive and unreasonable treatments hasten their death.
New strategy
The world health organization declared: 1/3 cancer patients who can not do resection can prolong their life after the comprehensive treatments.Ablation and immune therapies are the main combined therapy and play an important role in treating middle-advanced cancer.
Ablation” is under the guidance of ultrasound or CT to insert cold or hot probe into tumors by ultra-low temperature or high temperature to destroy the tumors.Modern cryotherapy is the arisen technology in the 1990s,during the treatment, the ultra-low temperature is limited to the top of the probe, needle bar is the normal temperature,therefore,it could only freeze tumors to death without damage to normal tissue.
Cryoblation is mainly used for removing the tumor that doesn’t work by surgical resection, such as lung cancer,liver cancer and etc,if the tumor is small, the effect of cryoablarion is similar with surgical radical resection, it is vary helpful and good for the aged, bad heart-lung-liver function, intolerable surgery cancer patients. For big tumor, can reduce the “load” of cancer and create conditions for other treatment.
The final use of hot ablation or cold ablation depends on the surgeon experience. According to our experience in more than 8000 cases, we tend to use “cryoablation”, because (1) cryoablation not only cure small tumor but also treat large tumor; (2) for general, cryosurgery won’t damage big blood vessel and windpipe, so the close tumor around these tissue also can be used cryoablation; （3）when doing the cryoablation treatment the patients cause less pain, in fact, the cryoablation itself relieve pain; （4）after the death of cancer cells by cryoablation, it will release antigen to stimulate human immune system, on the contrary, it will kill survival cancer cells. Clinic found that after the main tumors are killed by cryoablation, the survival tumor mass can disappear gradually, this is why the cryoablation stimulate the body’s immune system.
Immune therapy is a systemic treatment aim at strengthening the immune cells in the body to kill the survival or hidden cancer cells with few side effects. In 2008, the world's most famous magazine "New England journal of medicine “reported a 52 - year - old male patient from US has recurrent melanoma with right lung and pleura, multiple transfer to left iliac fossa and groin area, and various kinds of treatment are invalid to him.The authors isolated the immune cells from peripheral blood of patient, and then use particular antigen stimulated T cells back to the patients. 2 months later, the lung and other metastases diseases disappear entirely, and return to the hospital to review found there was no any recurrence after 26 months. The author has applied immunotherapy to treat a patient with advanced melanoma, he lived for 13 years from now, which far more than the patients from US.
At present, Immunotherapy is regard as the treatment can cure cancer. In order to improve the treatment effect, we must be aware of the following: （1）Before the immune therapy, need to do the immune cells and cytokines’test so as to choose the right immunotherapies; （2）Must to do the short -time chemo, at least using small dose cyclophosphamide for 1-2 times, this is because the blood has the adjustable T cells which can control lethal immune cells,the chemo can destroy this adjustable cells; （3）Several methods must be used simultaneously or successively, because the cancer cells have diversity and cancer gene is unstable and change constantly, therefore anti-cancer immune cells must be large and variable;（4）must insist for a long-time treatment.
New Idea
Cancer is considered a “chronic disease”. It is almost impossible to kill all the caner cells completely. Not satisfied with local tumor removal, the target of treatment is to prolong cancer patients’ life. To this end, firstly, need to prevent the recurrence after the surgery, including smoking, avoid alcohol,proper exercise,optimistic,eliminate inflammation,eat more fruit and vegetable, as well as regular monitoring of immune state to correct cancer; Secondly, For the inoperable patients, need to reduce their tumor “load”as soon as possible, apply the cryoblation and systemic therapies include chemo,immunotherapy and etc; Thirdly, for the middle-advanced cancer,which can not expect to give a therapy and a doctor can save the patients, we should depend on the patients’ personalized conditions and specific situation to combine different treatments to treat cancer; Fourthly, maintain the health and moderate treatments. American cancer society have declared: For the advanced cancer patients can prolong life with right treatments, but chemo is impossible.
In the treatment of locally advanced cancer, such as liver cancer, pancreatic cancer or lung cancer, our experience is:(1) first to use ultrasound or CT guided cryoablation;（2）for the tumor tissues that cryoablation failed to kill,implant 124 iodine seed is for close to do radiotherapy;（3）if the patients never accept the chemo before, was estimated as chemotherapy sensitivity, these patients can accept the chemo before or after cryoablation;（4）do genetic tests,if there is pointers, given the molecular targeted therapy;（5）if the patients have accepted the chemo before, can be given vascular intervention ( effective perfusion or embolism, or “cancer microvascular interventional therapy”);（6）Apply immnuotherapy to prevent the disease progression or recurrence.
We combine the cryosurgical ablation( seed implantation)(CRA),cancer miscrovascular intervention (CMI)and combined immunotherapy for cancer (CIC), and then according to personalized therapy (p) to form the model “3C+P”. Nearly ten thousand cancer cases showed that 70% of middle-advanced cancer patients included non-response on chemo/radio, or recurrent cancer patients can be improved or prolong their survival, some of them can be totally heal by using “3C+P”treatment model. It also make a great effect with the middle lung cancer, large liver cancer.The pancreatic cancer are the malignant tumors grow fastest for human,world literature shows that the survival rate of pancreatic cancer patients who can not accept surgical resection is lower than 10%, “ no effect” living days about 3-6 months, and there are 300 patients accepted the treatment of “3C+P”whose survival rate for one year reach 60%, for three years reach 15%, some of patients have survived more than 5 years. This achievement respectively awarded golden medal on International Low temperature medical conference in Tokyo 2008 and Vienna 2011.
Conclusion
There is a famous oncology from US have said that the future cancer therapies depend on personalized medicine, this need a large change for our traditional medical system, the cancer patients accept a best and right treatment or several treatments are good to a general treatment. This is the hope of cancer treatment.
As a oncology, I hope every patient can be given the best treatment to improve and prolong their life. As a cancer patient, I hope the most effective and no pain treatments can prolong my life and live happily.Oncology is a optimist, I feel honor to be one of them, in order to benefit the cancer patients, we all hope the current medical treatments' reform which is not only offer every patients a “standard treatment”as a insurance, but also promote the true value of various treatment for every doctor.
Pro. Xu Kecheng
【The author: Chinsese famous digestive disease expert and ocologist . Chief president of Fuda Cancer Hospial, Jinan university school of medicine, president of international society of cryosurgery (ISC), Winner of National "Bethune Medal". The mian composition «Modern Therapy of Digestive Disease», «Modern Cryosurgery for Cancer»,«I Tell the Truth for Cancer Patients»,«Anti-cancer With Me»】
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