肝癌分期 多種條件一併納入考量

[MK]

http://tw.news.yahoo.com/article/url/d/ ... 2l05v.html

更新日期:2011/01/18 04:11
文／許金川


Q：舅舅今年58歲，有B型肝炎，因為工作的關係，常熬夜又喝酒，最近被診斷出有肝癌。醫師說，舅舅的腫瘤因為跑到肝臟的門靜脈內，且肝硬化比較厲害（B級），所以情況不太樂觀，大概已經屬於後期肝癌了。


其實目前舅舅看起來好好的，活動也很正常，只是胃口稍微差一點，怎麼醫師會說，他的肝腫瘤已經是後期呢？


A：肝臟是一個很能忍耐的器官，輕微的肝炎、肝硬化或早期肝癌，肝臟都會不動聲色，只要有1/4正常的肝臟功能還在，肝臟都能忍著不出聲照常運作，也因為這樣，往往讓人忽略了它的健康，一旦有黃疸、腹水爆發出來，常常都已經錯失了治療的契機。


肝癌跟其他癌症一樣，臨床上，也有它的分期系統，不過，肝癌分期較特殊之處在於不是只專注於肝癌本身，也就是不只看腫瘤的大小、顆數、有沒有轉移等，還要看病人本身有沒有肝硬化，或肝硬化的程度，還有病患整體的生活功能，這些都是肝癌分期的重要參考條件。


現階段在國際上，有許多肝癌的分期標準，各有其優、缺點及爭議之處，有一套由巴塞隆納所發展出來的BCLC分期系統，近年來被美國肝病醫學會所推崇，其將肝癌分為5期，由輕至重分為0期（極早期）、A期（早期）、B級（中期）、C期（後期）、D期（末期），依據此分級標準來看，您的舅舅因為腫瘤已經侵犯到門靜脈且肝硬化B級，雖然整體生活自如，還是歸屬於後期肝癌。


肝臟沒有痛覺神經，加上肝癌容易入侵門靜脈，一旦入侵門靜脈，最好的治療包括手術切除或栓塞治療都不適合，因此B肝或C肝患者一定要密切追蹤。


（作者為台大醫學院內科教授、財團法人肝病防治學術基金會執行長）


●肝病防治學術基金會備有B型、C型肝炎治療小手冊、肝癌治療小手冊及好心肝會刊，提供民眾免費索閱。最新52期會刊內容包含「認識急慢性肝炎」、「對付肝硬化併發症」、「肝臟移植後，如何照顧新肝寶貝？」等。


許金川教授著作的「遠離肝苦很簡單-你必須知道的保肝知識」已出版。諮詢專線：0800-000-583，網址：www.liver.org.tw。

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