What should you do if a lung nodule is found in a health check-up? How can pancreatic cancer that cannot be surgically removed be treated? Is minimally invasive ablation effective for liver tumors? On the evening of November 1, Dr. Niu Lizhi, President of Guangzhou Fuda Cancer Hospital, along with Dr. Liu Shupeng, Director of the Fifth Medical Department, and Dr. Li Hongmei, Deputy Director of the Sixth Medical Department, were featured on the People’s Daily Health Client. The experts discussed minimally invasive tumor ablation treatments and shared valuable insights in the fight against cancer.
Empowering Medicine Through Technology. With advancements in minimally invasive techniques, more cancer patients, particularly those with mid-to-late-stage tumors, are experiencing extended lifespans and improved quality of life through minimally invasive treatments. Guangzhou Fuda Cancer Hospital, a national clinical key specialty (oncology) hospital specializing in minimally invasive tumor treatment, is at the forefront of this field, with Dr. Niu among the pioneers exploring these techniques in China. During the live broadcast, the experts provided an in-depth professional overview of the clinical applications and advantages of minimally invasive tumor technology.
**Interview Highlights**
**Q: What are the common treatment options for tumors or cancer? What new techniques are involved in emerging minimally invasive treatments?**
**Dr. Niu Lizhi:** Conventional cancer treatments include surgical resection, chemotherapy, and radiotherapy. With scientific advances, immunotherapy, targeted therapy, and minimally invasive ablation techniques are gaining increasing attention. Minimally invasive ablation is especially notable in modern oncology due to its minimal trauma, reduced pain, and proven efficacy. It encompasses techniques such as radiofrequency ablation, microwave ablation, cryoablation, NanoKnife ablation, chemoablation, laser ablation, and ultrasonic ablation. These techniques have brought us closer to achieving tumor cure without surgery.
**Q: Compared to traditional tumor treatment methods, what are the characteristics and advantages of minimally invasive ablation? What significance does this new treatment hold for cancer patients?**
**Dr. Niu Lizhi:** Surgical resection remains one of the most effective ways to treat cancer, and if surgery is feasible, it remains the first choice. However, if similar efficacy can be achieved without surgery, it marks a significant medical advancement. Both domestic and international guidelines suggest that early-stage liver cancer can be treated either by resection or ablation, both with curative potential. This signifies that minimally invasive ablation techniques can effectively treat tumors, alleviate symptoms, and improve patients' quality of life.
The main advantage of minimally invasive ablation is that it requires no open surgery, causing minimal harm. A procedure can be completed with just a needle, sometimes even under local anesthesia, allowing patients to chat with doctors during the operation—something that traditional surgery cannot offer. This technique offers a new option for patients unsuitable for surgery or experiencing tumor recurrence. Minimally invasive ablation can also be combined with radiotherapy, chemotherapy, targeted therapy, and immunotherapy as a “weapon” to enhance cancer treatment.
**Q: How do cryoablation and NanoKnife ablation work in tumor treatment?**
**Dr. Li Hongmei:** Cryoablation involves rapid freezing of cancerous tissue to form an ice ball, followed by thawing to induce necrosis or apoptosis of cancer cells, thereby achieving ablation. Cryoablation damages tumor cells through four main mechanisms: crystal formation, disruption of microcirculation, induction of cell apoptosis, and enhancement of immune response.
NanoKnife ablation, although it contains the word “knife,” actually utilizes electric pulses, making it a non-thermal ablation technology. Under CT or ultrasound guidance, probes are inserted to deliver short, high-voltage direct current pulses. These pulses create irreversible nanopores in cell membranes, disturbing intracellular and extracellular balance and leading to cell apoptosis. This technique is also called irreversible electroporation (IRE) and is known to “electrically” eliminate cancer cells.
**Q: What is your view on the current status of lung nodule diagnosis and treatment in China?**
**Dr. Niu Lizhi:** Lung nodules have become a “trending disease,” yet most nodules detected in health check-ups are benign, with only a small proportion being malignant. Identifying malignant lung nodules is crucial. High-risk patients need prompt intervention, while low-risk patients can be monitored or treated with ablation.
Because lung nodules may indicate early-stage lung cancer, there is considerable public concern, even leading to over-diagnosis and over-treatment in clinical settings. Academician Zhong Nanshan mentioned that the rate of unnecessary nodule resections ranges from 20% to 40%. For nodules under 6 mm, both domestic and international guidelines recommend not worrying excessively; for nodules over 6 mm, monitoring size, density, and shape changes is advised, with timely intervention if necessary.
Fuda Cancer Hospital has accumulated extensive experience in diagnosing and treating lung nodules, especially in cryoablation of lung nodules, and has made academic contributions in this area. In 2019, we were the first to publish a paper on cryoablation of lung nodules internationally, authored by Dr. Liu Shupeng. This paper was cited this year in the expert consensus released by the American Association for Thoracic Surgery (AATS).
**Q: What role does cryoablation play in lung cancer treatment?**
**Dr. Liu Shupeng:** The NCCN and ESMO guidelines recommend ablation for early-stage lung cancer. Statistics show that ablation has significantly prolonged the lifespan of lung cancer patients who are inoperable.
I recall a former health minister from abroad who visited us for cryoablation after being diagnosed with stage IV lung cancer. She had a background in medicine from Harvard and, in October 2010, was admitted to Fuda Cancer Hospital, where I was her attending physician. Following her diagnosis, we performed cryoablation the next day, with no adverse reactions. She was discharged on the fourth day. One month post-surgery, her tumor had shrunk by one-third; by the third month, it had reduced by 80%, with pleural effusion resolved and tumor markers returning to normal. Grateful to China and Fuda, she later wrote the foreword to our Chief Director Professor Xu Kecheng’s book, sharing her experience of treatment at Fuda.
**Q: Pancreatic cancer, with its high difficulty in treatment, is known as the “king of cancers.” What treatment techniques are suitable for pancreatic cancer?**
**Dr. Li Hongmei:** Pancreatic cancer originates in the pancreas, and its challenging location and non-specific early symptoms often lead to late-stage diagnosis. Besides traditional surgery and chemoradiotherapy, treatments like NanoKnife, radioactive seed implantation, cryoablation, and HIFU are commonly used in pancreatic cancer. NanoKnife is an advanced minimally invasive technique particularly suitable for pancreatic cancer. It was approved in China in June 2015, and by July, Dr. Niu and his team had completed China’s first NanoKnife ablation surgery for pancreatic cancer. NanoKnife for pancreatic cancer is highly complex, requiring excellent surgical expertise and comprehensive hospital capabilities. Dr. Niu, a member of the CSCO Pancreatic Cancer Guidelines Committee, has substantial expertise in this area.
**Q: Besides pancreatic cancer, what other types of tumors can be treated with NanoKnife?**
**Dr. Niu Lizhi:** NanoKnife can selectively protect tissues without phospholipid bilayers, such as bronchial walls, blood vessels, bile ducts, pancreatic ducts, and nerves, from thermal effects. It is widely used in treating tumors of the prostate, liver, pancreas, and kidneys, especially for tumors near complex structures like the hepatic hilum, bile ducts, and ureters. Fuda has published dozens of research papers on NanoKnife and authored the first book in China on NanoKnife ablation.
**Q: Do you have any recommendations for cancer prevention?**
Early prevention and screening are crucial, especially in avoiding carcinogenic factors. Those with a family history of cancer should prioritize regular check-ups; treating viral infections promptly is also essential. Diet, lifestyle habits, and environmental factors are other aspects to consider. Minimizing exposure to these carcinogens can significantly reduce cancer risk. I also plan to conduct 100 public lectures on cancer prevention to raise awareness.
**Dr. Liu Shupeng:** In summary, "Five More, Three Less" is the key: eat more fresh fruits, vegetables, and whole grains; exercise regularly; avoid harmful substances; get regular check-ups; and maintain a positive mindset. Conversely, smoke less or quit smoking, drink less or avoid alcohol, and eat less high-fat, high-sugar, high-salt food.
**Dr. Li Hongmei:** Besides focusing on early screening, diagnosis, and treatment, proactively receiving preventive cancer vaccines, such as HPV and hepatitis B vaccines, is also important.