On July 14, the relatives of Thierry Ardisson, a cult figure of French television, announced his death. The man in black had never hidden his illness, even if he had been discreet in recent months. How to explain what happened to him?
The disease, a part of Thierry Ardisson assumed
Thierry Ardisson has already explained in the past to have contracted hepatitis C in his youth. Probably in the 1970s, following “speedballs” type experiences, mixtures of cocaine and sniff heroin.
This chronic infection has slowly evolved towards cirrhosis. Then in hepatocellular carcinoma, the most common shape of primitive liver cancer. A trajectory that illustrates the direct link between viral hepatopathies and the appearance of hepatic malignant tumors.
Indeed, as Dr. Anaïs Palen, oncologist surgeon at the Paoli-Calmettes Institute in Marseille, explained to us, cirrhosis is the first cause of hepatocarcinoma. And its main risk factor is an excessive and chronic consumption of alcohol, followed by infection by viruses of hepatitis B or C.
Understand the different types of liver cancer
Liver cancer is not a single entity.
According to Dr. Palen, “It is necessary to distinguish the primitive tumors of the liver, which develop from cancerous liver cells, from liver metastases, which come from a cancer located elsewhere, such as breast or lung, and whose care is completely different“.
Among the primitive tumors, two types largely dominate: hepatocellular carcinoma, which represents around 85 % of cases, and intra-hepatic cholangiocarcinoma, a tumor of the internal bile ducts, much more rare.
The patient profile varies depending on the type of tumor. Hepatocellular carcinoma mainly affects men over 55, generally carrying cirrhosis or viral history. Cholangiocarcinoma, on the other hand, occurs on average around 70 years old, and its incidence increases particularly in women. “”These two cancers have neither the same origin, nor the same age of occurrence, nor the same evolution“Specifies Dr. Palen.
When can we still consider curative treatment?
The prognosis depends largely on the liver function and the size of the tumors at the time of the diagnosis. If the liver works properly and the tumor remains located (less than 5 cm, without severe portal hypertension), surgical resection can be considered.
For smaller lesions (less than 3 cm), less invasive, doctors often offer radiofrequency or microwave removal. In the event of contraindication to these approaches, intra-arterial chemotherapy (TACE) can slow down the progression of the disease.
Hepatic transplant is the only treatment considered as long -term curative, provided you respect the criteria of Milan: a single tumor of less than 5 cm or up to three nodules of less than 3 cm each, without vascular involvement or metastasis. The patient must still be able to support this heavy operation.
What remains when the disease becomes incurable?
When the tumor infiltrates liver vessels or extends to other organs, or cirrhosis alter the function of the liver too much, the healing treatments are no longer possible. Some patients are also excluded from the transplant because of age, associated pathologies or active addictions. At this stage, the objective is to offer prolonged survival and acceptable life of life.
- Immunotherapy (ATEZOLIZUMAB + BEVACIZUMAB) is now the first line reference treatment for advanced forms;
- In the second intention, targeted therapies such as Sorafenib, Lenvatinib or Rego can be proposed;
- Finally, support treatments are set up to relieve frequent complications: ascites, hepatic encephalopathy, abdominal pain.
In this context, systematic screening in people with cirrhosis is crucial. He goes through a half-yearly ultrasound with a dosage of alpha-foetoprotein.
In addition, it is possible to eradicate the virus of hepatitis C by direct action with direct action. This has made it possible to significantly reduce the incidence of liver cancer. But in cases where the virus was discovered too late or neglected, the chances of healing are often compromised.
PLet us recount that the explanations given by this doctor two years ago concerned liver cancer in general, and not an analysis of the specific case of Thierry Ardisson