Liver Cancer
Treatment Options
Liver cancer treatment varies from patient to patient. The treatment
approach is adjusted to the patient’s needs and takes in consideration
the following factors: (1) the tumor size and location, (2) the cancer
stage, (3) the general health state of the patient, and (4) the patient’s
age.
The treatment options for liver cancer are:
Surgery
Surgery, as a treatment option for liver cancer, is available
only for those patients whose tumors are no larger than 5 cm, are confined
to the liver, and the cancer has not invaded the adjacent blood vessels,
organs or lymph nodes.
There are four types of surgery performed in liver cancer patients:
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Partial hepatectomy is a type of surgery
where only part of the liver, where the tumor is located, is removed.
There are three types of partial hepatectomy: (1) wedge resection,
where a triangle-shape slice of tissue is removed, (2) lobe
resection, where only the liver lobe is removed, and (3)
partial resection, where a large portion of the liver
is removed.
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Total hepatectomy is a complex surgery where
the entire liver is removed. This procedure is followed by a liver
transplant because the body cannot live without the liver.
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Cryosurgery is a type of surgery that kills cancerous
cells by freezing them. This procedure uses the advantages provided
by the freezing temperature on the cells. The cells, when exposed
to low temperatures, form ice crystals inside that tear apart the
cell’s body. The most common substance used as a cooling agent
is liquid nitrogen. The nitrogen can be administrated (1) by spraying
it on the tissue, (2) through a tube (cryoprobe) inserted into the
tissue, or (3) swabbed directly on the tissue. Cryosurgery is a minimally
invasive procedure that substantially reduces the patient's recovery
time by minimizing the pain and scars. However, there are several
risks involved when this procedure is performed such as the damage
of nearby healthy tissue and nerves’ tissue.
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RadioFrequency Ablation (or RFA) is another
minimally invasive, highly successful procedure that removes the liver
tumors. Radiofrequency ablation uses a radiofrequency current to kill
cancerous cells by “cooking“ them. This procedure involves
several electrodes, which are placed into the tumor either through
the skin, or through small incisions in the abdomen, and sends out
radiofrequency current that ablates or removes the tumor. This procedure
is performed with the help of a CT scan or ultrasound guidance.
Radiation Therapy
or Radiotherapy is another treatment approach in the battle
against liver cancer. It uses high-energy rays or particles to
destroy cancerous cells. Liver cancer patient can receive radiation
therapy through several forms.
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External radiation therapy uses an external
device (linear accelerator) to generate high-energy rays that
focuses on the liver tumor.
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Internal radiation therapy uses radioactive
substances sealed in seeds, wires, needles, or catheters that
are placed in the tumor tissue.
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Radiolabeled antibodies uses radioactive
substances attached to artificially made antibodies to kill
cancerous cells. Normally, the body produces different types
of antibodies to fight against infections and germs. Each
type of antibody fight against a certain cell. The artificial
antibodies are designed to kill the liver cancer cells by
radiating them.
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Radiation therapy side effects include:
- Feeling tired as the treatment continues
- Skin irritation (the skin becomes red, dry, or tender in the area
where the body is irradiated)
- Loss of appetite
- Vulnerability to infection
Chemotherapy
Chemotherapy is a systemic treatment (affects cells throughout the entire
body) that uses drugs either to halt the abnormal growth and dividing
process of the cancerous cells, or to kill them. This type of treatment
involves either a single drug, or a combination of several drugs, and
is usually administered in cycles where a treatment period is followed
by a recovery period.
The liver cancer patient can receive chemotherapy differently: (1) as
pills, (2) intravenous, as an injection into the vein or through a catheter
(a thin, flexible tube) placed in the vein when the patient needs many
IV treatments, or (3) placed directly into the tumor, treatment called
regional chemotherapy (small pumps send the drugs through the blood vessels
straight in the tumor). The advantage of a regional chemotherapy is that
it reduces the harmful effects of the chemotherapy on the healthy body
cells.
There are several types of regional chemotherapy:
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Hepatic Artery Chemoembolization. This treatment
uses an anticancer drug that once injected into the hepatic artery
blocks the blood flow that goes to the liver. This blockage can be
temporary or permanent (depending on the drug used), and allows the
drug to kill the cancerous cells while the tumor stops receiving the
blood supply rich in oxygen and nutrients. However, this approach
does not harm the rest of the liver, which continues to receive blood
from the portal vein. The most common side effects of hepatic artery
chemoembilization are: nausea, vomiting, fever, abdominal pains, tiredness,
infections or problems with the pump devices (used to administrate
the treatment).
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Hepatic Arterial Infusion is a treatment option
where chemotherapeutic agents are infused in the hepatic artery. The
drugs are periodically administrated through a catheter inserted into
the artery. In this way, the treatment is directed straight into the
liver.
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Isolated Liver Perfusion is an experimental technique
used only in clinical trials. The purpose of this treatment is to
expose the liver to a high dose of chemotherapeutic agents while the
liver blood supply is temporary stopped. This treatment is possible
only after a complex surgery where catheters are inserted into the
hepatic artery, portal vein, and hepatic veins.
Chemotherapy’s side effects include:
- Increased vulnerability to infections.
- Easy bruising and bleeding.
- Lack of energy.
- Temporary hair loss.
- Mouth sores.
- Nausea and vomiting.
- Loss of appetite.
Percutaneous Ethanol Injection is an innovative, low morbidity
risk procedure where the liver cancer is killed with ethanol (alcohol).
This substance is administered into the tumor through a needle. The alcohol
destroys the tumor by dehydrating the cancerous cells and altering the
cellular protein structure. The most common side effects of this treatment
are fever and pain caused by the alcohol leakage on the surface of the
liver and into the abdominal cavity.
Portal Vein Embolization is a treatment approach where the portal
vein blood supply is blocked. This treatment has two benefits: 1) substantially
reduces one part of the liver (where usually the tumor is located) and
2) causes the remaining liver to grow. Portal vein embolization is a pre-operatory
step for those patients that need surgery but the tumor either is too
big to be removed, or the tissue that needs to be removed is too big while
the healthy liver tissue left behind is too small.
Interstitial Laser Photocoagulation and Microwave are two additional
treatment approaches that directly injure or kill the tumor cells. These
two treatments do not work as well as other types of cancer treatment
in killing big tumors. Interstitial laser photocoagulation uses a thin
optical fiber (which is inserted in the center of the tumor) and a laser
device. When the laser light is emitted, the cancerous cells undergo a
thermal necrosis. Interstitial macrowave is a thermal type therapy which
kills the tumor by heating them to a high temperature (50 degrees C) for
an extended period of time.
Biologic therapy also called immunotherapy is a type of
treatment used to improve the body’s natural defenses. This treatment
uses the body’s immune system either to fight against cancer, or
to decrease the side effects caused by the cancer treatment. Biologic
therapy uses substances produced in a laboratory that copy those naturally
produced by the body to boost, direct, or restore the natural defenses
of the body.
Liver Transplant is a solution for those patients that suffer
from hepatocellular carcinoma in advanced stages, when other treatment
option do not work. This surgical procedure involves two steps. The healthier
liver is removed from a donor (a person that is brain dead) and then implanted
into a patient whose own liver does not function normally. The main side
effects of a liver transplant include:
- High risk for infections.
- Bleeding (caused by the new liver's inability to produce enough blood
clothing proteins).
- Clotting in the main blood vessels that provides the liver with blood.
- Rejection (the new liver is not accepted by the body).
Article by Alina Morrow, MS
Medical Writer
OmniMedicalSearch.com
Page Covers: What is the treatment for liver cancer? How is treated?
Sources:
American Cancer Society, Detailed Guide: Liver Cancer, March 2006
American Cancer Society, Overview: Liver Cancer, April 2006
Healthfinder.gov, Laurie LaRusso MS. ELS, Liver Cancer, March 2006
Liver Cancer Treatment, Diagnosing Liver Cancer, 2003
Liver Cancer Treatment, Liver Cancer Treatment & Ongoing Care,
2003
Liver Cancer Treatment, Understanding Liver Cancer, 2003
University of Maryland Marlene and Steward, Greenebaum Cancer Center,
Liver Cancer, 2003
National Cancer Institute, What You Need To Know About Liver Cancer,
September 2002
National Cancer Institute, Adult Primary Liver Cancer (PDQ®): Treatment,
January 2005
Cancerbackup, Primary liver cancer, March 2007
MedicineNet.com, Liver cancer, April 2002
Liver Cancer Network, Diagnosis, 2002
Cancer Research Uk, The stages of primary liver cancer, March 2006
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