Liver Cancer Treatment Options

Conditions & Diseases: Cancers

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:

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.
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.
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 recovery 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.
Radiofrequency ablation (or RFA) is another minimally invasive, highly successful procedure that removes the liver tumors. Radiofrequency ablation uses 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 send 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.

External radiation therapy uses an external device (linear accelerator) to generate high-energy rays that focuses on the liver tumor.
Internal radiation therapy uses radioactive substances sealed in seeds, wires, needles, or catheters that are placed in the tumor tissue.
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 cells. The artificial antibodies are designed to kill the liver cancerous cells by radiating them.

The 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 stop 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 it is usually administrated 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:

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).
Hepatic Arterial Infusio 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.
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 brushing and bleeding.
Lack of energy.
Temporary hair loss.
Mouth sores.
Nausea and vomiting.
Loss of appetite.

Percutaneous Ethanol Injection is an innovative, low morbidity procedure where the liver cancer is killed with ethanol (alcohol). This substance is administrated into the tumor through a needle. The alcohol destroys the tumor by dehydrating the cancerous cell 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 to big to be removed, or the tissue that requires to be removed is to big while the healthy liver tissue left behind is to 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 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, MA
Medical Writer
OmniMedicalSearch.com

Sources:

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