Liver cancer or
Hepatocellular carcinoma (HCC) is one of the commonest cancers in the world
which have a high incidence of Hepatitis B infection. Apart from Hepatitis B,
it may be caused by other diseases that lead to cirrhosis of the liver such as
Hepatitis C infection, and alcohol abuse.
Unfortunately, like many other cancers, liver cancer may go undetected
until a late stage. It is often brought to attention by an ultrasound or CT
scan done for pain in the upper abdomen or another unrelated symptom. Liver
cancers are malignant tumors that grow on the surface or inside the liver.
Typers of liver cancer are Hepatocellular
Carcinoma , Cholangiocarcinoma ,Hepatoblastoma .
Surgical removal of liver
tumors offers the best chance for a cure. Unfortunately, liver tumors are often
inoperable because the tumor may be too large, or has grown into major blood
vessels or other vital structures. Sometimes, many small tumors are spread
throughout the liver, making surgery too risky or impractical. Surgical removal
is not possible for more than two-thirds of primary liver cancer patients and
90 percent of patients with secondary liver cancer.
There are a number of tests that can help in the
diagnosis of cancer, including blood tests, physical examination and a variety
of imaging techniques including X-rays (e.g., chest X-rays and mammograms);
computed tomography (CT); magnetic resonance (MR) and ultrasound. Usually,
however, the final diagnosis cannot be made until a biopsy is performed. In a
biopsy, a sample of tissue from the tumor or other abnormality is obtained and
examined by a pathologist. By examining the biopsy sample, pathologists and other
experts also can determine what kind of cancer is present and whether it is
likely to be fast or slow growing. This information is important in deciding
the best type of treatment.
Although
there are no standard or routine screening tests for liver cancer, the
following tests are being used or studied to screen for it
- Physical examination : Physical
examination may show an enlarged, tender liver. Also, your skin and eyes
may be checked for signs of jaundice.
- Blood tests :Physical
examination may show an enlarged, tender liver. Also, your skin and eyes
may be checked for signs of jaundice.
- Imaging Studies like Abdominal CT scan and Abdominal Ultrasound
test
- Liver biopsy or Aspiration.
- Liver enzymes (liver function tests)
In order to check
if the Liver Cancer has spread elsewhere in the body, the following tests are
to be done:
- PET Scan
- Bone Scan- to
check if the cancer has spread to the bones.
Tumors need a blood supply, which they actively generate, to feed
themselves and grow. As vascular experts, interventional radiologists are
uniquely skilled in using the vascular system to deliver targeted treatments
via catheter throughout the body. In treating cancer patients, interventional
radiologists can attack the cancer tumor from inside the body without
medicating or affecting other parts of the body by using embolization and
radiofrequency heat.
Embolization is a well-established interventional radiology technique
that is used to treat trauma victims with massive bleeding, to control
hemorrhage after childbirth, to decrease blood loss prior to surgery and to
treat tumors. In treating cancer patients, interventional radiologists use
embolization to cut off the blood supply to the tumor (embolization), deliver
radiation to a tumor (radioembolization), or combine this technique with
chemotherapy to deliver the cancer drug directly to the tumor
(chemoembolization)
Chemoembolization is a minimally invasive
treatment for liver cancer that can be used when there is too much tumor to
treat with radiofrequency ablation (RFA), when the tumor is in a location that
cannot be treated with RFA, or in combination with RFA or other treatments.
Chemoembolization delivers a high dose of
cancer-killing drug (chemotherapy) directly to the organ while depriving the
tumor of its blood supply by blocking, or embolizing, the arteries feeding the
tumor. Using imaging for guidance, the interventional radiologist threads a
tiny catheter up the femoral artery in the groin into the blood vessels
supplying the liver tumor. The embolic agents keep the chemotherapy drug in the
tumor by blocking the flow to other areas of the body. This allows for a higher
dose of chemotherapy drug to be used, because less of the drug is able to
circulate to the healthy cells in the body. Chemoembolization usually involves
a hospital stay of two to four days. Patients typically have lower than normal
energy levels for about a month afterwards.
Radiofrequency Ablation
For inoperable liver tumors, radiofrequency ablation (RFA) offers a
nonsurgical, localized treatment that kills the tumor cells with heat, while
sparing the healthy liver tissue. Thus, this treatment is much easier on the
patient than systemic therapy. Radiofrequency energy can be given without
affecting the patient's overall health and most people can resume their usual
activities in a few days.
In this procedure, the interventional radiologist guides a small needle
through the skin into the tumor. From the tip of the needle, radiofrequency
energy (similar to microwaves) is transmitted to the tip of the needle, where
it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms
a scar. The FDA has approved RFA for the treatment of liver tumors.
Targeted therapy is a treatment that targets
the cancer’s specific genes, proteins, or the tissue environment that
contributes to cancer growth and survival. This type of treatment blocks the growth
and spread of cancer cells while limiting damage to normal cells. Recent
studies show that not all tumors have the same targets. To find the most
effective treatment, your doctor may run tests to identify the genes, proteins,
and other factors in your tumor.
Benefits of
- Is most effective when all the cancer is localized in
the liver
- Can be used to treat primary liver cancer and tumors
that have metastasized (spread) from other areas in the body to the liver
- Usually does not require general anesthesia
- Is well tolerated-most patients can resume their normal
routine the next day and may feel tired for a few days
- Can be repeated if necessary
- May be combined with other treatment options
- Can relieve pain and suffering for many cancer patients
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