What is the treatment of liver cancer?
Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.
Treatment options for people with liver cancer are surgery, ablation, chemo-embolization, targeted therapy and radiation therapy. Often a combination of treatments may be required.
The treatment that’s right for you depends mainly on the following:
- The number, size, and location of tumors in your liver
- How well your liver is working and whether you have cirrhosis
- Whether the cancer has spread outside your liver?
At this time, liver cancer can be cured only when it’s found at an early stage (before it has spread) and only if people are healthy enough to have surgery. For people who can’t have surgery, other treatments may be able to help them live longer and feel better.
Surgery For Liver Cancer
Surgery is the best option for people with an early stage of liver cancer. A person with liver cancer may have part of the liver removed if lab tests show that the liver is working well and if there is no evidence that the cancer has spread. The extent of the surgery depends on the size, number, and location of the tumor.
The affected part of the liver is removed after confirming that the remaining amount of liver is sufficient for an adequate functioning of the body. Surgery to remove part of the liver is called Partial hepatectomy (Liver resection) and depending on whether the right or left part of the liver is removed it is called right or left hepatectomy respectively. As much as 70 percent of the liver may be removed if the remaining liver is healthy. The remaining healthy liver can then take care of the body functions. Also, the liver can re-grow some of the missing part. The new cells grow over several weeks.
The surgeon may sometimes remove the whole liver. If the whole liver is removed, it is replaced with healthy liver tissue from a donor. Such type of surgery is called Liver Transplant. To have a liver transplant you need a liver from a donor. It can sometimes take months to find a donated liver that closely matches yours. During this delay, the cancer may continue to grow and you may need to have other treatment to try to control it. Moreover there are strict criteria as to which patient can undergo liver transplant in the setting of cancers. Also after a liver transplant, you have to take drugs to stop your body rejecting the donated liver. These drugs damp down the activity of your immune system and reduce its ability to control the cancer
- Radio frequency Ablation (RFA)
- TACE - Trans Arterial Chemo-embolization
- TARE - Trans Arterial Radio-embolization
In certain cases, surgery to remove the tumor may not be possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems. In such cases some form of local destruction is used and is called ablation.
The most common method of ablation is Radiofrequency ablation (RFA). The doctor uses a special probe that contains tiny electrodes which open like an umbrella. Radio waves pass down this needle and around the tumor to kill the cancer cells with heat. Tumors of 3-5 cm size are best treated with this technique but even 7 cm probes are now available to ablate larger tumors.
This procedure is best done under ultrasound (sonography) guidance as it becomes necessary to see whether the needle is hitting the tumor properly. (CT scan may be used to guide as well). This procedure is ideally performed in the operation theatre and under suitable anaesthesia. The probe may be inserted directly through your skin (percutaneous RFA), or through a small incision in your abdomen (open RFA technique). The procedure generally involves a short hospital stay and can be repeated multiple times if necessary.
This type of treatment gives the chemotherapy directly to the area of the liver that contains the cancer. Depending on the drugs used, you usually have to stay in hospital overnight or longer. Your doctor may recommend it if you cannot have your tumour removed by surgery. It is also sometimes used to shrink a tumour so that it is small enough to remove with surgery at a later time.
This treatment is done in the X-ray department or a specialized room in the hospital called the Cathlab. The procedure is done under a local anaesthetic injection and possibly a mild sedative. The doctor puts a tube called a catheter into the large artery at the top of your leg called the femoral artery. The doctor can then thread the catheter along the femoral artery until it reaches the hepatic artery that supplies blood to the liver.
The doctor will check that the catheter is in the right place in the liver. Then they inject the chemotherapy (anti-cancer medicines) into the tube following which the doctor also injects something to block the blood flow to the tumour. This might be tiny plastic beads or a type of gel. Blocking the flow of blood allows the anti-cancer drug to remain in the liver for a longer duration to kill the cancer cells as it cuts off the tumour’s food and oxygen supply.
Chemoembolization can cause side effects. You may feel or be sick. Or you may have some pain or a raised temperature after the treatment. Your doctor will give you painkillers or anti sickness drugs (antiemetics) to control these side effects.
You may have chemoembolization more than once if your doctor thinks it will help.
This treatment is similar to chemo-embolization and differs from it by use of radiation particles instead of anti-cancer drugs through a catheter. Millions of tiny beads (sometimes called microspheres) are fed into the hepatic artery, the main blood vessel which supplies the liver. These beads block the supply of blood to the cancer. They contain a radioactive substance called Yttrrium-90, which works by sending out radiation. This helps to kill off the cancer cells. One has to be careful about shunting of blood from the liver to the lungs in which case the radiation particles may travel to lungs and destroy some part of it. Hence it always becomes mandatory to perform this procedure in two steps; first to determine the extent of shunting of blood from liver to the lungs and second the actual procedure if the shunting is within acceptable limits. This procedure cannot be done if there is excessive blood shunting to the lungs.