Treatment of Liver Cancer (HCC):
The aim of the treatment is to treat cancer and any symptoms it may cause. Complete surgical removal of the cancer is the mainstay of liver cancer treatment. The treatment of liver cancer depends on the stage of cancer and may differ from person to person because of:
Location of HCC:
can occur anywhere in the liver. The liver has lots of blood vessels and if cancer developed near one of the two main blood vessels some types of treatment, such as surgery and radio-frequency ablation, may impossible or very high risk. Cancer may affect more than one part of the liver, or it may affect both lobes, which can also restrict the types of treatment.
Size of HCC:
the tumor may grow to a relatively large size before they cause any symptoms, while others may be too small to identify using scans or other tests.
Spread of HCC outside the Liver:
Scans can detect whether cancer has spread to any other part of the body, including lymph nodes. The lymph node system runs throughout the body and if cancer spreads to it this can increase your risk of cancer spreading; further increasing the risk of cancer recurrence after main cancer has been removed.
Age of the patient:
Age can affect how well your body works, however, when deciding on which treatment is the best for each individual, it is important to assess each person’s actual health, rather than expected health for someone of that age.
Associated medical problems:
Are you well despite having another illness or does you have other medical problem limiting your lifestyle or life expectancy? Curable or palliative (may alleviate symptoms) therapies may be offered to you, depending on the factors mentioned above. The clinical team caring for you will discuss, with you, the different treatments and therapies available. They will assist and support you in making decisions and choices about what is right for you. If your other medical illness is a chronic liver disease, we may still be able to offer you treatment that cures you, such as liver transplantation. This depends on the size and position of your cancer.
Some patients can be offered treatments that potentially completely curative; others can be candidates for treatments that may shrink the tumor or slow its growth. Some patients can be offered only palliative care which aims to control their symptoms. The clinical team caring for you will discuss the different treatments and therapies available. The team will give you the help and support you need to decide what is right for you.
What are the treatment options available:
There are different treatments and therapies available;
Liver transplantation is a potential cure for you. Not all patients are suitable candidates for liver transplantation. There are certain agreed international guidelines that are followed to decide whether you are a potential candidate for a liver transplant. These rules consider how large the tumor is and whether it has spread outside the liver or invaded into the blood vessels. If you are considered an as suitable transplant candidate then you will undergo a full assessment. A big advantage of a liver transplant is that it not only potentially cures liver cancer, it also cures the underlying liver disease.
Liver resection involves the complete removal of the tumor. This treatment can offer a potential cure in few patients. To have a resection, the tumor needs to be restricted to one lobe of the liver and there should be no sign of it spreading to blood vessels or other organs. In addition, the baseline liver function needs to be good.
radio-frequency ablation (RFA), microwave ablation, cryoablation, and percutaneous ethanol injection (PEI). These treatments involve the local destruction of cancer. The most commonly used local ablative therapies are radio-frequency ablation (RFA) and percutaneous ethanol injection (injecting pure alcohol into your tumor). These can also be used as a ‘bridge treatment’ while you await liver transplantation or as a treatment prior to liver resection surgery.
With RFA a thin needle is inserted into the tumor using an ultrasound or CT scan to guide us and then use radio-frequency or microwaves to damage the tumor tissue. You have this treatment under local or general anesthesia.
With PEI, we inject a sterile and highly concentrated alcohol solution directly into the tumor to produce a similar effect to RFA.
Both techniques can control tumors long-term if they are small in size and number. We can also use them together with other treatments as part of an overall plan to manage your condition.
Trans-arterial chemo-embolisation (TACE):
TACE (or chemoembolization) is generally used if the tumor is too advanced to consider a treatment that could potentially cure you. It may also be used as a ‘bridging treatment’ while you await liver transplantation or as a treatment prior to liver resection surgery.
In TACE a thin tube called a catheter is passed via a blood vessel in your groin to the blood vessels supplying the liver. A chemotherapy drug is injected directly into the tumor and block the blood vessel supplying it. The drug and the ischemia (blocking the blood supply to the tumor) damage the tumor tissue. TACE will not cure you but aims to shrink your tumor and stop it from getting bigger.
Trans-Arterial Embolization (TAE):
TAE is exactly the same as TACE and with the same aim, but without the chemotherapy drug. It will offer to you if it is not appropriate to use a chemotherapy drug.
Trans-Arterial Radioembolization (TARE):
TARE is exactly the same as TACE and with the same aim, but with a radioactive isotope (small radiation-emitting particle) instead of a chemotherapy drug. It will be offered to the patients if it is not appropriate to use a chemotherapy drug.
Drug treatment (Sorafenib):
This is an oral medicine. It has been shown to prolong the lives of some patients with liver cancer in whom the liver cancer is advanced to cure. It is generally considered if the tumor is too advanced for treatments that could potentially cure you and TACE is either ineffective or not possible for technical reasons. Sometimes this drug is used as an adjunct treatment to TACE
Currently, there are multiple other drugs being tested in research (trials). The medical community is constantly researching new ways to treat cancer. Clinical trials are a way of assessing and/or comparing new treatments and new combinations of treatment. If we think you may benefit from any trial treatment we will explain what it involves when we offer it to you.
If after a detailed discussion of the treatment options you and your family decide rather not to receive any active treatment for your condition, or we feel that active treatment would not help you; the team will refer you for palliative care (supportive care to alleviate symptoms, not a curative treatment) near your home. Supportive care can also be offered to you if you are undergoing treatment such as chemotherapy, which is not expected to offer you a cure.