Liver cancer treatment options

VCU Hume-Lee Transplant Center utilizes a multimodal therapy for treatment of liver cancer, which is an aggressive approach to eradicate cancer in patients who may be on the transplant waiting list or for whom surgery or liver transplantation is not possible.

After your evaluation and testing, your doctor will discuss appropriate treatment options and will make a recommendation for the option that is best for you. Treatment plans may include surgery (liver resection or transplantation) or one or more of the following treatments:

Radiofrequency ablation

Radiofrequency ablation heats and destroys cancerous tissue by directing radio frequency energy into the tumor through a needle. This procedure has allowed us to treat patients who previously would not have been candidates for surgical treatments due to the number or location of the tumors, problems with cirrhosis, or an inability to remove the entire tumor while leaving enough normal liver tissue. It has proven safe and well-tolerated in an overwhelming majority of patients.

How it works

The surgeon uses an ultrasound to guide placement of a probe into the tumors that are going to be treated and applies electrical current from a small device called a radiofrequency current generator. The electrical current causes friction, creating heat that kills the targeted tissue. The probe is precise and only ablates the unwanted cancerous tissue, while leaving the surrounding normal tissue untouched.

Radiofrequency ablation may also be performed during an abdominal surgery using a laparoscopic or open approach. The laparoscopic surgical approach uses an intraoperative ultrasound to visualize the targeted tissue. The open approach allows the physician to see the entire procedure.

The treatment only destroys the tumors that can be detected with ultrasound, CT or MRI scans; patients may receive chemotherapy treatments for up to six months after radiofrequency ablation in an attempt to reduce the risk of new tumors developing.

Chemotherapy

Chemotherapy (transhepatic artery chemoinfusion) uses very powerful medications to treat cancer by attempting to kill and curb the growth of cancer cells.

How it works

Hepatocellular carcinoma tumors get their blood supply from the hepatic (liver) artery. During this treatment, a small tube called a catheter is inserted into the liver artery under X-ray guidance, and the chemotherapy is infused into the artery to stop or slow the tumor cell growth. The procedure takes one to two hours. The patient may be referred to a cancer specialist, or oncologist, if additional chemotherapy is needed.

Chemoembolization

Unfortunately, the medications used for chemotherapy target not only cancer cells but healthy cells as well. The goals of transhepatic artery chemoembolization are to give a maximum dose of chemotherapy to tumor cells and minimize the toxic effects of chemotherapy to the patient.

Chemoinfusion and chemoembolization are similar procedures. In both procedures, a chemotherapy agent is introduced into the liver’s blood supply to kill the cancerous cells. In chemoembolization, the procedure cuts off the blood supply to the tumor, and the lack of oxygen-rich blood causes the tumor cells to die. Chemoembolization also traps the chemotherapy at the tumor site.

How it works

Under X-ray guidance, the catheter is placed into the femoral artery in the leg and then advanced into the liver artery, where the chemoembolization medication is infused into the liver tumor. The procedure usually takes two to four hours.

Selective internal radiation therapy

Selective internal radiation therapy (SIRT) is a method of radiation therapy that delivers millions of microscopic radioactive beads directly to liver tumors. The targeted nature of the treatment allows doctors to apply up to 40 times more radiation to the liver tumor than is possible with traditional radiation therapy, and minimizes radiation exposure to other areas of the body.

How it works

A tiny incision is made in the groin and a catheter is placed in the artery and guided to the liver using X-ray imaging. The arteries feeding the liver and the tumors are studied by an Interventional Radiologist, a physician that specializes in minimally invasive image guided procedures. The radiation beads are then delivered through the catheter into the arteries selected by the IR physician. The radioactive beads get lodged in very small arteries and release high doses of radiation, which damages the tumor cells. After treatment, most patients will see a reduction or stabilization in size of the tumor, which can lead to an increase in survival time. Additionally, the treatment can be used to bridge patients to potentially curative treatments such as resection and liver transplantation. This minimally-invasive procedure is performed using state-of-the-art imaging technology and the patients return home the same day as the procedure.

For more information or to schedule an appointment to be evaluated by our Liver Cancer Team, please call (804) 828-4104.