Liver Cancer


Fast, pain-free treatment options for liver cancer reduce stress and impact on the quality of life.

Liver Cancer Overview

Your liver is the largest organ in your body cavity and is responsible for making key proteins, metabolizing fats and carbohydrates, and eliminating biochemical waste and toxins from the bloodstream. Although liver cancer can originate in the liver itself, it is more commonly metastatic – meaning it began somewhere else in the body such as the breast, lung, colon or pancreas. In the United States, primary liver cancer afflicts 21,000 men and 7,000 women annually, most over the age of 65 years old. Liver cancer is curable if detected very early.

Infection with hepatitis B virus (HBV) or hepatitis C Virus (HCV) is a long-term risk factor for liver cancer, where the malignancy can develop after many years of infection. Other risk factors include consuming foods affected by the aflatoxin mold, heavy alcohol use, cirrhosis of the liver, obesity, diabetes and iron storage disease where the body stores too much iron.

There are rarely symptoms for early liver cancer. Later stage symptoms may include bloating, fever, yellow skin and eyes, nausea, intense skin itching, unexpected weight loss and fatigue.

Liver Cancer Treatment Options

There are several different therapies used to treat liver cancer patients, including surgery, chemotherapy, targeted therapy and radiation therapy. Which therapy is appropriate for you depends on the location and number of tumors, how well your liver is currently functioning and, if it is primary liver cancer, whether or not it has spread. Your overall health and whether or not you are a good candidate for surgery are also key considerations. Your oncologist may also recommend a combination of liver cancer treatments and therapies.

Surgery

If the part of your liver unaffected by the cancer is in good working order, your Surgical Oncologist may recommend surgically removing the cancerous section. This is called a partial hepatectomy. As much as 80% of the liver may be removed and the remaining liver will continue to function properly. Livers can even re-grow missing parts. If your liver is more severely affected you may be a good candidate for a liver transplant.

Ablation

For patients who cannot have surgery or are waiting for a liver donor, tumor ablation may be an option. With image-guided ablation therapy, the clinician uses an imaging technology such as a CT scan or MRI to guide the ablation technology to the tumor site. Ablation technology includes Cryotherapy (using extreme cold to freeze and destroy the tumor), Radiofrequency ablation (using high-energy radio waves to heat and destroy the tumor) laser or microwave therapy (to heat and destroy the tumor) and ethanol injection through the skin (to kill the cancer cells by direct alcohol contact).

Embolization

Arterial embolization can be used as a liver cancer treatment for patients who are not candidates for surgery or ablation. The liver is unusual in that it has two blood supplies. Normal liver cells are fed by the branches of the portal vein but cancer cells are usually fed by branches of the hepatic artery. Embolization is the injection of a substance to reduce or block the blood flow to the cancer cells. A catheter is inserted into the hepatic artery through a small incision in the groin. Once in place, tiny particles are injected through the cannula into the artery to plug it up. This destroys the cancer cells by starving them of oxygen and nutrients. In some cases, the particles may be radioactive or infused with chemotherapy. The healthy liver tissue continues to get blood from the portal vein.

Chemotherapy

Because liver cancer resists most systemic chemotherapy, Medical Oncologists are now injecting the chemotherapy drugs directly into the hepatic artery.

Targeted Therapy

Targeted therapy uses biological agents to seek and attack molecules and cellular activity that the cancer depends on to survive and grow.  They may affect the proteins needed for the cancer cells to grow or they may interfere with forming new blood vessels that nourish the tumors.

Liver Cancer Radiation Therapy

Radiation therapy uses high-powered x-rays to kill cancer cells and shrink tumors. While there are different forms of radiation therapy, only highly targeted External Beam Radiation Therapy (EBRT) technologies are used against liver cancer.

Radiation Therapy for Liver Cancer

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT) are two forms of External Beam Radiation Therapy.

3D-Conformal Radiation Therapy 

During 3D-Conformal treatments, a device called a “multi-leaf collimator” will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.

Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. Typically, you will be scheduled for five sessions a week for four to six weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.

Stereotactic Body Radiation Therapy (SBRT) 

Stereotactic Body Radiation Therapy (SBRT), another form of External Beam Radiation Therapy, effectively treats cancers in high-risk locations. It is so precisely targetable that Radiation Oncologists can use it to shrink and destroy tumors without damaging vital, nearby tissue. As you undergo therapy, the system’s imaging technology tracks the tumor in real-time and makes adjustments as you breathe, a process called respiratory gating.

SRBT provides such precise targeting that Radiation Oncologists can increase the radiation dosage and deliver it over a shorter period of time. You will typically have one to five treatment sessions rather than the standard four to six weeks of traditional EBRT treatment. During each session, a Radiation Therapist will carefully position you on the treatment table using a full body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins.

These liver cancer radiation therapy sessions are pain-free and require no sedation so you can return to your normal activities right away.

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