Liver cancer, also known as hepatocellular carcinoma is diagnosed through tissue biopsy to learn the type, extent, and severity of the problem. Accordingly, the oncologist will choose between a number of treatment options available for liver cancer. The stage of cancer, the health of the liver and the overall health of the client are taken into account while devising the treatment strategy. The objective of liver cancer treatment is to improve the overall health, relieve the symptoms, mitigate the suffering and extend the life span of the patient.
Chemo is the treatment for cancer that makes use of chemical drugs to destroy the cancer cells. This is the treatment option for those who cannot tolerate surgery and have not responded to other therapies such as ablation or embolization. Recently, a combination of chemo drugs is being used to treat cancer effectively rather than a single chemo drug. The most commonly used chemotherapy drugs for liver cancer are,
Systemic Chemotherapy: A combination of these drugs are prescribed for those who can tolerate the treatment and are in generally good health. The chemo drugs are either injected through the vein or taken orally. Central venous catheters are also used for those who demand repeated chemo sessions to deliver higher volumes of IV chemo drugs. Chemotherapy is prescribed in cycles with a gap of two or three weeks in between.
Regional chemotherapy: Drugs are sent directly through the hepatic artery that supplies the liver. The focus of the drug is direct on the tumor of the liver. This method demands a higher dose of chemo than the systemic method but has fewer side effects. The drugs of choice for regional infusion are cisplatin, floxuridine, and oxaliplatin.
The focus of immunotherapy is to strengthen the immune system of the body to fight against cancer cells. Also, the immunoglobulins should be able to differentiate the healthy cells from tumor cells. To do this, Checkpoint proteins on the immune cells are turned off to start the immune response. Cancer cells use these checkpoints to avoid attacks from the immune system. Immunotherapy drugs target these checkpoints and attack the tumor cells. This has grown to be a promising treatment module for liver tumors.
Nivolumab and Pembrolizumab are the drugs of choice that target the PD1 protein of the T cells. By blocking PD-1, these drugs boost the immune response against tumor cells. The medicines are generally offered as an IV infusion typically every two, three or four weeks. The possible side effects of immunotherapy are fever, cough, generalized tiredness and weakness, loss of appetite skin rashes, etc. Some people have also reported infusion reactions while getting these drugs.
Radiation therapy makes use of high energy rays to shrink and kill the cancer cells. Radiation therapy is not suggested for clients who had liver cancer diagnosis secondary to hepatitis or liver cirrhosis. Radiation therapy is the best for liver tumors that cannot be removed by surgery. Tumors that cannot be treated by embolization or ablation are treated with radiation therapy. Metastatic liver cancer, where the tumor is spread to other major organs such as bones and brains are also best to be treated by radiation therapy. When the client has a huge liver tumor, radiation therapy is given to shrink the size of the tumor. This therapy is given by the following ways,
- External beam radiation therapy: EBRT focuses the radiation on the tumor from a source outside the body. The procedure is painless and each session lasts only a few minutes. The treatment is continued over several weeks depending on the severity of the condition.
- SBRT: This is a new technique where the tumor is targeted precisely to avoid damage to the surrounding healthy tissues. The duration of the treatment is short and the beams are aimed at the cancer lump from different angles. The treatment is ideal for those with small and localized cancers
- Radioembolization: Tumors of the liver can be treated by injecting small radioactive beads into the hepatic artery. These beads lodge in the liver next to the tumor and release small amounts of radiation, trying to shrink its size.
Injecting substances directly into the hepatic artery to block the blood flow to the tumor is gaining popularity as the best hepatocellular carcinoma treatment option. The liver has two blood supplies, the normal cells of the liver are fed by the portal vein, whereas the tumors in the liver are fed by the hepatic artery. Blocking the portion of the artery that supplies the tumor cells helps in killing the cancer cells. The procedure also leaves a majority of the healthy liver cells unharmed.
Embolization is the best option for those whose cancers cannot be removed by surgery or treated by other methods. Common types of embolization therapy are,
Trans-arterial embolization: A catheter is put into the hepatic artery by making a small incision on the thigh. After the catheter has reached the tumor (the path of the catheter is monitored through a dye), small particles are infused to cut down oxygen and blood supply to the tumor.
Transarterial chemo-embolization: This is a combined embolization and chemotherapy. First chemo drugs are infused followed by particles so that drugs stay close to the tumor and destroy it.
Radioembolization: Small beads of radioactive elements are injected into the artery to shrink the tumor. The effects of the radioactive elements are limited to the tumor.
The two surgical approaches for liver cancer are partial removal of the liver or total liver transplantation.
- Partial hepatectomy: Portion of the liver containing the tumor is removed. This surgery is indicated for those with good liver function and those who have a single tumor without blood vessel involvement. CT, MRI and other imaging tests are first performed to confirm if the tumor can be removed completely or not.
- Liver transplantation: This is the best treatment option for those people who have liver cancer. Those who have liver cirrhosis along with tumors and large liver tumors are posted for liver transplantation. With the transplant, the risk of cancer relapse is eliminated and there is also a guarantee that the new liver will function normally. Transplants can be obtained from dead donors or from a close relative (part of the liver is removed) for surgery.