Liver Cancer Treatment

Tumors of the liver whether primary or coming from other organs such as the colon are unfortunately common. In addition to standard chemotherapy care, interventional procedures can make a difference.

We can treat liver tumors if they are multiple with radioembolization which causes cell death by radiation effect. If there are only a few masses, they can be treated without surgery with RF or MW ablation where a needle is placed in these masses under ultrasound or CT guidance and the heat created causes complete tumor cell necrosis.

Consultation with the oncologist and other members of the tumor board team is suggested for each patient to decide the best course of care.

Liver Tumor Radioembolisation

What is Y-90 radioembolisation?

Y-90 radioembolization is a palliative treatment for primary liver lesions and liver metastatic disease which uses ionizing radiation to shrink tumors. It is generally used to relieve the symptoms of liver tumors rather than to cure the underlying condition.

The liver has two sources of blood supply: the hepatic artery and the portal vein. Liver tumors tend to rely on the hepatic artery for their blood supply.

During a radioembolization procedure, an interventional radiologist injects microspheres filled with the radioactive isotope yttrium (known as Y-90) into the vessels feeding the tumor. Because the radiation is focused only on the tumor, higher and more effective radiation doses can be used compared to other treatments.

How does the procedure work?

Depending on your situation, you may be given the procedure as an out-patient or you may require hospital admission following the treatment. The interventional radiologist will carry out the procedure using fluoroscopic guidance.

You will be given a local anesthetic. After this, the interventional radiologist will insert a catheter (a thin tube) and a guide wire into an artery. You will then have some images taken of your upper abdominal arteries to show the exact location of the vessels feeding the tumor.

The interventional radiologist will then insert microspheres filled with Y-90 into these vessels to deliver a high dose of radiation to the cancer cells. This radiation dose will decrease over the following two weeks.

Your vital functions will be monitored during the procedure. You may be given antibiotics to prevent infection, and, if necessary, IV analgesics or medication to prevent nausea.

Why perform it?

If you have an inoperable liver tumor, or if you are not fit for surgery, you may benefit from Y-90 radioembolisation. Y-90 is beneficial for hepatocellular carcinoma (the most common type of cancer) affecting the portal vein of the liver, or if you have not responded to chemoembolization.

Because the radiation dose is delivered directly to the tumor, the dose is higher than in standard radiation therapy and there are fewer possible complications.

Radioembolization can extend the patient’s life expectancy from months to years, as well as improve quality of life.

In some cases, this procedure enables them to undergo surgery or liver transplantation.

What are the risks?

The most common complication is post-radioembolization syndrome, which occurs in around 50% of patients. Symptoms include fatigue, low-grade fever, nausea, vomiting, and abdominal discomfort.

Less common complications include a build-up of fluid, high levels of alkaline phosphatase, and infection. You may also experience stomach ulcers, inflammation of the pancreas, raised blood pressure, gallbladder inflammation or pneumonia. As with all percutaneous procedures, there is a risk of bleeding or damage to a blood vessel.

In some cases, patients react to the iodinated contrast materials used in the procedure, experiencing allergic reactions and harmful effects on the kidneys.

Liver Tumor Ablation

What is percutaneous tumor ablation?

Percutaneous tumor ablation refers to a range of techniques that destroy tumor tissue via needles placed through the skin. Some techniques use chemical agents (such as absolute ethanol), while others use physical agents, which may be thermal (using heat) or non-thermal:

Thermal ablation techniques destroy tumors by using different kinds of applicators to freeze the tumor (called Cryoablation) or to heat the tumor, such as radiofrequency ablation, laser ablation, microwave ablation and high-intensity focused ultrasound (HIFU).

Non-thermal ablation techniques use other sources of energy to achieve tumor destruction. Ablation uses an electrical plasma field to disintegrate the tissue by rupturing the bonds between the molecules that make up the tumor tissue. Irreversible electroporation uses high-voltage electric shocks to pierce the cell membranes and cause cell death.

How does the procedure work?

The procedure is carried out using image guidance, such as ultrasound, CT or MRI, to control the insertion of the devices and the energy deposition.

The patient is anesthetized for the procedure. For most ablation procedures, the interventional radiologist will insert one or more needles or applicators into the tumor to deliver the chemical agent or physical energy.

Why perform it?

The goal of ablation is to destroy the tumor without using surgery. Whether you are suitable for this procedure depends on the size and location of the tumor as well as your clinical situation

What are the risks

The insertion of the needle or applicator may cause bleeding or puncture surrounding organs.

Accidental leakage of the chemical agent or uncontrolled depositing of radiation energy may cause serious damage to the surrounding tissues.