Liver Cancer (Hepatocellular Carcinoma or HCC) Overview
Recent advances in liver cancer care seek to address the rising incidence of liver cancer, which has steadily increased over the past three decades. At the UMC Center for Transplantation, our team sees individuals with both hepatocellular carcinoma (primary liver cancer) and metastatic liver lesions. Current treatment options include surgical removal of tumors, the application of chemotherapy and radiation into the liver, and systemic chemotherapy treatments.
Liver cancer may be hard to detect. Most patients are asymptomatic. For this reason, physicians advise screening high-risk patients periodically.
Surveillance tools for HCC include ultrasound and the alphafetoprotein (AFP) blood test. AFP is a protein produced by the liver. An elevated level can indicate tumor growth, though some patients with liver cancer have normal AFP levels. For patients with abnormalities in these tests, an evaluation with a contrast-enhanced CT or MRI is recommended to determine if cancer is present.
If patients develop symptoms, the first is usually pain in the right side of the abdomen. Weight loss is common and sometimes patients have episodes of severe pain, fever, and nausea. Rapidly deteriorating health, weakness, swelling, and jaundice may also imply HCC.
Determining the Size, Stage and Scope of a Liver Lesion
Once blood tests reveal an elevated AFP level or an ultrasound shows a lesion in the liver, patients should undergo further evaluation to determine if liver cancer is present and to assess for size and number of tumors. This preoperative evaluation includes the diagnosis and localization of the lesion, staging, and a determination of treatment options. UMC uses a variety of techniques to help determine the location and stage of HCC. Diagnostic imaging procedures are the most accurate methods. In some cases, a liver biopsy is required to determine the type of liver tumor.
At UMC, liver imaging may include a four-phase computed tomography (CT), including spiral CT scans obtained during hepatic arterial and portal venous phases following intravenous contrast administration. Imaging also involves state-of-the-art magnetic resonance imaging (MRI). These techniques can accurately demonstrate the number of primary tumors within the liver and their relationship to vascular structures. Doppler ultrasound can be used as a complementary imaging technique. FDG positron emission tomography (PET) is occasionally helpful in characterizing atypical hepatic masses as well as in detecting extrahepatic malignancy.
Patients with HCC require a metastatic work-up to determine if cancer has spread to surrounding tissue. This work-up includes a chest CT scan and a nuclear medicine bone scan. After treatment, patients should continue to be staged every three to six months with chest/abdomen CT and bone scans.
Surgical Interventions for Liver Cancer
When determining treatment options for hepatocellular carcinoma (HCC), our team evaluates the lesion imaging and lab results, along with the patient’s age, liver function, and overall health to recommend appropriate treatment options. Because choosing a treatment plan is an important decision, we review all options with patients and their families, explaining the benefits and disadvantages of each.
Some patients may require liver biopsy to determine surgical candidacy, since advanced liver scarring or cirrhosis limit the ability to safely perform surgery to remove the tumor.
Some patients are not candidates for resection due to inadequate liver reserve, large or multiple lesions in multiple lobes, or cirrhosis. These patients may benefit from minimally invasive ablation therapy. This therapy uses extreme heat to destroy liver tumors.
The ideal patient for ablation generally has no more than three lesions that are no greater than 5 cm in size. Ablation delivers radiofrequency energy to the tumor, heating it to temperatures above 113º F, thereby destroying the lesion. This technique can be performed either by an interventional radiologist or by a surgeon, depending on the lesion’s size and location.
Systemic chemotherapy uses a mixture of anti-cancer drugs injected into a vein or taken by mouth. Typically, this alternative is reserved for patients with metastatic disease or those who are not candidates for other procedures. Depending on any underlying disease, different drugs are applied. Patients are always encouraged to seek out and participate in clinical trials, which offer hope and help us learn how to better care for patients with this disease.
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