Hepatocellular Carcinoma Management

The symptoms of this condition are usually nondistinct and only occur once the cancer has reached an advanced stage. If diagnosed at an early stage, it may be possible to treat hepatocellular carcinoma. The treatment options for patients diagnosed at an early stage of disease include surgical resection to remove the affected liver tissue, transplantation with a donor liver and microwave or radiofrequency ablation to destroy the cancer cells.

Unfortunately, the cancer is only diagnosed at an early stage in a small proportion of patients and in most cases, the cancer has already spread and cannot be removed. Surgical resection is only a viable treatment option in a round 10-15% of patients, because most have extensive disease and poor liver function by the time they are diagnosed. Surgical resection involves removal of the cancerous tissue and surrounding tissue, while leaving an adequate amount of healthy tissue for adequate function. The aim of surgery is to preserve more than 25% of the liver tissue in cases of non-cirrhotic liver and more than 40% in cases of cirrhotic liver. The overall rate of recurrence following a resection procedure is 50 to 60%.

After surgery, a patient may choose to undergo liver transplantation with a replacement donor organ.

Other forms of treatment are describe below.

• Transcatheter arterial chemoembolization (TACE) is used in cases of non-resectable tumors or as a temporary therapy for patients who are waiting for a transplant. An anticancer and embolic drug are injected into the right or left hepatic artery. The goal is to limit the tumor’s blood supply while the chemotherapeutic agent targets the cancer.
• Percutaneous ethanol injection (PEI) is a well tolerated treatment that has been shown by some studies to achieve a 5-year survival rate in around 60% of patients with small hepatocellular carcinomas.
• Radiofrequency ablation (RFA) uses high frequency radio waves to destroy the tumor under the guidance of ultrasound imaging. This treatment is most effective in patients with a single tumor that is less than 4 mm in diameter. As RFA is a targeted therapy that only has a minimal effect on healthy tissue, the procedure can be repeated several times.
• Selective internal radiation therapy is another targeted therapy that can be used to destroy the tumor from within the body, while only having a minimal effect on surrounding healthy tissue. The procedure usually involves the use of Yttrium-90 which is placed inside embolic microspheres that target the blood vessels supplying the tumor. This disrupts the blood supply while radiotherapy is delivered directly to the cancer.
• Cryosurgery involves the use of extreme hot or cold temperatures to destroy cancerous tissue in the liver. The destroyed tumor debris is reabsorbed by the body. The procedure is often used in conjunction with resection.
• No trials have yet shown a benefit of adjuvant or neoadjuvant therapy in hepatocellular carcinoma.