Treatment options

Multimodal therapy for treatment of hepatocellular carcinoma is an aggressive approach to eradicate cancer in cirrhotic patients who may be on the transplant waiting list or for whom surgery or liver transplantation is not possible.

After you have been seen and evaluated, your doctor will discuss treatment options with you and make recommendations on the option that is best for you. Treatment plans may include surgery or one or more of the following treatments.

Radiofrequency ablation

Radiofrequency ablation heats and destroys cancerous tissue by directing radio frequency energy into the tumor through a needle. This procedure has allowed us to treat patients who previously would not have been candidates for surgical treatments due to the number or location of the tumors, problems with cirrhosis, or an inability to remove the entire tumor while leaving enough normal liver tissue. It has proven safe and well-tolerated in an overwhelming majority of patients.

How it works

The surgeon uses an ultrasound to guide placement of a probe into the tumors that are going to be treated and applies electrical current from a small device called a radiofrequency current generator. The electrical current causes friction, creating heat that kills the targeted tissue. The probe is precise and only ablates the unwanted cancerous tissue, while leaving the surrounding normal tissue untouched.

Radiofrequency ablation may also be performed during an abdominal surgery using a laparoscopic or open approach. The laparoscopic surgical approach uses an intraoperative ultrasound to visualize the targeted tissue. The open approach allows the physician to see the entire procedure.

The treatment only destroys the tumors that can be detected with ultrasound, CT or MRI scans; patients may receive chemotherapy treatments for up to six months after radiofrequency ablation in an attempt to reduce the risk of new tumors developing.

Chemotherapy

Chemotherapy (transhepatic artery chemoinfusion) uses very powerful medications to treat cancer by attempting to kill and curb the growth of cancer cells.

How it works

Hepatacellular carcinoma tumors get their blood supply from the hepatic (liver) artery. During this treatment, a small tube called a catheter is inserted into the liver artery under X-ray guidance, and the chemotherapy is infused into the artery to stop or slow the tumor cell growth. The procedure takes one to two hours. The patient may be referred to a cancer specialist, or oncologist, if additional chemotherapy is needed.

Chemoembolization

Unfortunately, the medications used for chemotherapy target not only cancer cells but healthy cells as well. The goals of transhepatic artery chemoembolization are to give a maximum dose of chemotherapy to tumor cells and minimize the toxic effects of chemotherapy to the patient.

Chemoinfusion and chemoembolization are similar procedures. In both procedures, a chemotherapy agent is introduced into the liver’s blood supply to kill the cancerous cells. In chemoembolization, the procedure cuts off the blood supply to the tumor, and the lack of oxygen-rich blood causes the tumor cells to die. Chemoembolization also traps the chemotherapy at the tumor site.

How it works

Under X-ray guidance, the catheter is placed into the femoral artery in the leg and then advanced into the liver artery, where the chemoembolization medication is infused into the liver tumor. The procedure usually takes two to four hours.