Liver cancer

The treatment of liver cancer has undergone significant changes in recent years due to the introduction of innovative approaches that significantly increase the life expectancy of patients, but the radical method, surgery, still remains the same. As with most malignant neoplasms, only adequate surgery can do away with the disease, assisted chemotherapy, but with a very limited range of effective drugs.

In what cases the operation is impossible?

Radical surgery for hepatocellular carcinoma is possible with a small and single tumor node or several small ones (up to 3 cm), closely grouped in one hepatic lobe. Hepatic tissue has a rare ability to restore, after removal of almost 70% of the liver its size fully regenerates after a while.

Restoration of hepatic lobes lost as a result of the operation is possible only with a healthy liver that does not suffer from chronic hepatitis or cirrhosis and fully performs its diverse functions. The issues of surgical treatment of cancer depend on the organ health, since the presence of marked cirrhosis can be an absolute contraindication for surgery even with a small malignant neoplasm.

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Distant metastases of hepatic carcinoma in other organs, as well as spread of the cancer conglomerate to the hepatic portal vessels or a tumor thrombus in the portal vein, are regarded as an absolute contraindication to surgical treatment.

Surgical treatment is impossible with ascites, an accumulation of excess fluid in the abdominal cavity, regardless of its cause, be it a cardiovascular system dysfunction, a severe cirrhosis, or metastases into the peritoneum lining the abdominal cavity. Ascites indicates a decompensation of the organ’s functional capabilities. This clinical situation requires conservative therapy with evacuation of effusion.

What operations are performed for liver cancer?

There are only two radical interventions for hepatocellular carcinoma:

  • Resection — a partial removal of hepatic tissue;
  • Complete removal of the liver with simultaneous transplantation of a donor organ.

Transplantation is not performed urgently, it is a planned process that requires serious preparation and search for a donor, which takes months that the patient with hepatocellular cancer may not have.

Resection is an operation sparing in terms of the amount of tissues removed; nevertheless, it is not possible with cirrhosis or liver fibrosis, when the possibility of postoperative recovery is almost impossible. Unfortunately, an adequate compensation for the substantial insufficiency of the hepatic function still cannot be achieved.

In all cases, access to the diseased organ is gained through the abdominal wall in the right hypochondrium. Today, it is possible to perform resection with sparing laparoscopic access through several punctures of the abdominal wall under optical control. Few Russian surgeons have mastered this innovative and technically challenging manipulation, but the experts of our clinic have sufficient experience in high-tech endoscopic and oncologic surgery.

What surgical techniques help fight a liver tumor?

In certain cases, there are doubts about the technical possibility of liver resection, for example, with several small cancer nodes up to 3–5 cm each. Treatment standards suggest combining organ resection with local methods for malignant tissue elimination.

The local manipulation technique consists in leading to the neoplasm of a physical factor that causes death of cells followed by replacement of the dead hepatic parenchyma with connective tissue and cicatrix formation.

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The following is used as the «killer» component introduced into the tumor by a special needle under ultrasound control:

  • liquid nitrogen — the process is called «cryodestruction»;
  • high frequency currents — radio frequency ablation (RFA);
  • a beam of radiation energy — stereotactic irradiation.

Yttrium isotopes enclosed in microscopic capsules or chemotherapy drugs in fat emulsion are also led to the cancer conglomerate, but not directly into a tumor, but through a catheter inserted into a large artery feeding the cancer. This process is called transarterial radioembolization (TARE) or chemoembolization (TACE).

With any local exposure, a good end result may require several manipulations.

The clinic widely uses local methods of treating primary hepatocellular cancer, in each case an individual therapeutic strategy is developed, sometimes with a combination of several local methods, but in all situations it is optimal for the patient.

When can a local exposure be used without an operation?

All local techniques can be applied completely independently with a primary cancer of less than 3 cm, when the patient is unable to undergo volumetric surgery for health reasons, and with a relapse after resection and hepatic metastases, stage IV. Clinical studies have shown their good tolerability and long-term results with a decent quality of the patient’s life.

The listed interventions are not among widely used ones because, in addition to expensive equipment, they require unique exceptionally dexterous experts with an excellent professional education. In our clinic you will surely be consulted by a master of the highest surgical level wielding a unique technique of local surgical treatment.

The possibilities of chemotherapy, a treatment with drugs, are limited for liver cancer, however, they may also be required. The liver performs a lot of functions, its disease disrupts the normal biochemistry of all life processes, therefore, without regular rehabilitation support and symptomatic therapy, it is impossible to go through a serious antitumor treatment without loss.

The material was prepared by Alexei Nikolaevich Severtsev, chemotherapist, Doctor of Medicine, Professor.

In our clinic, each patient will be offered an individual program of accompanying therapy, facilitating antitumor treatment and aimed at improving life quality and maximum expectancy.

Reference list:

  1. Schukina O. E. Ultrasound Diagnostics of Liver Cancer (In Russian) // Saratov Journal of Medical Scientific Research. 2014. No. 1.
  2. Podymova S. D. Liver diseases (In Russian) // Moscow, Medicine Publ., 2006; 554 pp.
  3. Ternovoy S. K., Vasilyev А. Yu., Sinitsyn V. Е., Shekhter А. I. Radiological diagnostics and therapy (In Russian) // Moscow,
  4. Medicine Publ., 2008.
    Merabishvili V. М., Merabishvili E. N., Chepik О. F. Epidemiology of liver cancer (In Russian) // Russian Journal of Oncology. 2014. No. 4.
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