Hepatocellular carcinoma is the most common form of liver cancer in adults.
The primary risk factors for development of Hepatocellular carcinoma are:
Non-alcoholic steatohepatitis (NASH)
Hepatitis B virus
Hepatitis C virus
Alcoholic liver disease
Other causes of cirrhosis
What Treatments are Available?
Systemic chemotherapy – A treatment that uses anti-cancer drugs, either injected into a vein or given orally. The drugs travel through the bloodstream to all parts of the body and kill cancer cells.
Liver transplantation – Liver transplantation is considered when the liver no longer functions adequately (liver failure). An evaluation by our multidisciplinary team is needed to determine if transplantation is appropriate. There are specific requirements that need to be met to be eligible for consideration.
Surgery - Surgical resection (removal) is the best therapy for liver tumors and is considered to be curative.
If you are not a candidate to have the tumor removed with surgery, there are several minimally invasive procedures that may be an option. These procedures are considered a primary treatment (palliative), in combination with other treatments, or as a bridge to surgery – more commonly while waiting for liver transplantation.
Liver tumor embolization
Embolization is the process of injecting microscopic particles into a branch of the hepatic artery (vessel that provides blood flow to the liver) to block or reduce the blood flow to a tumor in the liver. A small cut is made into the skin and a catheter (a thin, flexible tube) is introduced into the artery in front of the hip. Using image guided technology, a catheter is advanced into the hepatic artery in the liver. X-ray dye is injected into the bloodstream to assure proper position. The small particles are then injected into the artery to plug it up, which blocks oxygen and nutrients from getting to the tumor, causing the tumor to die and shrink. The catheter is then removed and then either a small device is used to plug up the artery in your groin or pressure is applied to that area to prevent bleeding. After the procedure you will lay flat for 2 to 6 hours to keep the artery from bleeding.
There are a few different types of embolization procedures that Interventional Radiology provides:
Transarterial chemoembolization (TACE) – Chemotherapy is administered directly into the tumor and the artery is then embolized trapping the chemotherapy within the tumor.
Transarterial radioembolization – Particles covered in radioactive material is injected into the tumor through the hepatic artery. In this type of procedure, the artery is not completely blocked off.
Drug-eluting bead chemoembolization (DEB-TACE) – Chemotherapy embedded onto microscopic beads are packed into the branch of the artery feeding the tumor blocking further blood flow to the tumor. This method cuts off blood supply to the tumor and provides chemotherapy to it a well.
Bland embolization - Microscopic beads are packed into the branch of the artery feeding the tumor blocking further blood flow to the tumor. This treatment cuts off the blood supply to the tumor however does not deliver any medications.
Radio frequency ablation (RFA) – Uses image-guided technology to target the tumor. Probes are then directed into the tumor which applies heats and destroys the cancer cells.
Which treatment is best for you?
Treatment decision is based on a number of things:
- Liver function
- Location of the tumor/s
- Size of tumor
- Tumor spread to other sites other than the liver (metastasis)
- Functional capacity
Side effects of embolization – Post embolization syndrome (PES) is a common complication that is encounter after embolic procedures. These include:
- Abdominal pain – usually in the right upper abdomen. You may feel the pain move into your shoulder or back. This may be experienced for up to a week after the procedure.
- Fever – can be as high as 101° F (38.3 °C) and last for up to 1week
- Decreased appetite
- Fatigue – this may last for up to 3 weeks after the procedure
Complications are not common, but may arise with embolization procedures:
- Vascular injury – Injury to the vessels accessed for treatment
- Nontarget embolization – non-intentional embolization of a vessel, which may lead to ulceration or perforation
- Liver failure – development of jaundice (yellowing of the skin and eyes or very dark urine)
- Kidney failure
- Infection in the liver – may manifest with fever, chills or shaking. Depending on the procedure you have, a course of antibiotics may be recommended
Is it painful?
These procedures are performed with local anesthesia and some conscious sedation. Depending on the complexity of the intervention, sometimes anesthesia (General or MAC) is involved.
What are the risks involved?
This depends on the procedure. Some of these include discomfort, pain, bleeding, and hematoma.
Do I need pain medications after the procedure?
Mild analgesics are recommended for discomfort
Do I need to stop any of my medications prior to the procedure?
This depends on the type of medications that you are. Some of the anticoagulants have to be stopped prior to the procedure. Please refer to your local hospital guidelines where the procedure is being performed.
What about the recovery?
Depending on the type of angiogram, instructions will be given.
What about the results?
These will be discussed by the physician after the procedure.