Navigating Different Liver Cancer Treatment Options

Liver cancer is a serious, life-threatening condition and one of the most prevalent cancers on a global level.

With advancements in medical science now multiple new techniques are used to treat liver cancers.

How Doctors Choose Proper Treatment for Liver Cancer

The exact treatment for liver cancer depends on these factors:

• Type of liver cancer – Metastasis from other organs to the liver, primary liver cancer ( cancers arising from the liver).
• Stage of liver cancer
• Patient’s liver function
• Patient’s age
• Overall health
• Personal preferences

Potential treatments for liver cancer include:

• Liver Surgery
• Liver Transplantation
• Ablation
• Embolization
• Chemotherapy
• Radiation therapy
• Targeted drug therapy/ Immunotherapy
• Palliative care
• Active surveillance

Active Surveillance for Liver Cancer

Active surveillance refers to closely observing the patient’s condition without administering or recommending specific treatment unless changes in cancer lesions are evident. This approach is utilized for lesions that are smaller than 1 centimeter, which are found during screening. A specialist such as an oncologist schedules an appointment every three months to look for signs of change. Patients need to do various tests and checkups during active surveillance.

Surgery for Liver Cancer

Surgery to remove cancer from the liver is the only curative option for most of liver cancers. Surgery may involve –

Hepatectomy

Part of the liver is removed along with cancer. The liver has the potential to regenerate itself and it may restore its mass to compensate for tissue that was removed during the surgery. In addition to removing cancer, a small portion of healthy tissue that surrounds it is also removed.

Liver surgery is one of the most challenging surgeries as the liver is very vascular and can cause severe bleeding. We at King’s College Hospital have not only highly experienced liver surgeons but also state-of-the-art technology which helps in making liver surgery as safe as possible.

The procedure is usually performed in cases of:

• Intrahepatic cholangiocarcinoma (primary liver cancer)
• Hepatocellular carcinoma (primary liver cancer)
• Metastatic colorectal cancer (secondary liver cancer)

When the resection is smaller, a surgeon may choose minimally invasive techniques such as laparoscopic surgery or robotic surgery. Open surgery is necessary for larger resections.

Liver transplant

In certain groups of patients with primary liver cancer (hepatocellular cancer or cholangio carcinoma) liver transplant can be considered. This is mainly in patients who also have underlying cirrhosis.

As Kings College is also a liver transplant center, our doctors will discuss with you if a liver transplant can be an option for you.

Ablation for Liver Cancer

Ablation is a type of localized treatment that a specialist may recommend to patients with liver cancer. The term localized treatments refers to treatments that are administered directly to the affected area i.e. cancer cells or tissue surrounding them.

The main goal of ablation is to destroy liver tumors without removing them.

In terms of tumor size, ablation works best for tumors that aren’t bigger than 3 cm. For tumors that are 3-5cm, ablation may be used together with another approach called embolization.

There are different types of ablation for liver cancer:

• Radiofrequency ablation (RFA): relies on high-energy radio waves to heat the tumor and destroy cancer cells. It is one of the most common types of ablation for small tumors.
• Microwave ablation (MWA): employs energy from electromagnetic waves to destroy the tumor.
• Cryoablation: freezes the tumor with very cold gasses to kill cancer cells.
• Ethanol ablation: also known as percutaneous ethanol injection (PEI), relies on injecting concentrated alcohol directly into the tumor to destroy cancer cells.

Embolization for Liver Cancer

Embolization is a type of minimally invasive procedure that works by blocking one or more blood vessels or abnormal vascular channels. An oncologist may recommend embolization when:

• Surgery can’t remove liver tumor
• The tumor is too large to use ablation (larger than 5cm)

There are different types of embolization for liver cancer:

• Trans-arterial embolization (TAE): involves injecting small particles into the hepatic artery in the liver to plug it up and block oxygen and nutrients from the tumor.
• Trans-arterial chemoembolization (TACE): a combination of embolization and chemotherapy. It is administered directly into the artery to block it and make sure chemotherapy stays as close to the liver tumor as possible.
• Drug-eluting bead chemoembolization (DEB-TACE): uses embolization and tiny beads containing chemotherapy drugs to destroy cancer cells.
• Radioembolization: combines embolization and radiation therapy. It uses beads that administer small amounts of radiation to the tumor site in order to kill cancer cells.

Chemotherapy for Liver Cancer

Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. In treatment of liver cancer, chemotherapy is an option when:

• Surgery isn’t an option to treat cancer
• Cancer doesn’t respond to ablation and embolization

In some cases, a patient may receive a combination of two or three chemotherapy drugs to treat liver cancer. Chemotherapy is administered intravenously or taken in pill form.

Radiation Therapy for Liver Cancer

Radiation therapy, or radiotherapy, is a cancer treatment that relies on radiation to destroy cancer cells or significantly decrease the size of a tumor. Radiation therapy is an option when:

• Surgery can’t remove liver cancer
• Cancer doesn’t respond to ablation and embolization
• Cancer has metastasized to other regions such as bones or the brain
• Liver cancer has advanced (radiation can relieve symptoms)
• The patient is experiencing pain due to a large cancer
• Tumor thrombus (tumor invasion into blood cells) blocks the portal vein (a vein that carries blood from organs in the abdomen to the liver)

Radiation therapy approaches in the treatment of liver cancer include:

• External beam radiation therapy (EBRT): a painless procedure that focuses radiation from a source outside of the body on liver cancer. Each session lasts several minutes. Patients may need small doses of radiation five days a week for several weeks.
• Stereotactic body radiation therapy (SBRT): radiation targets tumors from different angles while a patient is in a specifically designed body frame.
• Radioembolization: a combination of radiotherapy and embolization.

Targeted Drug Therapy / Immunotherapy for Liver Cancer

Targeted drug therapy is a type of cancer treatment that acts on abnormalities within cancer cells. The patient receives medications that block these specific abnormalities and destroy cancer cells.

Examples of targeted drug therapy for liver cancer include:

• Kinase inhibitors: inhibit kinase proteins which promote the growth of cancer cells.
• Monoclonal antibodies: man-made versions of antibodies that affect the ability of liver cancer to form new blood vessels.

Immunotherapy for Liver Cancer

Immunotherapy is a type of cancer treatment that recruits and empowers the immune system to destroy cancer cells. Medications that help the immune system find and kill cancer cells may be used when:

• Liver cancer can’t be treated by surgery
• Liver cancer metastasizes to other organs or tissues

Palliative Care for Liver Cancer

Palliative care is a type of medical care that focuses on relieving symptoms of an incurable medical condition. In this case, palliative care aims to improve quality of life and manage symptoms of advanced liver cancer that have spread to other organs or tissues and can’t be removed with surgery.

A multidisciplinary team of specialists works together with the patient and their family to provide the best possible care.

Liver Cancer Treatment at King’s College Hospital London in Dubai

An excellent team of world-class specialists including world-renowned oncologists and surgeons provide liver cancer treatment that suits the specific needs of each patient. The treatment protocol is developed bearing in mind a patient’s overall health, severity of disease, and preferences. A dedicated team of doctors helps patients overcome liver cancer, manage its symptoms, and improve their quality of life.

Diagnosed with liver cancer? Or maybe your loved one is? Schedule an appointment to start your journey toward recovery today.