Contents:
- Medical Video: Demystifying Medicine 2017: Hepatocellular Cancer and Liver Transplantation
- Treatment of liver cancer
- Laparoscopic surgery
- Liver transplant
- Radiation therapy
- Target therapy
- Chemotherapy
- Virus therapy
- Prevention of liver cancer
- Screening
- Determine the risk of recurrence after surgery
Medical Video: Demystifying Medicine 2017: Hepatocellular Cancer and Liver Transplantation
Liver cancer is a common type of cancer. Until now, there have only been a number of effective ways to prevent or treat liver cancer. However, many efforts have been made in research on new ways to prevent and treat liver cancer. Scientists work relentlessly to find the cause of liver cancer for prevention better, and doctors work to improve treatment in patients. There has been great progress in liver cancer research.
Treatment of liver cancer
Now there are many ways to treat liver cancer:
- Life resection: Surgery to remove all or part of the liver
- Liver transplant: Change the liver
- Arterial embolization: Seals or blocks blood vessels to the tumor
- Radiofrequency ablation: A form of tumor ablation (destruction without removing a tumor) that uses heat to destroy tumor cells
- Alcohol injection: Entering alcohol which is toxic to the tumor through needles. This is used in small tumors
- Kriotherapy: A form of therapy that uses cold temperatures to kill cancer cells
- Chemotherapy: Using chemicals to treat cancer
- Biological therapy: Use agents such as viruses to kill cancer cells
- Target therapy
- Care support
Doctors also learn how to make liver cancer more easily removed by shrinking it before surgery. There are already studies of therapies given before surgery, including targeted therapy, chemotherapy, ablation, embolization, and radiation therapy. Preliminary results have been promising but only seen in a small number of patients.
Treatment for cancer also means preventing cancer from recurring after surgery. Most studies that have so far used chemotherapy or chemoembolization after surgery have not proven effective. However, there are new drugs that are promising and perhaps more effective. Some of the drugs studied include the targeted drug sorafenib (Nexavar) and menatetrenone, drugs that are chemically similar to vitamin K. Some positive results have also been seen with radioembolization, but this needs confirmation in a larger study.
Surgery has become the main treatment for liver cancer. A new technique developed to make both partial hepatectomy (lifting parts of the liver) and liver transplant safer and more effective.
Laparoscopic surgery
In laparoscopic surgery, several small incisions are made in the abdomen. The doctor will insert a special thin long tube to see and cut off the part of liver cancer. Does not require a large incision in the abdomen, which means that there is at least blood loss, less pain after surgery, and faster recovery.
At present, laparoscopic surgery is still considered experimental and is used mainly for small tumors in certain parts of the liver which can be easily achieved through a laparoscope.
Liver transplant
Liver transplant patients must meet many strict criteria. For this reason, only a few patients are liver transplant candidates. Some doctors are now looking for ways to expand these criteria. One study examined the replacement of the liver with slightly larger but still healthy.
Liver transplantation is a major surgery and there is a risk of potentially life-threatening complications. It is estimated that about 1 in every 30 people will die during the procedure and up to 1 in 10 will die at some point in the following year after surgery.
Liver transplantation might be suitable for you if:
- You only have a single tumor less than 5cm in diameter
- You have three or fewer small tumors, each less than 3cm
- You have responded very well to other treatments, with no evidence of tumor growth for six months
Radiation therapy
The biggest concern for radiation therapy is that it will damage healthy tissue. The researchers are now working to focus on radiation therapy against cancer, so that the surrounding healthy tissue is not affected. One of the approaches studied is called brachytherapy. In this treatment, a thin tube called a catheter is placed in the tumor and then the pellets that emit radiation are inserted into the catheter for a short time. After treatment, both pellets and catheters are removed. This allows radiation to be targeted at cancers that are less harmful to the normal liver.
Target therapy
New drugs are being developed that work differently from standard chemotherapy drugs. Newer drugs target certain parts of cancer cells or the surrounding area.
Therapy focuses on blood vessels that supply blood for tumors. The tumor grows by getting a blood supply. A new type of drug, sorafenib (Nexavar), has been used in several types of liver cancer that cannot be removed surgically. This drug works by preventing the growth of new blood vessels in the tumor. Sorafenib is now being studied for use early, such as after surgery or trans-arterial chemoembolization (TACE). Researchers also study whether combining it with chemotherapy can make it more effective.
Regorafenib (Stivarga®) is another targeted and promising drug in treating liver cancer.
Chemotherapy
Chemotherapy combined with other treatments is being tested in clinical trials. A small number of tumors respond to chemotherapy. However, it has not been shown to prolong patient survival.
Chemotherapy drugs, such as oxaliplatin, capecitabine, gemcitabine, and docetaxel, are being tested. Oxaliplatin has shown promising results in early studies when combined with doxorubicin. Oxaliplatin combined with gemcitabine and drugs from cetuximab (Erbitux®) targeted therapy have proven effective.
Virus therapy
The latest approach to treatment is the use of a virus, known as JX-594. This is the same virus used to make the smallpox vaccine, but has been changed to only infect abnormal cancer cells and cells. In this treatment, a solution containing the virus is injected into liver cancer. The virus will then enter the cancer cell, which causes these cells to die, or pushes the immune system to attack cells. This treatment has been tested in patients who do not respond well to other treatments and appear promising.
Prevention of liver cancer
An ounce of prevention is worth a pound of cure. It is more effective to stop cancer before it starts. Vaccination and better treatment for liver cancer can prevent about half of liver cancer cases worldwide. Researchers are studying ways to prevent hepatitis C or treat hepatitis infections before they cause liver cancer. Treatment for chronic hepatitis also shows progress.
Screening
Scientists recommend using blood tests to detect liver cancer in the early stages rather than using AFP and ultrasound. One promising test is called DKK1.
Determine the risk of recurrence after surgery
After liver surgery, the main concern for everyone involved is the risk of recurrent cancer, which means the cancer will come back. Knowing a person's risk of recurrent cancer can help doctors determine the next follow-up or one of the additional treatments to reduce this risk.
The researchers are studying cells in surgery as samples. They see cell gene patterns near the tumor and are able to predict who has high risk. These initial findings need to be confirmed in other studies before widespread use.
In conclusion, there has been great progress in the field of liver cancer. Prospects are better for people who do liver transplants. Overall, around 75 out of 100 people survive for 5 years or more after this type of surgery.
