Liver cancer,Hepatocellular Carcinoma or Liver Metastases
When a patient is diagnosed with cancer of any part/organ of body, he is supposed to visit a medical or surgical oncologist and then after work up (staging and grading) of cancer, wither surgery, chemotherapy, radiotherapy or a combination is prescribed. While the role of Interventional Radiologists was limited to image guided biopsy (acquiring a tissue sample from the cancer area using a specialized needle) of most cancers, it is expanded in liver cancer to the extent that Interventional Radiologists treat a majority of these cancers.
Amongst liver cancers, hepatocellular carcinoma is the most common primary cancer arising in the liver and one of the most deadliest as well. Besides primary liver cancers, liver is one of the commonest sites where cancer spreads from other organs. Such spread is termed metastases. While previously, the options for treatment of such liver cancers included surgery or liver transplantation, many patients were not candidates for either due to various reasons. Even chemotherapy and radiotherapy were largely ineffective for such cancers. Focusing the chemotherapeutic agent or radiotherapy to the liver cancer without affecting the normal liver parenchyma or rest of the normal body cells was the main technical challenge. This is where Interventional Radiologists came in and this led to establishment of an entire branch of treatment for such cancers called ‘Interventional Oncology”.
Interventional oncologists found a way to cure small liver cancers completely by destroying them using heat directed via a small needle directed using ultrasound or CT guidance. This technique is thermal ablation and most commonly involves use of radiofrequency waves or microwaves for creating heat enough to destroy the cancer without affecting adjacent liver. This preciseness is achieved by evolution of hardware and image guidance software aside from the skill of the oncologist.
However, for larger cancer lesions, this was inadequate. Hence, the interventional radiologists used hollow tubes or catheters inserted via the groin or hand vessels and accessed the blood vessels feeding the liver and the cancers in particular. They used even thinner tubes to inject chemotherapeutic agents and radiotherapy particles in the cancer without affecting the blood vessels supplying the normal cancer free liver or other organs. These therapies termed trans – arterial therapies revolutionized liver cancer treatment and became a major palliative /curative option in most if not all liver cancers.
The advantages of these procedures were
- Minimal invasiveness.
- Faster recovery.
- No /minimal chances of liver decompensation/failure compared to surgery.
- No requirement of a liver donor or lifelong medications.
- Less cost.
- Scar less.
- Easily reproducible or repeatable if cancer recurred after treatment.
They were sometimes also used as bridging ancillary therapies for cancer patients to downstage their tumors to such an extent that they became candidates for liver transplant.
The options offered are
- Radio-frequency or microwave ablation.
- Trans-arterial chemotherapy.
- Trans-arterial radiotherapy.
