MINIMAL ACCESS TREATMENTS FOR LIVER CANCER:
Interventional radiology helps inprove quality of life
The best chance for a cure for liver tumors is to have the tumors surgically removed. On the downside, liver tumors are often inoperable because they may be too large or have grown into major blood vessels or other vital organs. Also because many tiny tumors are growing throughout the liver, surgery can be too impractical or risky. For more than two-thirds of patients that have primary liver cancer and 90 percent of patients having secondary liver cancer, surgical removal is not an option.
Chemotherapy drugs have, historically, been ineffective at curing liver cancer.
Primary liver cancer:
- Each year, about 18,500 cases of primary liver cancer are diagnosed. Hepatocellular Carcinoma (HCC) is the most common form. HCC is a tumor that starts in the hepatocytes (main cells of the liver. Primary liver cancer is doubly more prevalent in men than women.
- Hepatocellular Carcinoma (HCC) occurs most frequently in people who have cirrhosis, a form of liver disease. When the liver becomes diseased and develops scarring, cirrhosis occurs, usually over a period of several years. The liver attempts to regenerate, or repair itself. The repetitive process can lead to tumors forming. The most common reasons for developing cirrhosis are chronic infection from the liver virus hepatitis B or C and from alcohol abuse.
- Due to the increase of hepatitis C, worldwide, the incidence of primary hepatocellular carcinoma (HCC) is on the rise.
Metastatic liver cancer
Cancer can spread from any area of the body to the liver. The cancer cells may grow for months or years before they are found there. Tumors of the colon and rectum are one of the most common sources of metastatic liver cancer. Each year, about 140, 000 people are diagnosed with colon cancer, roughly have of these patients will develop liver tumors. About one in 10 patients will have the tumors removed surgically and will be cured. People with other types of cancer are also having a risk of developing liver cancer. Serving as way-station for cancer cells, the liver circulates through the bloodstream. The cells could grow and form tumors in the liver. Nearly 70 percent of patients with uncontrolled cancer will eventually develop secondary liver tumors, or metastases (tumors that are formed by primary cancer cells that have spread from other sites containing cancer).
LIVER CANCER DIAGNOSIS
Blood tests, physical examination and a variety of imaging techniques including chest X-rays and mammograms; computed tomography (CT); magnetic resonance (MR) and ultrasound are some of the tests that can help in the diagnosis of cancer. However, until a biopsy is taken, a final diagnosis of cancer cannot be made. A pathologist takes a sample of tissue from the tumor or abnormality. From the examination of the biopsy sample, pathologists and other experts can determine what type of cancer is present and whether it is a fast or slow growing cancer. By utilizing this information, the best type of treatment can be determined. Sometimes, open surgery is performed to take a tissue sample for biopsy. However, in most cases, tissue samples are obtained by interventional radiology techniques instead of by open surgery.
Image-guided biopsy, also called needle biopsy, is usually conducted using a dynamic X-ray technique (fluoroscopy), computed tomography (CT), ultrasound, or magnetic resonance imager (MRI) to maneuver during the procedure. Often, needle biopsies are performed with the assistance of equipment that renders a computer-visualized image and permits physicians and other medical professionals to see inside a certain part the body from various perspectives. The “stereotactic” equipment that they use helps them to identify the precise concentration of the anomalous tissue. Needle biopsy is often an outpatient procedure and does not typically involve complications; less than 1 percent of patients develop bleeding or infection. In nearly 90 percent of patients, needle biopsy provides a sufficient tissue sample for the pathologist to do the necessary analysis and diagnose the likely cause of the abnormality. Benefits of needle biopsy include:
- Since doctors are able to guide instruments, the abnormal tissue can be sampled while sensitive close by structures such as blood vessels and vital organs can be seen and avoided.
- Because there is no open surgery, the biopsy rarely leaves any scarring or complications and also is much less painful for the patient.
- Patients may more rapidly resume their typical activities and it requires a much shorter time for recovery.
Large core needle biopsy. In this procedure, a special needle is used that enables the radiologist to obtain a larger biopsy sample. This technique is often utilized to select tissue samples from lumps or other abnormal tissue in the breast that are suspected by physical examination or on mammograms or other imaging scans. Because approximately 80 percent of all breast abnormalities result in them not being cancer, this technique is often preferred by women and their physicians because it:
- is less painful and requires less recuperation time than open surgical biopsy, and
- avoids the scarring and any disfiguring marks that may come about because of open Surgery.
A comparable procedure called fine needle aspiration might be utilized to withdraw cells from a suspected malignancy. It additionally can diagnose fluids that have gathered in the body. In some cases, these liquid accumulations likewise may be emptied through a catheter, for example, when pockets of disease are diagnosed. Numerous interventional radiology techniques for the analysis and treatment of growths might be performed on an outpatient premise or amid a short clinic visit. Much of the time, these procedures:
- offer innovative cancer treatment options
- are less painful and debilitating for patients
- result in faster recuperation
- experience fewer side effects and complications.
LIVER CANCER TREATMENTS
As vascular specialists, interventional radiologists are remarkably talented in utilizing the vascular system to convey targeted treatments through a catheter to all parts of the body. In treating ill patients, interventional radiologists can treat the tumor from inside the body without medicating or influencing other non-targeted parts of the body. Tumors require a blood supply, which they energetically create, to encourage themselves and develop. As vascular specialists, interventional radiologists are particularly gifted in utilizing the vascular framework to convey tailored medicines through a catheter throughout the body. In treating tumor patients, interventional radiologists can attack the diseased mass from inside the body without delivering medicine or influencing different parts of the body by utilizing embolization and radiofrequency heat. Embolization is an entrenched interventional radiology procedure that is utilized to treat trauma victimized people with massive bleeding,, to control bleeding after labor, to diminishing blood loss after surgery and to treat tumors. In treating cancer patients, interventional radiologists use embolization to stop the blood supply to the tumor (embolization), convey radiation to a tumor (radioembolization), or join this procedure with chemotherapy to deliver drugs directly to the tumor (chemoembolization). Also, interventional radiologists can utilize imaging to guide them specifically to the tumor through the skin to control radiofrequency heat to “cook” and extinguish the growth cells (radiofrequency removal) or cyroablation to stop the tumor.
Chemoembolization is a negligibly intrusive treatment for liver growth that could be utilized when there is an excessive amount of tumor to treat with radiofrequency removal (RFA), when the tumor is in an area that can’t be treated with RFA, or in blending with RFA or different medications. Chemoembolization conveys a high dosage of tumor fighting medication (chemotherapy) directly to the organ while denying the tumor of its blood supply by blocking, or embolizing, the conduits nourishing the tumor. Utilizing imaging for direction, the interventional radiologist extends a small catheter up the femoral artery in the crotch area into the veins supplying the liver tumor with nourishment. The embolic agents keep the chemotherapy in the tumor by obstructing the blood flow to different parts of the body.This permits a higher dose of chemotherapy medication to be administered, in light of the fact that less of the medication has the capacity to affect the healthy cells in the body. Chemoembolization typically includes a recuperative hospital stay of two to four days. Patients commonly have lower than ordinary energy levels for a month thereafter. Chemoembolization is a palliative, not a healing, treatment. It could be to a great degree compelling in treating primary liver malignancies, particularly when joined with different treatments. Chemoembolization has demonstrated promising early results in treating certain sorts of metastatic tumors. In spite of the fact that the individual materials utilized as a part of this treatment are FDA sanction, the treatment itself is not endorsed for intra-arterial therapy of liver tumors.
Radioembolization is very much alike to chemoembolization yet with the utilization of radioactive microspheres. This treatment is utilized to treat both primary and metastatic liver tumors. This treatment joins with the radioactive isotope Yttrium-90 into the embolic spheres to convey radiation straightforwardly to the tumor. Every sphere is about the span of five red platelets in width. These globules are infused through a catheter from the crotch into the liver conduit supplying the tumor. The dots are finally to be stopped inside the tumor vessels where they push their neighborhood radiation that causes cell passing. This strategy takes into consideration a higher, neighborhood measurement of radiation to be utilized, without subjecting healthy tissue in the body to the radiation. The Yttrium-90 transmits from inside and, since it is delivered through the hepatic artery, it might be seen as “inner” radiation.Radioembolization is a palliative, not a therapeudic, treatment-however patients profit by developing their lives and enhancing their personal satisfaction. It is a moderately new treatment that has been compelling in treating essential and metastatic liver tumors. It is executed as an outpatient treatment. There are less symptoms from this treatment contrasted with standard growth medications, with the fundamental one being weakness for seven to 10 days.