Minimally invasive methods of treatment of patients with liver cancer

Surgical removal of liver tumors offers the best chance of recovery. Unfortunately, liver tumors often are too large or affect large blood vessels, as well as other vital structures. This makes operations too risky or impractical. Surgical removal is not possible in more than 30-40% of primary patients and in 90% of patients with secondary liver cancer.

Historically, drugs have been ineffective in the treatment of liver cancer. Therefore, there are a number of methods to combat this disease.

Kinds

Primary liver cancer : The most common form of primary cancer is hepatocellular carcinoma (HCC). It is a tumor that begins in the main cells of the liver. Primary liver cancer is two times more common in men than in women. HCC occurs more often in those who have cirrhosis of the liver.

Metastatic liver cancer: Cancer can be transmitted from any part of the body to the liver. There, cancer cells can grow for several months or years before they are detected. Metastases in the liver are often with tumors of the colon and rectum. Patients with other types of cancer are also at risk of developing liver cancer.

The liver acts as the starting point for cancer cells circulating in the bloodstream. These cells can grow and form a tumor. It is believed that 70% of all patients with uncontrolled cancer receive ultimately a secondary liver tumor or metastases (tumors formed by primary cancer cells that have spread from other cancer sites).

Diagnostics

There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and various imaging techniques, including X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.

Usually, the final diagnosis can not be made until a biopsy is done. After examining a biopsy specimen, experts can determine which cancer is present and how quickly it can spread. This information is important when deciding on the type of treatment.

Treatment

Tumors need a blood supply so that it actively generates, feeds itself and grows. Radiologists together with specialists in the field of vascular surgery deliver the targeted drugs injected into the blood vessels through the catheter, throughout the body.

When treating cancer patients, radiologists can attack the tumor by affecting it by embolization and radio waves. Embolization is a well-developed method of interventional radiology that is used to treat traumatized patients with massive bleeding, monitoring bleeding after childbirth, reducing blood loss before surgery and for treating tumors.

When treating patients with cancer, embolization is used to reduce blood supply to the tumor, deliver radiation (radioembolization), or combine this method with chemotherapy to deliver cancer medicine directly to the tumor (chemoembolization).

In addition, cancer cells are killed by thermal methods (radiofrequency ablation) or they freeze the tumor (cryoablation).

Chemoembolization

Chemoembolization is a minimally invasive treatment for liver cancer, which can be used alone or in combination with other procedures. Chemoembolization provides the introduction of a high dose of chemoembolizate directly into the organ, depriving the tumor of its blood supply by blocking or embolizing the arteries that feed the tumor. Using the scanner as a guide, the intervention radiologist introduces a tiny catheter into the femoral artery. A large dose of the drug is used, since the procedure is selective and, accordingly, less of the drug circulates in healthy cells of the body. Chemoembolization usually involves staying in the hospital for two to four days. Patients, as a rule, return to a normal lifestyle for a month.

Chemoembolization is extremely effective in the treatment of malignant neoplasms of the liver, especially in combination with other methods of treatment. Chemoembolization showed promising results in the treatment of metastatic tumors. This type of treatment is approved by the FDA for the treatment of metastases.

Radioembolization

Radioembolization is very similar to chemoembolization, but using radioactive microspheres. This therapy is used to treat both primary and metastatic liver tumors. The embolic spheres of the radioactive isotope yttrium-90 are used to deliver radiation directly to the tumor. Each sphere is five red blood cells wide. These granules are introduced through the catheter into the groin and cause cell death. The technique provides a higher, local dose of radiation, without risk for healthy tissues.

This is a relatively new therapy that has been effective in the treatment of primary and metastatic liver cancers. It has fewer side effects than standard cancer treatments.

Radiofrequency ablation

For inoperable liver tumors, radiofrequency ablation offers non-surgical, localized treatment that kills tumor cells with heat, sparing healthy liver tissue. Thus, this treatment is much easier for the patient than systemic therapy. The FDA approved RFA for the treatment of liver tumors.

In a small number of cases, RFA can prolong the life of patients. Depending on the size of the tumor, RFA can compress or kill the tumor, increasing the patient's survival time and significantly improving the quality of their life. Because this is a local treatment and does not harm healthy tissue, the treatment can be repeated as often as necessary to keep patients in a comfortable zone. This is a very safe procedure, with a complication rate of the order of two to three percent, and has been available since the late 1990s.

New methods of cancer treatment

Interventional radiology plays an important role in developing new methods that can improve the treatment of cancer in the future, including using magnetic particles and delivering genetic material called gene therapy to fight or prevent cancer. These methods are still explored and they give new hope in the war against cancer.

"Magnetic" chemotherapy

Interventional radiologists are currently investigating a new technique in which magnets are used to draw a chemotherapeutic drug into a tumor. Microscopic magnetic particles are attached to the drug and delivered through a catheter into a blood vessel that feeds the tumor. A rare earth magnet is placed over the body of the patient directly above the localization of the tumor. The magnet attracts particles so that they enter the tumor. Although the technique is still experimental, but very promising. Doctors hope that it will support the effects of chemotherapy, avoiding some of its side effects, such as hair loss and nausea.

Gene therapy

In recent years, scientists have gained a new understanding of genes - the basic biological units of heredity and the role they play in the formation of diseases. This knowledge laid the foundation for the medical science - gene therapy. Although science is still at the beginning of the experimental stage, researchers hope that in the future it can be used for:

• Treatment of cancer and other genetic diseases;
• Changes in the cells of the immune system of the patient with cancer and returning them to the body where they could attack the disease or act as a vaccine;
• Replace the faulty gene responsible for the growth of cancer to a "good" gene.

One of the problems of gene therapy is to find safe and effective ways of delivering genes or genetically altered cells to a tumor.

Physicians place high hopes on new developments and their rapid application in medical practice.