Interventional radiologists are specially-trained physicians who utilize cutting-edge technology and techniques to treat many different types of liver cancer. The treatment, called a Minimally Invasive Interventional Procedure (MIIP), is guided using equipment which allows the interventional radiologist to see inside the patient’s body using X-rays, CT scan, or ultrasound.
Liver cancer can be treated in different ways, depending on the number of tumors in the liver, the presence of any cancer related outside of the liver and the general health of the patient. Infusion is the release of a medication directly into the vessels feeding the tumors. Typically chemotherapy is used for this procedure.
For all patients, the amount of disease in – as well as outside of – the liver will determine the most appropriate therapy.
For patients where there is a possibility of cure and the cancer is limited to the liver, treatment can be performed with surgery with a scalpel, or it can be performed through a pinhole, without a scalpel.
The options for potential cure include:
- Liver transplant – the patient has their liver removed and replaced with a donor liver, which can be from a family member in some instances.
- Surgery – part of the liver containing the tumor is removed by the surgeon.
- Minimally invasive image guided procedures through a pinhole without a scalpel
- External beam radiation therapy
Treating the disease using minimally invasive treatments include:
- Heat, called ablation
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This is the preferred MIIP for patients where cure is possible. Ablation is a technique using energy in the form of microwaves or radiowaves transmitted into the tumor with a thin needle. The tumor is heated until the cancer cells are killed and the patient is able to go home with a band-aid on the same day.
- Injecting tiny beads soaked in chemotherapy called TACE (Transarterial chemoembolization)
- This has traditionally been reserved for those patients where the disease is too advanced for cure. In select cases, this technique can be used, often in conjunction with ablation to kill the tumor.
- Injecting tiny beads carrying high doses of radiation to the tumor called Y90, Radioembolization, or SIRT (Selective Internal Radiation Therapy)
- This technique is injecting tiny beads carrying very high doses of radiation to the tumor to kill it. This method allows for much higher doses of radiation to be placed into the tumor through a very small tube called a catheter through the patient’s wrist or groin. The interventional radiologist uses X-rays to guide the catheter into the artery in the liver and to the tumor. This technique allows for much higher doses of radiation compared to the traditional radiation treatments where the radiation must be passed through the skin. By placing the catheter as close as possible to the tumor, minimal damage occurs to normal tissue. This means the patient has fewer side effects to the therapy and can be done as a day case, allowing the patient to recover at home, with no hospital stay necessary.
In some cases, thermal ablation is not possible due to the anatomy, and two techniques can be used to kill the tumor.
Lastly, one further MIIP uses alcohol, injected directly into the tumor to kill it. It is reserved for very small tumors that are close to vital organs, where other techniques are not possible due to possible injury to surrounding tissue.
Options for control when a cure is not possible:
- Minimally invasive image guided procedures through a pinhole without a scalpel
- Systemic therapy
- Radiation therapy
In patients where the cancer is too advanced in the liver, the interventional radiologist can perform MIIPs to control the progress of disease. This is referred to as palliative therapy. As with those patients for curative intent, beads soaked in chemotherapy or Y90/SIRT/radioembolization can be performed.
In these cases, the intent of the treatment is to control the disease, therefore the treatment may be targeted on the whole liver, treated in stages, one side of the liver, or a segment of liver involved in disease.
In the majority of cases, these therapies are performed as day case procedures and do not require the patient to remain in hospital overnight.
For those patients where MIIPs are not possible, experts may advise the use of radiotherapy or chemotherapy in the form of oral medication.
During your consultation, the interventional radiologist will discuss all available options, and recommend the most appropriate therapy depending on the extent of the malignancy, the overall health of the patient, and the presence of cancer outside the liver, called metastatic disease or stage 3/4 disease.
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