Ablation to Treat Liver Cancer
Ablation is a way of destroying cancer cells without surgically removing them. It’s best for smaller tumors, less than 3 centimeters, and may be used as a treatment option while a patient is waiting for a liver transplant.
The Compass Oncology team will typically perform a radiofrequency ablation if this treatment is needed. However, there are several ways an ablation can be performed, including:
- Radiofrequency ablation: using a special probe containing tiny electrodes to kill the cancer with heat.
- Cryoablation: using a special instrument to freeze and destroy cancer cells. The liver cancer doctor may use ultrasound to guide the instrument. Cryoablation is also called cryotherapy or cryosurgery.
- Percutaneous ethanol injection: using ultrasound to guide a thin needle into the tumor. Alcohol (ethanol) is injected into the tumor directly to kill cancer cells. This procedure may be repeated once or twice a week. Local anesthesia is commonly used, but if you have many tumors in the liver, general anesthesia may be needed.
- Microwave therapy: exposing the tumor to high temperatures created by microwaves. This damages and kills cancer cells, or makes them more sensitive to the effects of radiation and other anticancer drugs.
Embolization Therapy for Liver Cancer
Embolization is a procedure typically for patients who can't have surgery or a liver transplant. It may also be combined with ablation for some larger tumors.
During embolization, substances are injected into the body to reduce or block the blood flow to cancer cells. Blocking the blood flow from the hepatic artery causes the tumor to die. Even though the hepatic artery is blocked, healthy liver tissue can still receive blood flowing from the hepatic portal vein.
There are two main types of embolization therapy:
- Transarterial embolization (TAE): A cancer doctor inserts a small catheter into an artery in your leg and navigates it into the hepatic artery. Tiny sponges or other particles are injected into the catheter to block blood flow through the artery. The blockage may be temporary or permanent, depending on the type of particles used.
- Transarterial chemoembolization (TACE): This procedure is similar to TAE, except chemotherapy is given in addition to injecting the tiny particles that block blood flow. Because of the reduced blood flow, the drug stays in the liver longer. TACE is also called chemoembolization.
Liver Cancer Radiation Therapy
Radiation therapy uses high doses of radiation to kill cancer cells. This type of treatment is often best for patients who can’t have surgery or to help relieve pain from liver cancer that has spread to the bones. Radiation therapy may be combined with other liver cancer treatments and given in a few different ways:
- External - Stereotactic body radiation therapy (SBRT): SBRT is an external beam radiation therapy that uses special equipment to consistently position the person for each treatment, reducing damage to nearby healthy tissue. Over several days, a radiation machine delivers a larger-than-usual dose of radiation directly at the tumor. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
- Internal - Radioembolization (RE): Radioembolization combines embolization and radiation therapy. Small beads, called microspheres, are attached to a radioactive isotope (yttrium-90 or Y-90) and injected into the hepatic artery. These beads then become lodged in the blood vessels near the tumor and emit tiny amounts of radiation to the tumor site for several days. Because the radiation has a limited range, minimal damage is done to the surrounding healthy tissue.
Targeted Therapy
Patients who can't have surgery or a liver transplant may receive targeted therapy. The most common type of targeted therapy for liver cancer is a category of drugs called kinase inhibitors. Proteins called kinases are found on the surface of cells and tell the cell how to function. Some kinases help liver cancer grow, while others help form new blood supplies to the tumor so it can grow. In either of these situations, kinase inhibitor drugs will stop these signals and stop the cancer’s growth.
Another type of targeted therapy found effective for liver cancer is an angiogenesis inhibitor. Lab-made monoclonal antibodies are given to the patient to block the tumor's ability to form new blood vessels. This will essentially starve the cancer of the fuel it needs to grow.
Fatigue, loss of appetite, mouth sores, headaches, high blood pressure, weight loss, diarrhea, pain in the abdomen, and hand-foot syndrome (redness and irritation of the hands and feet) are common side effects associated with various targeted therapy drugs.
Immunotherapy
Immunotherapy stimulates the body's immune system to fight cancer. Cells have a “checkpoint” that allows the body to see them as healthy or damaged, allowing the body to destroy unhealthy cells. Cancer cells will turn off the checkpoint so the body thinks the cells are healthy. Checkpoint inhibitor drugs can force the body to see cancer cells as something to be attacked.
Fever, cough, skin rash, nausea, loss of appetite, muscular or joint pain, and fatigue are common side effects of immunotherapy treatment.
Chemotherapy
Chemotherapy is not widely used as a first-line treatment for liver cancer because it’s not as effective as other treatments. Research has proven that a combination of drugs is the most effective when chemotherapy is used. The most common combination is GEMOX, which combines gemcitabine and oxaliplatin. FOLFOX is another option combining 5-FU, oxaliplatin, and leucovorin.
Common side effects of chemotherapy include fatigue, hair loss, nausea, vomiting, loss of appetite, mouth sores, easy bruising, and increased likelihood of infections. Those who receive FOLFOX have a high sensitivity to heat and cold, especially in the hands and feet.
Clinical Trials for Liver Cancer in Portland, Oregon
Some liver cancer patients might be eligible to take part in a clinical trial. Clinical trials study new treatments that could improve or replace standard cancer treatments. Some treatments tested during clinical trials could benefit certain liver cancer patients. However, it’s important to understand that clinical trial participation may have a higher risk as there are more unknowns.
Compass Oncology offers clinical trials for qualifying liver cancer patients. Speak to your oncologist about the available trials and your eligibility.
Liver Cancer Care in Portland & Vancouver
If you have been newly diagnosed with liver cancer, the first step is to schedule a consultation with an oncologist who specializes in liver cancer. If you are in the Portland, OR, or Vancouver, WA area, we use a multidisciplinary approach that includes a liver cancer surgeon. We offer personalized treatment plans and second opinions on treatment.
Find a location convenient to you and schedule a consultation with a liver oncologist about your specific diagnosis and treatment plans.
