Liver Cancer (Hepatocellular Carcinoma): Therapy

General measures

  • Alcohol abstinence (complete abstinence from alcohol).
  • Nicotine restriction (abstaining from tobacco use).
  • Normal weight to strive for or maintain!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
    • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Avoidance of environmental stress:
    • Carcinogens (substance that can cause cancer) such as: Arsenic (latency period 15-20 years) and chromium (VI) compounds.

Conventional non-surgical therapy methods

  • High-intensity focused ultrasound (HIFU) – ultrasound waves are focused and can be precisely focused on an area only a few millimeters in size; temperatures of up to 80 °C result in tumor cells being effectively killed.The HIFU procedure is used in China for non-operable hepatocellular carcinoma of the liver.
  • Irreversible electroporation (IRE) – nonthermal tissue ablation procedure: In this procedure, repetitive high-current pulses of 1,650-3,000 V are performed via needle-shaped electrodes inserted into the target tissue. The pulse length was 90 μs and 70 pulses were delivered per cycle under constant ECG monitoring to avoid life-threatening arrhythmias. The resulting electromagnetic field causes electrical breakdown of the cell membrane in the target area, creating nanopores in the cell membrane. These in turn lead to uncontrolled ion influx as well as loss of macromolecules resulting in disturbed cell homeostasis. The use of IRE as an alternative therapy for the treatment of inoperable hepatocellular carcinoma (HCC) has not been adequately supported by evidence. However, experts agree that the procedure has high potential for the treatment of malignancies. A five-year retrospective study of 71 patients treated with IRE found that patients lived longer than two years on average after treatment. Complete tumor removal was demonstrated in approximately 93% within the six-week follow-up period; one-third of treated patients developed recurrences. According to the authors, IRE can be used in the liver for tumors up to six centimeters in size.
  • Percutaneous ethanol injection (PEI) – using a fine needle, 95% alcohol is injected into the tumor under computed tomography (CT) or ultrasound guidance
    • Indication: when the tumor can be neither surgically removed nor treated locally-ablative.
    • This form of therapy causes direct destruction of tumor cells. In the process, healthy liver tissue is hardly destroyed.
    • The therapy takes place in several sessions at intervals of two to four weeks.Often it must be repeated after several months.
    • A cure is possible with this method of treatment.
    • The ethanol injection we performed in Germany increasingly rare. In the foreground of treatment in recent years is the radiofrequency ablation. This treatment method is superior to ethanol injection (also acetic acid injection) in effectiveness.
  • Radiofrequency ablation (RFA, RFTA, RITA) – local-ablative (local, tumor-destroying) procedure in which tumor is destroyed by local (local) application of heat.
    • Indication: when the tumor can be neither surgically removed nor locally-ablative treatment.
    • Heat is introduced into the tumor via a probe. The heat coagulates (“cooks”) the tumor. The complete therapy is accompanied by ultrasound monitoring.Radiofrequency ablation has the advantage of few side effects and complications. In addition, in most cases, one session is sufficient.This method can destroy tumors with a maximum size of seven centimeters.
    • A cure is possible with this treatment method.
    • Tumors in the area of the bile ducts can not be treated with the method due to possible injury to these structures.
    • A combination of RFA and drug therapy with the tyrosine kinase inhibitor sorafenib is possible.
    • A combination of RFA and percutaneous iodine-125 implantation results in prolonged progression-free survival.
  • Transarterial chemoembolization (TAE, TACE): this counts as regional chemotherapy.
    • Indication: when the tumor can be neither surgically removed nor treated locally-ablative.
    • This is an outpatient minimally invasive procedure. Here, in the case of hepatocellular carcinoma, a chemotherapeutic agent is introduced into the liver via the hepatic artery.
    • Transarterial chemoembolization is also used as a new therapy against liver metastases in breast cancer.Possible chemotherapeutic agents include cisplatin, doxyrubicin or mitomycin.
    • In addition to the insertion of chemotherapeutic agents, embolizing factors such as ethiodol or gelatinous sponges are also used to occlude the arteries supplying the tumor.
    • A combination of TAE and drug therapy with the tyrosine kinase inhibitor sorafenib is possible.
    • Transarterial chemotherapy can cause severe side effects such as fever, abdominal pain (abdominal pain) but also weight loss and increase in ascites (abdominal dropsy).

    Transarterial chemoembolization (TAE, TACE) patients treated with acetylsalicylic acid (ASA) at the time of TAE had lower post-embolization bilirubin levels compared with patients not treated with ASA: one day (0.9 vs. 1.3), one month (0.9 vs. 1.2), and one year (0.8 vs. 1.0); ASA-treated patients also lived longer (57 vs. 23 months).

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular follow-up examinations for early detection of recurrence (recurrence of the disease).
  • Examinations every six months: by sonography (ultrasound), by computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen (abdominal cavity) and thorax (chest incl. chest organs) and/or by determination of alpha-fetoprotein (AFP) in serum.

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
    • Consume only limited energy-rich foods.
    • Moderate total fat intake
    • Little red meat (pork, beef, lamb, veal) and sausages.
    • Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Refrain from contaminated foods such as offal and wild mushrooms
  • Observe the following special dietary recommendations:
    • Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for hepatocellular carcinoma (liver cancer).
    • Not eat moldy food – molds form toxic substances such as aflatoxin B and other mycotoxins (mold toxins).
    • Diet rich in:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
    • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes.Exercise should be performed at about 80% of maximum heart rate for a total of 30 minutes.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy