Therapy of liver cancer

Note

All information given here is of general nature only, a tumor therapy always belongs in the hands of an experienced oncologist (tumor specialist) ! !

Introduction

Hepatocellular carcinoma (liver cancer) is a serious disease of the cells and tissue of the liver. In most cases, the cause of this uncontrolled cell proliferation is due to various previous diseases of the liver. For example, 80% of liver cell carcinomas are based on cirrhosis of the liver, the cause of which is excessive alcohol consumption or an inflammation of the liver (hepatitis).

The metabolic disease hemochromatosis (iron storage disease) can also lead to liver cell carcinoma. The rate of new cases in Germany is 5-6 patients per 100,000 inhabitants. The age of the disease is between 50 and 60 years. Men are more frequently affected than women. Earlier and more frequently this disease occurs in the population of tropical areas in Africa and Asia.

General information

The complaints develop late and range from upper abdominal discomfort, feeling of fullness, nausea and weight loss to stomach bleeding. A common sign of liver cancer is the so-called icterus, a yellow coloration of the eyes and skin, which is caused by a lack of detoxifying work of the liver. The classification of hepatocellular cancers is based on the distribution in the liver, the histological type, and the TNM classification, which is typical for cancers.

Therapy of liver cancer

The type of therapy for liver cancer depends on the number of liver foci found and whether the primary tumor is located in the liver or has migrated as a metastasis from another organ. In the case of primary hepatocellular carcinoma, whose foci are already widespread in the liver or have already grown through larger blood vessels, no curative therapy is possible, but only a life-improving (palliative therapy). This usually consists of the administration of a chemotherapeutic agent (5-fluorouracil), which does not have a life-prolonging effect.

If it is a metastasis of another tumor, no more than 50% of the liver should be affected and no cirrhosis of the liver should be known when 5-fluorouracil is used. The possibility of treatment with a drug that inhibits an enzyme called multikinase – sorafenib – can also be considered. Another possibility of palliative treatment is the local injection of an alcohol solution directly into the metastasis/tumor center of the liver.

Alcohol injection is most successful if the tumor is less than 3 cm in size. In this case, the hoped-for tumor necrosis (tumor death) occurs in 70% of cases. 5 years after an alcohol injection treatment, 30-60% of patients are still alive.

The disadvantage of this type of treatment is the frequent relapse rate (33%-43%) and the resulting need for repeated therapy sessions. Furthermore, icing (cryotherapy) or heating locally directly on the tumor in the liver is also used. If the tumor is minor, a curative therapy can be attempted.

This includes the surgical removal of the affected liver section (partial resection of the liver). Since humans are able to live with a small part of their liver, this therapy option is a sensible consideration. It is important that the diagnosis is made at an early stage (T1-T2) and that the tumor is limited to only one liver lobe.

Surgical removal of liver metastases is only possible if individual, maximum 4 metastases are found in 4 segments, no other organ is affected and the primary tumor is also operable. During surgery, a transverse or middle abdominal incision is made. An incision along the costal arch or laparoscopic surgery is also possible.

Nowadays, so-called ultrasound knives are used in this operation, which should make it easier to reach the liver and reduce blood loss during the operation. Depending on the location of the liver tumor, a so-called peripheral resection is chosen. Here the tumor is located at the edge of the liver, and the surgeon does not have to adhere to anatomical conditions.

A wedge is cut out and a safety distance of about 1 cm is observed, i.e. 1 cm must be cut into healthy tissue that is unaffected by the tumor. If the tumor is restricted to a specific liver segment, the entire segment (segment resection) of the liver is removed. If the tumor is affected accordingly, the entire half of the liver may also be removed (hemihepatectomy). Palliative surgery is also possible and is intended to eliminate bottlenecks caused by the tumor.