The treatment of a liver cancer disease depends firstly on the stage of the tumor, ie on its size and location. On the other hand, the age and health status of the patient also play a decisive role in the choice of treatment method. For the therapy is also important in which state the liver is, that is, whether cirrhosis is present or not.
Therapy procedure in liver cancer: overview
Basically, there is a wealth of different treatment options available for the treatment of liver cancer. Individual procedures can also be combined with each other.
- Operation: partial removal of the liver or liver transplant
- Local therapy: These range from desquamation of the tumor via a heat treatment or a contrast medium therapy to an internal irradiation of the liver.
- Drug therapy: chemotherapy or treatment with the active substance sorafenib
- Palliative therapy: In this form of therapy is no longer the cure of the disease, but the improvement in the quality of life in the foreground.
Treatment of liver cancer: surgery
Surgery is currently the treatment option most likely to completely cure a liver cancer. Whether liver cancer can be treated by surgery depends largely on the number of tumors, their location and their size. It is also crucial if the liver tissue is still healthy or if there is already advanced cirrhosis of the liver. In addition, the health of the patient must allow surgery.
Especially smaller tumors can usually be easily removed by surgery. In addition to the tumor, surrounding healthy tissue is also removed to reduce the likelihood that cancer cells will remain in the body. It is important in partial liver removal that enough healthy liver tissue remains in the body to maintain liver function.
For patients with liver cirrhosis, a liver transplant is a better decision than a partial liver removal. Because if a part of the diseased liver is removed, it is possible that the remaining liver tissue is insufficient to detoxify the body and cause liver failure.
However, for a liver transplant to be performed, the patient must have a good general condition. Certain comorbidities can also be an exclusion criterion for the procedure. In contrast to a partial removal, the patient must take medication for a long time after a liver transplant. These prevent the donor organ from being rejected.
Treatment of liver cancer: local therapy
The aim of local therapy is to slow down the progression of the disease, extend the survival span and alleviate concomitant symptoms. They are used when a liver cancer surgery is not possible. In addition, local procedures are also used to bridge the waiting time to a transplantation.
When the tumor is obliterated, highly concentrated alcohol is injected through the skin directly into the liver tumor. With small tumors this procedure can lead to a destruction of the tumor and thus to a cure of the disease. In a radiofrequency ablation (heat treatment), however, the tumor cells are overcooked by a laser or high-frequency vibrations and then removed. To completely eliminate the tumor, several sessions may be needed.
In a transarterial chemo-embolization, a cytotoxin and a vaso-occlusive agent are injected into the branches of the hepatic artery, which supply the tumor. Due to the lack of supply, the tumor shrinks. Often this procedure is therefore also used before surgery. The liver continues to be supplied with this method via a second access - the portal vein. If this is closed, the procedure can not be used.
In contrast therapy, a contrast agent (Lipiodol), which accumulates in the liver, is loaded with radioactive particles and injected into the hepatic artery. The agent accumulates in the tumor and kills the cells. Relatively new is the method of internal radiation, the so-called selective internal radiotherapy (SIRT), which is based on contrast therapy. In this case, small beads, to which a radioactive substance is bound, are introduced directly into the vessels that supply the liver. Since the radiation only has a range of up to one centimeter, healthy tissue is not or only slightly affected by the radiation. The small globules also ensure that the vessels supplying the tumor are blocked.
Treatment of liver cancer: drug therapy
Chemotherapy is relatively rarely used in liver cancer in Germany. Generally, it is performed when metastases have already formed or when no other therapy is considered. In contrast to the previously presented local procedures, chemotherapy is effective throughout the body. The drugs that are used in chemotherapy - the so-called cytostatics - primarily cancer cells are attacked. However, other fast-dividing cells are also being controlled, such as the hair root and mucosal cells.
In addition to chemotherapy, sorafenib has been used for some years to intervene in the metabolism of the tumor, thereby combating it in a targeted manner. The active ingredient is taken in the form of tablets and is used when liver cancer can not be operated on. Mostly sorafenib is used to increase the average survival time of an advanced cancer.
Treatment of liver cancer: palliative therapy
If a liver cancer disease is no longer curable due to its advanced stage, a palliative therapy tries to keep the quality of life of the patient as high as possible. It is mainly used in patients with end-stage liver cancer. Palliative therapy focuses particularly on relieving pain and eliminating other discomfort caused by the tumor.
Liver cancer: aftercare is important
After surviving liver cancer, follow-up is of central importance. In the follow-up examinations, physicians support patients with physical or emotional problems. In addition, they check whether comorbidities have occurred due to the therapy. If this is the case, the diseases must be treated accordingly.
However, the most important goal of follow-up care is to recognize the possible recurrence of liver cancer at an early stage and to initiate appropriate treatment. As a rule, such a follow-up examination should be carried out every six months.