Liver Cancer Treatment - Success Rate, Procedure Type, Results

Liver cancer is a condition defined as the rapid growth of tumour cells inside the liver. This growth can be found anywhere in the liver. The liver is a football-sized organ at the top right side of the stomach and under the diaphragm. Several types of cancer can occur inside the liver, such as hepatoblastoma (uncontrolled growth of liver tissues), intrahepatic cholangiocarcinoma (formation of tumour in the bile duct in the liver), and hepatocellular carcinoma (uncontrolled growth of hepatocytes). The most commonly caused in the liver is hepatocellular carcinoma which is massive growth in hepatocytes. Sometimes liver cancer can start in the liver and spread to other parts of the body. The primary stage is the initial stage, which starts developing within the liver. When it is spread to other body parts, it is termed metastatic liver cancer.

Treatment of liver cancer in its secondary or metastatic stage is very difficult because, by this time, cancer has already spread to the other parts of the body. There are various treatment approaches available for treating liver cancer. The type of approach to be used in your case depends upon the following points:-

1. The size and type of cancer you are having
2. Treatment depends on the location of the tumour within the liver also.
3. Your general health status also affects the selection of the procedure.
4. The following types of treatment can be used to treat liver cancer:-
5. Localised treatment: It involves the administration of drugs directly into the liver. There are several techniques for the localised treatment of liver cancer. These include:
6. Heating cancer cells: Electric current is used for the destruction of cancer cells.
7. Freezing cancer cells: The doctor uses the cryoprobe (a probe filled with liquid nitrogen) to freeze and kill cancer cells.
8. Injecting chemotherapy drugs into the liver: It involves the administration of strong ant-cancer drugs directly in the liver. 
9. Injecting alcohol into tumour: The doctor injects the alcohol directly into liver cells. Alcohol kills cancerous cells. 
10. Placing radiation-filled beads in the liver: The doctor places the radiation-filled beads near the cancerous cells resulting in their destruction. 

Surgery for liver cancer: This is among the best methods to cure liver cancer. The two most widely used methods of treating liver cancer are surgical resection (tumours are removed by surgery) and liver transplant. If there are small tumours in the liver, they can be cured by ablation and other procedures. But if the tumours are large, then surgical resection is preferred. 

1. Partial hepatectomy: It is a type of surgery used to remove a part of the liver. This process can be done only on people having a fully functional liver. It is not done in patients having liver cirrhosis. If it is to be done in a person with liver cirrhosis, then there should be a single tumour in the liver, which should not be spread to the blood vessels.

Ablation is done in patients who have a few small tumours. It can also be used in cases where surgery cannot be done. 

In this treatment, the tumours are destroyed without removing them from the liver. 

Ablation is an ideal procedure for patients who have other health complications like poor health and reduced liver functionality and is also performed in patients waiting for a liver transplant and whose tumours need to be removed immediately. 

Ablation is less effective than surgery but still very useful in some cases. However, 

it may not be recommended in cases where the tumours are near the major blood vessels. 

1. The ablation procedure also damages some healthy tissues around the tumour. The ablation procedure is used for destroying tumours that are less than 3 to 5 centimetres. 
2. The procedure is done under the influence of general anaesthesia. 
3. The following types of ablation procedures are used to remove liver cancer:
4. Radiofrequency ablation (a high-energy radio wave is used for destroying the tumours),
5. Microwave ablation (microwave heat is used to destroy the tumours), 
6. Ethanol ablation (tumours are destroyed by injecting a concentrated solution of ethanol).

In radiation therapy, the rays of high energy are used to kill the tumours of the liver. This treatment approach is not used in patients suffering from a liver disease in which their liver is damaged, like in cirrhosis. Radiation therapy is used in the treatment of different cases of cancers like:-

Liver cancer in which surgery cannot be done

People who are having pain due to large tumours.

In the case where tumours have spread to other body parts

How is Radiation Therapy done?

Getting radiation therapy is very much like getting an X-ray done. Radiation is exerted from a radiation source outside the body. 

This process is completely painless. The time taken in performing this procedure is only a few minutes. 

The liver is exposed to a smaller amount of radiation at a time. The radiation therapy is done about five days per week. 

This treatment is given for several weeks to eliminate the tumours. Cancers cells in the liver are very sensitive to radiation. 

Thus, much care is taken to avoid damage to the nearby healthy tissues. 

Targeted Drug Therapy: 

Due to advancements and developments in technology, researchers have known more about the cells and the reason behind causing cancer. 

They have been able to develop more specific drugs that could target these cells. These newly developed target drugs enter the bloodstream after getting absorbed from the stomach. 

After this, it reaches all the areas of the body. This character of the drugs has made them more useful in cancers spread to the other parts of the body. 

Two types of drugs mostly used in treating liver cancer are Kinase inhibitors and Monoclonal antibodies. 

Drugs like Nexavar and Lenvatinib are the first-choice drug in treating cancer that is not treated by surgery and has already spread to other parts of the body. 

Other targeted drugs like regorafenib and cabozantinib are used to treat the advanced case of liver cancer, especially when other drugs have failed to treat liver cancer. 

Monoclonal antibodies are also used for treating liver cancer. These are man-made antibodies. They stop angiogenesis (tumours forming new blood vessels in the liver). 

In this approach, the person's immune system is stimulated to form the proteins that could kill the tumour present in the liver. 

Drugs like Atezolizumab and Pembrolizumab are used to boost the person's immune response. 

These drugs can be used along with targeted drug therapy as the first choice of drug. Atezolizumab blocks the protein named PD-L1. As a result, it shrinks the tumours in the liver and also helps in slowing down the cancer cells from growing further. 

These drugs are given to the patient in the form of IV infusion. 

Chemotherapy: 

In this therapy, the cancer cells are destroyed using drugs. Chemotherapy is the last option left. 

It is done only after treating the patient with all possible treatment methods.

If the cancer is cured by surgery or targeted drug therapy and there are no benefits after doing radiation therapy and immunotherapy, then, in that case, we can go for chemotherapy. 

Some of the most common chemotherapy that is used to treat liver cancer are:-

Cisplatin

1. Gemcitabine
2. Oxaliplatin
3. 5-flurouracil
4. Capecitabine
5. Mitoxantrone
6. Doxorubicin

Unfortunately, most of the drugs used in chemotherapy do not have any significant effect on cancer cells. Still, in recent studies, it has been revealed that combining these drugs may be more helpful in treating cancer through chemotherapy. Even if a combination of drugs is used, only a small number of cancer cells are shrunk. This effect is not permanent. Sometimes, 2 or 3 drugs are used in patients who can tolerate the higher dose of chemotherapy.