All Disciplines Come Together in Liver Cancer Treatment

In the diagnosis and treatment of hepatocellular cancer, which is the most common liver cancer, multidisciplinary perspectives and tumor councils are as important as current treatment options.

Each organ of our body is undoubtedly very valuable with its different features and functions. Just like our liver, which stands out for its ability to repair and renew itself. So much so that even if we remove 75% of the liver from the body, it is possible to continue living with the remaining 25%. Our liver also grows the 75% it lost within 4-6 weeks and returns to its previous state. Of course, even the liver, which has such a high capacity to repair and renew itself, can only resist all-out and long-term attacks against itself to a certain extent. Due to the damage caused by hepatitis viruses and advanced fatty liver, the liver gradually hardens and shrinks and loses its power to regenerate itself. This picture is called cirrhosis development and there is no chance of reversal. In this developing background of cirrhosis, the risk of developing hepatocellular cancer (HCC) is also higher. HCC is the most common of the three subtypes of cancer that originate from the liver itself. Therefore, the majority of hepatocellular cancers (more than 90%) develop in livers that are damaged and have reduced capacity, suffering from cirrhosis. What this means is; Preventing liver cirrhosis also means reducing the risk of developing hepatocellular cancer. Not without reminding. Hepatitis B – C viruses, fatty liver disease (NAFLD), rarely some genetic diseases (such as hemochromatosis and alpha-1 antitrypsin deficiency) and exposure to some chemicals (aflatoxin) are important factors in the development of cirrhosis and subsequent HCC. This important issue was discussed by Anadolu Health Center Hospital General Surgery Specialist and General Surgery Department Coordinator Prof. Dr. We have discussed all aspects within the information provided by Sedat Karademir…

Is early diagnosis possible?

We can list the symptoms of hepatocellular cancer as weakness, fatigue, abdominal pain, loss of appetite, weight loss, swelling in the abdomen (fluid accumulation), yellowing of the eyes and skin, darkening of the urine color, lightening of the stool color and fever. However, these symptoms are also present in many different diseases. Additionally, the presence of these symptoms in a patient with hepatocellular cancer (HCC) usually indicates that the disease has reached an advanced stage. However, it is important to detect HCC at an early and treatable stage. Especially in people at high risk (with chronic viral hepatitis, advanced fatty liver or cirrhosis), early detection and surgical treatment of a new developing HCC focus is possible, thanks to liver ultrasound and AFP testing performed at regular intervals. During the diagnosis process, which begins with blood and radiological tests, liver function tests, hepatitis markers and some genetic tests are also requested when necessary. If a suspicious structure is seen, CT or MRI is used. PET, on the other hand, provides information about whether the mass in the liver is malignant or not, and since it scans the whole body, it also shows whether HCC has spread to other places.

What are the treatment options?

Making a treatment plan for HCC is like a war game. For HCCs up to 2 cm in diameter, ethanol injection into the mass with a needle was a very popular ablation method in the past, but today the situation has changed with advanced technological devices. Radiofrequency ablation (RFA) and microwave ablation (MWA) with high temperature provide success close to surgery even for a 3 cm diameter HCC. Another method is embolization (occlusion of the artery), which has two types. In these interventional procedures, a needle is inserted into the leg artery and a thin tube is advanced over a special wire into the main liver vein. If an artery branch feeding the HCC mass can be found in the images taken, either chemotherapy drug is given into the HCC from here and then the vessel is closed with a plug (chemoembolization), or microspheres that emit radiation are injected into the HCC in the same way (radio-embolization). Surgery is still the gold standard in the treatment of HCC, but there are two conditions for this: The tumor will not have spread outside the liver and the liver left behind after surgery will be sufficient for the patient in terms of quality and quantity. Therefore, in the treatment of HCC, most of which are caused by cirrhosis, surgery should be decided after a detailed evaluation of the liver’s capacity. Liver transplantation may be offered as an option for patients with liver failure despite limited HCC in the liver. Palliative and supportive treatments are available for patients with advanced stage cirrhosis and widespread HCC in the liver and body.

While chemotherapy treatments are not very effective in HCC, promising studies on targeted drugs and immunotherapy continue. All these treatment options can be used alone or together. However, treatment planning in HCC is too complex a process for a single person or department to undertake. Each patient requires a treatment plan appropriate for that person. That’s why multidisciplinary councils and the decisions taken are important. It should not be forgotten that; No matter which treatment method is chosen, there is a risk of recurrence of the disease in HCC patients. As long as a cirrhotic liver remains, it is common for a new HCC to develop elsewhere in the liver.