Liver Cancer

In general, liver cancer can be classified as either primary or metastatic. When normal liver cells begin to grow abnormally and out of control, these cells become cancerous, leading to primary liver cancer. Primary liver cancer can onset as either a single tumour or as multiple tumours, with the latter kind scattered all over the liver and most often in people with cirrhosis. By contrast, metastatic cancers spread from somewhere else in the body. This is also known as secondary liver cancer. The most common primary sites of cancer cells that spread to the liver are from the large intestines, pancreas, stomach, lungs and breasts.

Liver cancer is most often seen in people aged between 50 to 70. Men are at four times higher risk of liver cancer than women^[4]. Liver cancer symptoms are not apparent in the early stages and only become so once the disease has progressed to an advanced stage.

The treatment approaches for liver cancer tend to have to take into account more factors than other cancer types^[6], mainly because the liver is one of the most important organs in the body with an extremely complex structure and over 500 different functions, including absorbing substances that are beneficial to our health and releasing toxic substances.

Before deciding on which treatment option is best for the patients, the doctor needs to consider whether the patient has enough remaining liver function to cope with a large scale resection of their liver and avoid liver failure following the procedure. Cancer staging, which is the size, number, location and the extent of the spread of the tumour, is also an important indicator for the devising of an appropriate treatment plan.

As with most cancers, the stages of liver cancer are determined according to how big the tumour has grown and whether or not cancer cells have invaded the blood vessels and spread beyond the liver to other organs. Based on TNM staging system, liver cancer can be divided into Stage I to Stage IV, although there are still some cases that cannot be classified. Stage I and Stage II usually imply the tumour remains small and cancer cells have yet to invade the blood vessels and metastasised to other parts of the body. For Stage III and Stage IV liver cancer, the tumour has already invaded the blood vessels and metastasised to the surrounding organs.

Researchers from the University of Hong Kong (HKU) have developed Asia’s first liver cancer staging system with treatment guidelines, namely the Hong Kong Liver Cancer (HKLC) staging system aimed at the unique risk factors in Asian populations. Based on the patient’s general health conditions, liver function and the progression of the disease, it classifies patients into five stages, rather than the current four in the TNM staging system widely adopted in Western countries^[7]. The objective of the new staging system specific to Asia’s populations is to encourage doctors and patients to adopt more proactive treatments to improve survival rates, whereby patients with liver cancer at mid to advanced stages may elect to undergo surgical resection.

Surgical resection is the most ideal treatment option for liver cancer. However, because of concerns over potential impacts on liver function, only one-fifth of patients with liver cancer are considered clinically suitable for surgery and tumour removal^[8]. Doctors devise different treatment plans for patients based on the types of cancer cells and the stage of the cancer, alongside their age and general state of health, as well as the degree of side effects they may be capable of bearing with particular treatment plans. The following are the more common treatment plans for liver cancer^[9]:

Is suited to patients whose liver function remain largely unaffected and who are diagnosed with an early-stage liver cancer in one of their two lobes, where the cancer cells have yet to metastasise to other organs.

Resection involves resecting the immediately affected cancerous portion and is the most ideal solution. After which, the liver can recover on its own to its original state without liver function being affected. Risks involved include infection, post-operative liver failure, thrombosis, pneumonia and haemorrhage.

Is suited to patients with early-stage primary and metastatic liver cancers; it is also suited for use in those patients where their liver cancer is inoperable from poor liver functionality.

Ablation therapy destroys liver cancer cells via a number of different ways such as radiofrequency energy, thermal ablation, cryoablation and alcohol septal ablation. The side effects include abdominal pain, haemorrhage and liver infections. Furthermore, in recent years the new generation of equipment sees fewer side effects with HIFU^[10], This treatment method uses high-frequency ultrasound energy, directing waves at the tumour and destroying the cancer cells by heating them up to temperatures as high as 60-degree Celsius.

TACE treatment is suited to patients whose liver has tumours in both lobes that have yet to metastasise to other organs, or where one lobe has an unresectable tumour from poor liver function, or who cannot undergo ablation therapy from the tumour being larger than 5cm.

This method aims to destroy the cancer cells by “starving” the tumour’s feeder vessel supply of nutrients, and is achieved through the injection of blocking materials into the arteries such as special oils and drugs. TACE treatment tends to be combined with chemotherapeutic drugs and radiation therapy to kill the cancer cells. Common side effects include infections, nausea, vomiting, gastrointestinal discomfort (such as constipation and diarrhoea) and alopecia.

Y-90 therapy is suited to patients whose tumours are unsuited to surgical resection or focal therapy, and for those patients with mid-to-late-stage liver cancers with limited treatment options.

Y-90 therapy is one of the major breakthroughs in radiation therapy of liver cancer. It is a minimally invasive procedure that delivers a high dose of radiation to the tumour while sparing normal tissue, by placing a tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 inside the blood vessels that feed a tumour. It has significantly fewer side effects and is more effective than most other traditional radiation therapy.

A number of clinical research studies have demonstrated that the Y-90 therapy is able to bring the tumour under control in ten to sixteen months, significantly longer than the six months of TACE treatment. Other advantages of using the Y-90 therapy include being able to be discharged from hospital immediately following the procedure. Please enquire at radiation therapy services in this clinic for more information.