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Saturday, June 7, 2008

Treatment for Liver Tumors

Many patients – and even some physicians – believe that liver tumors are always fatal and that no treatment is possible. This is not true. Recent progress in surgical methods has significantly decreased the complications and mortality of liver operations.

Many patients are surprised to find out they have a liver tumor because they usually do not have pain or other symptoms and feel quite well. When significant symptoms exist, the tumors are often far advanced and treatment options are severely limited. But more recent treatments that have been developed can provide better outcomes than we were previously able to attain. These include destroying tumors by freezing or heating; or directing chemotherapy to the specific area which is affected.

Primary Liver Tumors
Many liver tumors are cancers that arise within the liver itself, rather than coming from another organ. These are termed "primary" tumors and can be hepatocellular cancers (sometimes referred to as hepatomas) or cholangiocarcinomas.

Hepatocellular cancers most often occur in livers that are damaged by hepatitis B or C or by alcohol and the development of cirrhosis. This fact influences the treatment options and the outcome because:

1) surgery on cirrhotic livers is more risky and removing too much may cause liver failure and death, and

2) new and multiple tumors may occur anywhere in the liver even if others have been adequately treated.

Surgical treatments include surgical resection and cryoablation (or freezing) of the tumors. Many treatments are done by interventional radiologists in the x-ray department, including alcohol injection, radiofrequency ablation chemo-embolization.

Chemoembolization is performed by placing a catheter into the specific artery that supplies blood to the tumor. A chemotherapy drug is then infused and the section is plugged to stop further blood flow to the area. This is generally done on an outpatient basis and requires only sedation, not general anesthesia.

Only rarely it is possible to perform a liver transplantation. The decision process is very complex and requires individual evaluation.

Metastatic Liver Tumors
Liver tumors that originate in another part of the body and then migrate to the liver are called "metastatic tumors." The most common tumor type in the liver actually starts in the colon or rectum. About 25% of patients with these metastases have a tumor that has only spread to the liver and therefore local treatment with surgery is likely to be beneficial.

Tumor treatments are classified as systemic or local.

Systemic treatment reaches all tumors in the body. The majority of patients with colon cancer that metastasizes to the liver will get one or two specific chemotherapy drugs during their treatment course. While these chemicals are useful, they rarely kill all of the tumor in the liver and chemotherapy alone rarely allows patients to survive 5 years; the average (median) survival length is 12 to 14 months.

Local treatment of liver tumors is appropriate when there is no identifiable tumor outside the liver. Local treatments include surgical resection, cryoablation or radiofrequency ablation. Ideally, surgical resection is combined with one of the ablation techniques to achieve complete removal or killing of all the tumor in the liver.

Cryoablation kills a tumor by freezing it. This is done by placing a metal tube into the tumor while watching the process with intra-operative ultrasound. The tube is then cooled to -190°C (-360°F) and an iceball engulfs the tumor. The killed tumor is later re-absorbed by the body.

Radiofrequency ablation is a similar process that uses radio waves to heat the tumor to kill it.

Hepatic artery infusion is a technique that infuses chemotherapy drugs through a catheter into the artery that goes to the liver. The catheter may be inserted at the time of the liver surgery or in another subsequent operation. This technique produces better tumor response to treatment with less toxicity than systemic chemotherapy.

The appropriateness of using these local approaches is determined by the number of tumors in the liver, their size and their location. Whether this approach should be used for any particular patient is a decision only an experienced liver surgeon should make.

The actual surgical approach used is determined by findings in the operating room when the surgeon feels the liver and uses the intra-operative ultrasound machine. Often the number of tumors found is greater than the number predicted by CT or MRI scanning.

If all tumors can be removed or ablated during the surgery, approximately 25% to 30% of patients can live for 5 years or more. If tumors recur in the liver after the surgery, a repeat operation or ablation can often be performed.

Large amounts of liver can be removed during surgery, since the liver does regenerate back to near normal size. Even removal of large amounts of tumor is relatively safe and in the hands of experienced surgeons the mortality is generally less than 2%.

Other Tumors in the Liver
In addition to the tumors that metastasize from the colon and rectum, there are a large number of other cancers that can spread to the liver. Some of these can be treated by surgical therapies in the liver and others must rely on systemic chemotherapy. Some tumors can be treated with surgery if they are few in number and grow slowly. Tumors that are not usually candidates for local treatments are those from the lung, stomach, pancreas and skin.

Benign Tumors
Not all tumors of the liver are malignant cancers. There are three common benign tumors of the liver:

Hemangiomas arise from blood vessel tissue. They are the most common benign tumor of the liver. Most often these tumors are not treated and are only observed. Under some circumstances they might be removed, for instance if the tumors continue to grow while the patient’s progress is being monitored with ultrasound or CT scan, or if the patient experience pain.

Focal nodular hyperplasias are also often not treated. However they should be removed if growth continues, if they are very large or are causing pain – suggesting they may rupture or bleed.

Adenomas are usually removed when found due to their (infrequent) change to a malignant tumor and also because they are more likely to rupture and bleed.

In addition to the newer treatments described above – such as cryoablation, radiofrequency ablation, chemoembolization and hepatic artery infusion – progress in tumor imaging has allowed us to detect tumors while they are in the earlier stages of development. These tools, including CT scans, MRI, and intra-operative ultrasound, let us detect of even small tumors, not previously seen, allowing us to help plan the treatments that will achieve the best results for each patient.

Via: http://healthlink.mcw.edu

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