Medical treatments

Treatments with a “curative” aim are:

– Surgery, with tumor removal or in some cases, liver transplantation and liver resection,

– Methods of destroying the tumor through the skin (avoiding opening the abdomen since we go through the skin); initially with chemicals (pure alcohol or acetic acid),these methods have been supplanted by methods of destroying the tumor by more efficient physical means :

        — Thermal methods to destroy the tumor :

              – cryotherapy (by cold)

              – radiofrequency (hot thermal diffusion),

              – microwave (very high temperature at 100 °)

        – Non-thermal methods to destroy the tumor:

              — electroporation, a very recent technique whose studies are still in progress.

              – selective arterial chemoembolization which has supplanted the use of radioactive beads.

The choice between surgery and percutaneous ablation, the most common curative treatments depend on several criteria (condition of the underlying liver, number and size of lesions) and are discussed during multidisciplinary meetings, which bring together at least 3 specialties. different (surgeon, oncologist, gastroenterologist) in reference centers.

surgery

Where possible, surgery is the 1^er treatment choice and consists of a ” partial hepatectomy »Ie removal of part of the liver. Various conditions must be met: the tumor must be small (<3cm) and single. It should be easily accessible and care should be taken to ensure that the volume of healthy liver remaining is sufficient to ensure normal liver function.

The tissues of the liver have the ability to regenerate, at least partially. Thus, in the weeks following the partial hepatectomy, the size of the liver will increase. However, the liver will never return to its original size.

 Surgical treatment may consist of “Total hepatectomy” followed by graft, ideal treatment if it is possible. The diseased liver is completely removed, and replaced with an entire liver, or liver lobe, from a compatible donor. Patients are selected in expert centers. Note that it is rare that it is possible to perform a liver transplant to treat primary liver cancer. The wait is indeed very long, (6 months minimum), and the conditions required for the feasibility of the transplant are often exceeded: very sick underlying liver (advanced cirrhosis), tumor larger than 3 cm, more than 3 lesions .

Radiofrequency ablation (RFA)

When removal of the tumor by surgery is not possible, or the waiting time for a graft too long, its radiofrequency ablation is the local therapeutic approach of 1^ages intention. This technique involves inserting small electrodes into the liver to cause a discharge of high-frequency waves that induce movements ionic, resulting, by a thermal phenomenon, a necrosis by coagulation of abnormal cells (cell death). Depending on the case, it is performed under local or general anesthesia.

Targeted therapy

Increasingly, therapies aimed at fight factors that contribute to tumor growth. For example, agents antiangiogéniques block the formation of new blood vessels (angiogenesis) that allow the tumor to grow. This type of therapy shows great promise. It arouses a lot of interest and hope in the medical community.

Other methods

Thermal method:

cryosurgery

Cryosurgery is no longer used nowadays, due to the appearance of techniques for destroying liver tumors by heat (mainly radiofrequency). This technique consisted in inserting into the liver a probe containing liquid nitrogen at –200 ° C in order to burn by the froid cancer cells.

Microwave

This technique causes movements of the molecules ofwater in the cells, making it possible to reach a very high temperature, 100 °, in a few seconds. It is still little used, and being evaluated in relation to radiofrequency.

Chemical method: ipercutaneous injection

This other approach remains possible, but is used less and less. It consists of destroying one or more small tumors by injectingethanol or acetic acid. This has the effect of dehydrating them and causing their necrosis (cell death). This procedure can be performed under local anesthesia and can be repeated if the tumor does not disappear entirely.

New Technique: irreversible electroporation:

Under evaluation, this technique plays on the permeability of the cell, and could be indicated in the contraindications of the radio frequency.

Chemotherapy

Chemotherapy is a solution when surgery or techniques for local destruction of the tumor are not possible, or in the event of recurrence.

In case the primary liver cancer is extensive (measuring more than 3 cm, with several lesions, but on the same side of the liver (we have a right liver and a left liver), it is sometimes possible to inject into the artery which supplies the tumor, beads containing chemotherapy directly into the tumor, which helps reduce side effects.

Radiotherapy

Radiation therapy is very rarely used to treat primary liver cancer. This type of cancer is not very sensitive to radiotherapy. For a while, we tried injecting radioactive beads by selective injection into the tumor through the arterial route.

Complementary approaches

Reviews. Consult our Cancer file to learn about all the complementary approaches that have been studied in people with cancer, such as acupuncture, visualization, massage therapy and yoga. These approaches may be suitable when used in complement medical treatment, and not as a substitute for it.