Hepatobiliary/Liver Cancer

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Treatment

There are three treatment options for HCC. The first is conventional resection, either lobar or wedge resection. The second is liver transplantation and the third is either pre-operative chemotherapy (neoadjuvant) followed by resection or post-operative chemotherapy (adjuvant). The type of therapy used is determined by several factors, including the stage of the patient and his/her overall medical condition. Radiation therapy does not play a large role in the treatment of HCC because it can cause damage to the liver.

Chemotherapy is typically administered intravenously (systemic) or via the hepatic artery or portal vein infusion (regional). In general, systemic chemotherapy produces extremely poor results and is therefore usually reserved for clinical trials.

Regional therapy, on the other hand, has shown some encouraging results. Additionally, a local therapy, percutaneous ethanol injection (PEI), has proven useful for tumors less than 2 cm. in size. This involves injecting 100% alcohol directly into the tumor. The alcohol is highly toxic to the tumors, causing them to dry out and disintegrate. This treatment usually is administered to patients who refuse surgery, or who have severe liver disease that prevents them from having liver surgery.

Additional local therapies that may be of some usefulness include microwave coagulation therapy, interstitial laser therapy, laproscopic guided cryosurgery and focused sonography.

The following table shows a summary of potential treatments for HCC by stage of disease. Remember that treatment of HCC is still evolving, and that treatment on a clinical protocol study may be the best choice available.

Stage I	Options include conventional resection or local therapy with percutaneous ethanol injection (PEI). Patients with severe cirrhosis may require liver transplantation. The long-term results of these treatments are approximately the same.
Stage II	In general, therapy is similar to that rendered to stage I patients. However, PEI is less satisfactory in tumors larger than 5 cm. in greatest dimension when compared to tumors less than 3 cm. in largest dimension.
Stage III	These patients have either vascular invasion (with either single or multiple tumors) or evidence of regional lymph node involvement, or both. In this group the results of liver transplantation seem to be superior to conventional resection. The use of either neoadjuvant or postoperative regional chemotherapy should be considered for such patients.
Stage IV A	These patients have either multilobar tumors or invasion of the portal vein or hepatic vein. In this group, liver transplantation alone consistently has a poor outcome. The preferred therapy is aggressive neoadjuvant regional chemotherapy followed by liver transplant.
Stage IV B	This group of patients has extra hepatic (i.e., metastatic) disease. Unfortunately, there is no satisfactory therapy for this group of patients. Participation in a clinical study should be offered to all those eligible for participation.

Prognosis

Overall, prognosis depends on the size of the tumor and the extent of liver function impairment. Treatment of primary cancer of the liver may be directed towards a cure, or focused at relieving symptoms and prolonging the patient's life (palliation). For tumors that are small and limited to one lobe of the liver, surgical removal (resection) offers a chance at cure. If the tumor is larger or involves more than one lobe of the liver and cannot be removed, liver transplantation may be the preferred option. In either case, the cure rate averages only 20% to 30%. Some recent studies show a 50% to 60% survival result with a combined treatment approach using both liver transplantation and various types of chemotherapy.

Hepatobiliary/Liver Cancer, Treatment, Prognosis reprinted with permission from oncologychannel.com
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