The liver is one of the largest organs in your body and lies in the upper right-hand side of your abdomen underneath your ribs. It has several very important functions including the manufacturing of proteins, the removal of toxins from your blood, aiding in metabolism of fats, proteins and carbohydrates and the secretion of bile, which helps digest foods.
There are 2 main categories of cancer that is found in the liver. The most common form of liver cancer is actually cancer that has spread to the liver from another organ. When this happens, the liver cancer is called secondary. The most common type of secondary liver cancer is colon cancer that spreads to the liver. There are other types of secondary liver cancers as well. These can include breast cancer, kidney (aka. renal cell) cancer, melanoma and other types of cancer that spread to the liver.
The second category of cancer found in the liver is cancer that starts in the liver. This is called a primary liver cancer and the most common primary liver cancer is hepatocellular carcinoma or HCC.
Treatment of liver cancer depends on the type of cancer (primary or secondary) as well as the size, number and location of the tumor. Often, a combination of methods are used to treat liver cancer. This can include chemotherapy, surgery and/or procedures performed by interventional radiology to provide therapy to the liver directly through blood vessels that enter or exit the liver. At TriHealth, a multidisciplinary team of specialists with the consideration of each individual patient determines the specific method or methods of treatment used.
Surgery for liver cancer depends on the size, number and location of the liver cancer. The two main options for liver surgery include surgical resection of the tumor or tumor ablation.
Liver resection involves removing the portion of the liver that contains the tumor or tumors. Occasionally this can be done in a minimally invasive fashion. The portion of liver that needs to be removed is determined based on the location of the tumor or tumors. The liver is a unique organ because it can regenerate (grow back) after surgery—even if up to 75% is removed.
Liver tumor ablation essentially destroys the liver tumor without removing it from the body. There are several different technologies that can be used to destroy the tumor but what we use most commonly is call microwave ablation. This technique uses thermal energy to burn the tumor, thereby killing all the tumor cells.
How is a liver tumor ablation performed?
Most liver ablations can be performed in a minimally invasive fashion through laparoscopic or robotic surgical techniques. This involves making a few small incisions in various locations around the abdomen. We then use a small video camera to visualize the surface of the liver. Likewise, an ultrasound probe is inserted into the belly and used to visualize the inside of the liver. The tumors are located within the liver. We then place a special needle or probe through the liver and directly into the tumor seen on the ultrasound machine. The ultrasound image is used to confirm correct placement of the ablation probe. Once in place, a generator is used to heat up the tip of the probe. This heat will burn the tissue surrounding the probe and destroy the tumor.
Often times tumors in the liver preferentially receive blood supply from the hepatic artery. At Trihealth, a team of doctors known as interventional radiologists can often treat tumors that are too large for surgery, by accessing the artery and treating the tumor directly with drugs. The anticancer drugs are attached to small beads that block the blood supply of the tumor. This procedure, known as chemoembolization can treat tumors in the liver without having to give chemotherapy to the entire body. We also have expertise at Trihealth to combine embolization and radiation therapy to treat liver cancer. Small beads filled with radioactive isotope yttrium Y-90 are used to directly treat the tumor. Sometimes a large tumor can be treated with chemo or radioembolization to make surgery possible.
Sometimes tumors of the liver are best treated with non-surgical local therapy. One option for this is a technique called embolization. We know that tumors in the liver preferentially receive blood supply from branches of the main artery in the liver. This artery can be accessed through the groin much like the technique used to perform a heart catheterization. Instead of accessing the blood vessels in the heart, the physician, called an interventional radiologists, can access the arteries in the liver. The tumor can then be “embolized”, which means cutting off the blood supply to the tumor. Very small beads are injected into the artery to perform the embolization. Often times chemotherapy or radiation can be attached to the beads. This procedure allows us to give high concentration chemotherapy or radiation to the tumor without having to give it to the entire body. Sometimes embolization will be used to shrink large tumors to make surgery possible later.