Cancer seems to have a way of deeply invading the lives of those stricken by the disease. And very often the treatment isn’t much friendlier to patients. But some recent advances in cancer treatment are helping, including some minimally invasive and non surgical procedures, especially in case of Liver tumours. When liver tumors are small in size and number and have not spread to nearby blood vessels – and no cirrhosis or other liver conditions are present – patients may also be eligible for a liver transplant. But again, not many patients are in condition to go through a liver transplant surgery. In such circumstances, interventional radiologists have advanced options for performing minimally invasive surgeries like Microwave Ablation, Radio Frequency Ablation, Trans Arterial Chemo Embolization (TACE) and Radio Embolization. These minimally invasive therapies use imaging techniques such as CT, ultrasound, or MRI to guide the delivery of treatments directly to tumor sites.
How is liver tumor treated?
While surgery to remove a liver tumor offers the best chance for a cure, surgery is not an option for more than two-thirds of patients with primary liver tumor which is said to be the fifth most common ailment and the third most common cause of mortality worldwide. Approximately, seventy percent of patients with liver tumor cannot opt for surgery for many reasons, like, the tumours could be too large to be removed or they could be too close to major blood vessels or other organs. And many a times, patients may have many small tumors in the liver, thus making surgery too risky or impractical. Also liver surgery is a complex procedure because many of the major blood vessels leading to and from the heart pass behind or through the organ. In addition, the liver can tear easily and will bleed profusely if injured.
Minimally invasive procedures
These can significantly reduce recovery time compared with traditional surgery.
1. Radioembolization (Y-90) is a minimally invasive procedure to treat liver tumors, with a combination of embolization and radiation therapy. This therapy is highly beneficial in extending better quality of life for patients with inoperable tumors. Radioactive isotope of Yttrium (Y-90) is placed in the blood vessels of the tumor that blocks the blood supply to the cancer cells and delivering high doses of ionizing radiation to the tumor while keeping the healthy cells intact. Unlike External beam therapy where high energy beam from the equipment is directed towards the tumor site, this therapy involves placing a radioactive material that lodges in the tumor delivering high doses of radiation from within. This technique is used to treat both localized and metastasized tumors (spread to liver from other body parts). Being a palliative treatment it does not completely reverse the condition but helps in restricting further growth and spreading of tumor cells.
2. Trans Arterial chemo Embolization (TACE) is a combination treatment of delivering of chemotherapy along with a procedure known as embolization. It is the most often used procedure for treating liver cancers. The procedure involves injection of anti-cancer drugs along with synthetic agents called embolic agents into the blood stream directed towards the tumor site, to cut-off the blood supply, trapping the anti cancer drugs at the site thereby depriving the required oxygen and nutrients for its growth. This therapy is highly beneficial in preventing the mortality by preventing further growth/ shrinking the tumor, that potentially preserves the liver functions and improves the quality of life.
3. Microwave ablation(MWA) – It is one of the latest and advanced minimally invasive treatment techniques for cancer that uses image guidance to guide a needle-like probe to the tumor site. Unlike in case of Radiofrequency Ablation where high frequency electric current is passed through an electrode in the needle to generate small region of heat, MWA generates microwave to create heat in the region. This method is highly beneficial and effective for patients unsuitable for surgical resection and if the tumor is less than 4 cm in diameter. This procedure is usually performed on an outpatient basis reducing the hospital stay and is highly safe with minimal risk and higher success rate. Patients make better and quicker recovery. It is also used to treat multiple tumors simultaneously and the chances of recurrence of the tumor are also minimized. The method is not only best suited for treating liver tumors, but also for thyroid nodule, breast nodule, tumors in the kidney and varicose vein. Also these treatments benefit patients not just by extending their lives but also improves their quality of life, which is of utmost importance in cancer patients.
(The author is Head Interventional Radiologist, Fortis Hospital, Vasant Kunj New Delhi)