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.
While surgery to remove a liver tumour offers the best chance for a cure, surgery is not an option for more than two-thirds of patients with primary liver cancer which is said to be the fifth most common cancer and the third most common cause of cancer-related death worldwide. Approximately, seventy percent of patients with liver cancer 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 tumours 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.
When liver tumours 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 may perform minimally invasive surgeries like embolisation or thermal ablation, etc, depending on the patient’s case history. These minimally invasive therapies use imaging techniques such as CT, ultrasound, or MRI to guide the delivery of treatments directly to tumour sites.
In a typical Embolisation surgery, the interventional radiologists inject chemotherapy drugs through a thin tube into the major vessel that delivers blood to the liver. The drug is mixed with a substance that not just blocks the artery for cutting off blood flow to the tumour but also restricts most of the chemotherapy drug from reaching out to other parts of the body. Thus, it is trapped near the tumour only.
This type of treatment often keeps the tumour away from getting the oxygen and nutrients it needs to grow, and therefore, healthy tissue is protected. The blockage may be temporary or permanent, depending on the kind of drug that is used to block the blood vessel. The liver still receives blood from a vein that brings blood from the stomach and intestine to keep the healthy tissue alive. Embolisation can be repeated to treat recurrences that may develop later.
If required, radiologists may use this procedure to send radioactive particles to tumours that are too large to be treated with surgery which is called radioembolisation. It’s a therapy used to treat both primary and metastatic live tumours. This is primarily a palliative, which means it relieves patients’ of symptoms and is not a curative treatment. It elicits fewer side effects if compared with standard cancer treatments.
Another alternative way is to send particles into the tumour to release chemotherapy directly inside it for days or weeks. This is usually done with the help of X-rays that guides surgeon/radiologist directly to the tumour.
Another technique involves destroying tumour by heat or cold. This technique is often meant for people with three or fewer tumours. There are several types of thermal ablation, including radiofrequency ablation, which uses radio waves to superheat the tumour, and cryoablation, which freezes the tumour. Other types of thermal ablation use lasers, microwaves, and focused ultrasound waves to kill tumour cells. The selection of heat or cold depends on the size, location, and shape of your tumour.
Another non surgical way to treat liver Tumour is through minimally invasive laparoscopic or robotic surgery. In this procedure, a thin, lighted tube with a camera on its tip is inserted through a tiny incision in the abdomen to remove tumours or, in selected cases, part of the liver.
Medical professionals are evaluating the effectiveness of these minimally invasive approaches and their potential to reduce complications that can often arise with traditional, open surgery. For instance, having minimally invasive surgery can significantly reduce recovery time compared with traditional surgery.
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.
By-Dr. Ravinder Pal Singh Malhotra
(The author of the article is a Liver & Kidney Transplant & Gastro Sciences expert.)