Cancer in the liver

Liver cancer is a serious condition that can affect people of all ages. It can originate in the liver itself (primary liver cancer) or spread to the liver from another part of the body (metastatic liver cancer).

Types of Liver Cancer

  • Hepatocellular carcinoma (HCC): The most common type of primary liver cancer.
  • Cholangiocarcinoma: Cancer of the bile ducts within or outside the liver.
  • Metastatic liver cancer: Cancer that has spread to the liver from another part of the body, such as the colon, breast, or lung.

Certain risk factors are associated with development of cancer that originates in the liver including chronic hepatitis B or C, excessive alcohol consumption, obesity, diabetes, and exposure to certain chemicals or toxins.

Symptoms of liver cancer can include abdominal pain or discomfort, weight loss, loss of appetite, nausea and vomiting, fatigue, jaundice (yellowing of the skin and eyes), and swelling of the abdomen.

How is cancer in the liver diagnosed?

Diagnosing cancer in the liver usually involves a combination of the following:

  • Blood tests to check for liver enzymes and markers of liver cancer.
  • Imaging tests such as CT scans, MRIs, and ultrasounds, to visualize the liver and detect any abnormalities.
  • A biopsy to remove a sample of tissue from the liver for examination under a microscope.

How can cancer in the liver be treated?

Treatment options for liver cancer depend on the type of cancer, its stage, and the overall health of the patient. Possible treatments include:

Medication

Oncologists use medications administered through intravenous (IV) infusion, orally, or directly into the liver to kill cancer cells. The best medication for you depends on the type and stage of your liver cancer, as well as your overall health. Targeted chemotherapy drugs specifically attack cancer cells without harming healthy cells. Immunotherapy is similar to chemotherapy but instead works by helping the body’s immune system fight cancer cells. While side effects with medical therapy are common, they can often be managed.

Surgery

Surgery is often a viable option for treating liver cancer, especially in the early stages. Resection involves removing the cancerous part of the liver, along with a margin of healthy tissue.  Recovery time varies depending on the extent of the surgery, but can typically take several weeks.  Liver transplantation removes the cancer and also replaces the damaged liver with a healthy liver from a donor. Recovery from a liver transplant can take several months, and lifelong immunosuppressant medications are required to prevent rejection of the new liver.

Interventional Oncology

Unlike traditional surgery, which involves large incisions, interventional oncology procedures are performed using small incisions or punctures and imaging guidance to treat tumors. There are two main categories of this type of therapy for cancer in the liver. Radioembolization is a targeted delivery of radioactive beads directly through the blood vessels that supply the tumor. This kills the tumor while sparing as much of the surrounding liver as possible. Ablation involves inserting a thin needle through the skin and into the tumor.  Once in place, energy is delivered (like heat or cold) to kill the tumor without harming the surrounding healthy tissue.

What is Y90 Radioembolization?

Yttrium-90 (Y90) radioembolization is a minimally invasive treatment for liver tumors, including primary and metastatic liver cancer. Y90 therapy involves injecting radioactive microspheres loaded with Yttrium-90 into the blood vessels that feed the liver tumor. The radiation destroys cancer cells while sparing nearby healthy tissue, with fewer side effects compared to traditional radiation therapy. Y90 can also be used in combination with other treatments for enhanced effectiveness.

The decision to treat liver tumors with Y90 typically begins with a multidisciplinary discussion between specialists from medical oncology, surgery, hepatology and interventional radiology.  Y90 can be useful for patients in many different scenarios, including:

  • When the liver is healthy enough to tolerate a high dose of radiation to the tumor, which can be curative in some cases
  • When the patient is not a surgical candidate
  • When shrinking  of the tumor can help the patient become a surgical candidate
  • When there are many tumors in the liver and the goal is to delay progression of the cancer, often in combination with medical therapy

How Y90 Radioembolization works

1
Consultation

Prior to the procedure, together we will determine if you are a candidate for Y90. This involves a review of your lab work and imaging. You will have the opportunity to ask questions about the procedure before deciding to move forward.

2
Mapping

Before Y90 can be used, we need to obtain detailed images of the the arteries in your liver and identify the specific branches that supply the tumor. We do this by having you come in for an angiogram (using a catheter to inject contrast dye in the arteries). This can take 1-3 hours depending on the complexity of the case, and is typically done as an outpatient procedure. We will give you sedation to make you comfortable. At the completion of the mapping, we will have all the information needed to order the Y90 dose which is customized based on your anatomy and treatment goal.

3
Y90 Treatment

Once the custom Y90 dose has been prepared (typically 1-2 weeks) you will return for the treatment session. The steps of the treatment are similar to the mapping procedure. A catheter is navigated to the artery branch or branches that supply the tumor, and the radiation microspheres are then injected. You will be observed in recovery for a few hours and will be able to go home the same day.

4
Follow Up

Two weeks after your procedure you will need bloodwork to check your liver function. Approximately three months after the procedure we will have you get repeat imaging to evaluate treatment response.

Frequently Asked Questions about Y90 radioembolization

The most common symptoms following Y90 are fatigue and mild abdominal pain. This typically starts within a few days after treatment, peaks within two weeks, and resolved within a month. You may have some soreness and  bruising in the groin at the site where the catheter was placed.

With careful planning, Y90 treatment is a safe procedure. There is always a small risk of infection and bleeding. There can also be bruising in the groin area where the catheter was inserted. Rarely, Y90 can cause a significant injury to the liver or adjacent organs that may require additional treatment. 

What is liver tumor ablation?

An image guided ablation for cancer in the liver involves placement of a needle through the skin and guiding it into the tumor using ultrasound or CT guidance. Microwave ablation uses heat at the tip of the needle to burn and destroy the tumor, while Cryoablation lethally freezes the tumor. The choice of which ablation technique to use depends on the location of the tumor and other factors, but both can be performed safely and effectively in the liver.

The most important factor that may lead your cancer care team to choose ablation for treatment is small size and number of tumors. A tumor size of 3 cm or smaller can often be completely killed with an ablation treatment. If this is the only site of cancer in the body the treatment can be curative in this way.

What to expect for the liver tumor ablation procedure?

  • Prior to the procedure, you will have a consult with one of the interventional radiologists to review your imaging and make sure you are a candidate.
  • The ablation is done as an outpatient procedure. Most often this is done with deep sedation or general anesthesia, depending on the specifics of your tumor and other health conditions.
  • On average, the procedure takes about an hour for a single tumor. The most important part of the procedure is a careful review of the imaging as the ablation needle is advanced into place in order to avoid critical structures and ensure the whole tumor is adequately treated.
  • After the procedure you will need to be monitored for at least two hours. Depending on the risk involved with your specific case and any complications encountered, you may go home after that or may need to stay overnight for observation.
  • In most cases pain at the procedural site is mild, manageable with over the counter medication and resolves within about a week. The minority of patients who experience more severe pain will be prescribed stronger pain medication if necessary.
  • Follow up imaging of the liver will be done between 1-3 months after the treatment.

Frequently Asked Questions about liver tumor ablations

Liver ablation is generally safe but the most significant risk is bleeding. This can happen during the procedure or can be delayed in some cases. It is important to contact your doctor if you begin to develop worsening pain and/or lightheadedness in the days following the procedure. Less common risks include infection and injury to nearby structures.

In these cases we will have a discussion with the rest of your care team. If the remaining tumor is in a safe location, a second ablation can be considered.

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