Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver, derived from the parenchymal cells. HCC is one of the most frequent cancer types worldwide and requires complex treatment and surgical intervention.
Surgery is the best option for the treatment in case of HCC.
- Tumor resection
Resection of the tumor may be curative only if liver function is not impaired and there are no signs of portal vein thrombosis. In general, liver resection is the treatment of choice when the lesion is less than 5 cm in size in the absence of cirrhosis. This intervention may be even performed laparoscopically. However, liver resection is associated with the high rates of carcinoma recurrence within 5 years. In the case of cirrhosis (especially at advanced stages of the disease) the resection of the lesion is not possible, therefore, liver transplantation should be performed. Liver transplantation is also preferred to resection in case of hepatitis C as an underlying cause of HCC.
- Liver transplantation
Liver transplantation is a life-saving surgical procedure during which the diseased liver, which fails to person’s life is replaced by a healthy organ. Brain-dead individuals are donors for transplantation. Sometimes for recipients with prior hepatitis B and C organs may be withdrawn from infected donors. For transplantation in children, one donor organ may be split between two recipients: the left segment will be transported to a small child and the right lobe – to an adult. After the liver is removed from the cadaver the surgery should be performed within 12 hours.
Living healthy adult may also become a donor. Typically, the right lobe of the liver is transplanted in these cases. Those who underwent organ transplantation should receive lifelong immunosuppressive therapy to prevent organ rejection.
Nonsurgical management is usually offered for individuals who cannot be treated surgically. The following techniques are used in order to shrink the tumor. Once it is done, some of the patients may later undergo liver resection or transplantation.
- Tumor ablation
At the early stages of the disease, the lesion may be destroyed by the chemical substances or by extremely low or high temperatures, which are delivered through the skin, during the laparoscopy or open surgery.
- Radiofrequency ablation – is a procedure during which the malignant lesions usually less than 5 cm in size are destroyed by local heating created by high-frequency radio waves.
- Cryoablation – a technique when the tumor is destroyed using cold temperatures created by liquid nitrogen.
- Percutaneous ethanol injections are also highly effective for small tumors.
- Systemic chemotherapy
Despite the fact that HCC doesn’t very well respond to systemic chemotherapy it is administered for irresectable tumors. Doxorubicin, mitozantrone, methotrexate, and cisplatinum may be used as single agents or in combination with 5-fluorouracil.
- Tumor devascularization
Transcatheter arterial chemoembolisation is the most commonly performed procedure. During this procedure, high doses of chemotherapeutic agents (such as doxorubicin, cisplatin, mitomycin C) are delivered exclusively to the artery which feeds the lesion. Then the artery is occluded with coils or gel foam. This technique helps to reduce the tumor’s size and improve the prognosis.
Some patients develop postembolization syndrome after the procedure which is characterized by fever and abdominal pain.
Low-dose radiation may also be delivered to the tumor (brachytherapy). During this procedure, radioactive yttrium is used. A total dose of radiation received during brachytherapy is about 150 Gy.
- Lactulose is administered to stimulate the motility of the gut and provide the excretion of the toxins.
- The combination of diuretics (spironolactone and furosemide) is recommended to manage fluid retention.