Hepatocellular carcinoma is the cause of liver tumors in the majority of cases.
Stereotactic body radiotherapy (SBRT) is a novel, outpatient, painless and non-invasive technique. It allows for a rapid return to the patient’s normal life.
At iTAcC our main objective is the administration of an individualized treatment in order to achieve the highest success rate in each patient
The liver is the largest solid organ in the body. It is located under the diaphragm and in the upper right region of the abdominal cavity. Its fundamental roles are maintaining the balance of the body regarding protein synthesis, vitamin storage and secretion of bile and digestive enzymes, among others. It is also responsible for removing certain harmful substances from the blood.
There are five main types of liver tumors, each of which have specific characteristics and require different types of treatment:
- Hepatocellular carcinoma: it is the most common primary malignant liver cancer and originates from the liver’s own cells called hepatocytes.
- Cholangiocarcinoma: it originates in the cells of the liver bile ducts (cholangiocytes) in the liver (peripheral cholangiocarcinoma) or outside the liver (extra hepatic cholangiocarcinoma). It is a relatively rare cancer whose origin is related to risk factors relating to the chronic inflammation of the biliary tract.
- Gallbladder carcinoma: it originates in the cells of the wall of the gallbladder.
- Liver metastases are the most common tumors of the liver. They are caused by the proliferation of cells from primary tumors from other organs (secondary disease).
- Benign tumors (hemangioma, focal nodular hyperplasia and adenoma) are rare lesions and usually do not require medical or surgical treatment.
The medical team at iTAcC has extensive experience in the diagnosis, treatment and monitoring of liver tumors
Hepatocellular carcinoma accounts for most liver tumors. This type of cancer is more common in men than in women and is usually seen in persons over the age of 50.
The most important risk factors for the development of hepatocellular carcinoma are:
- Liver Cirrhosis is chronic scarring of the liver and more than 90% of malignant liver tumors originate from this disease.
- Heavy alcohol consumption.
- Autoimmune diseases: primary biliary cirrhosis.
- Hepatitis B or C infection.
- Chronic inflammation of the liver.
- Hemochromatosis: iron overload in the body.
- Alpha1-antitrypsin deficiency: an enzyme that protects tissue from injury that causes swelling.
- Toxic substances: vinyl chloride, thorium dioxide, arsenic, aflatoxins (produced by fungi) as well as anabolic substances.
Prevention is based primarily on the identification and elimination of potential risk factors for the disease. Specialists at iTAcC strongly recommend correct control of body weight, limit alcohol intake, vaccination against hepatitis B and avoid exposure to toxic substances. Screening tests for the detection of hemochromatosis is necessary in selected patients.
A correct antiretroviral treatment should be carried out in patients diagnosed with hepatitis B or C as well as a comprehensive follow-up in order to prevent disease progression as well as reducing the risk of liver cancer.
Liver lesions are usually asymptomatic. Abnormalities are often detected in laboratory analyses during routine health examinations.
Various signs and symptoms can be observed as a liver tumor increases in size. They are: yellowing of the skin due to the accumulation of bilirubin and destruction of liver cells, pain and heaviness in the right side of the abdomen, loss of weight and appetite and even mental confusion and somnolence in advanced cases.
The routine diagnosis method is based on performing blood analysis with serum markers (AFP, CEA) as well as specific imaging tests.
The most suitable imaging tests for making a correct diagnosis of suspected liver malignancy are:
- Abdominal ultrasound: a medical specialist performs an ultrasound examination of the entire abdomen using an ultrasound probe obtaining images of the liver and adjacent organs. It is a quick, painless, safe and effective test.
- CT (computed tomography) is an imaging technique that uses X-rays to obtain razor sharp images for a precise study of the entire abdominal cavity. A radiopaque contrast is injected for better visualization of lesions in the liver in many cases.
- MRI (magnetic resonance imaging): This technique uses electromagnetic fields and waves to obtain images that allow for differentiating liver lesions with an extreme accuracy. As in the CT contrast is often used.
- Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EU): it is an endoscopic examination which provides a direct view of the bile ducts inside and outside the liver.
- Percutaneous trans-hepatic cholangiography (PTC): it is a radiological examination which shows the bile ducts in detail by puncturing the liver directly through the abdominal wall.
- Liver biopsy: a sample is taken order to obtain a definitive histologic diagnosis of a suspicious lesion discovered by an imaging technique. It is done by direct puncture of the lesion guided by ultrasound or CT.
The ITAcC medical team maintains direct contact with all the specialists involved in arriving at the best treatment decision for patients diagnosed with HCC. These specialists include surgeons, gastrointestinal specialists, radiologists, pathologists, radiation oncologists, and medical oncologists. As an open institution, our specialists count on the opinions of the patients’ trusted physicians.
At iTAcC our main objective is administering individualized treatment to each patient in order to obtain the highest success rate.
Liver surgery is performed using ultrasound image guided techniques. They allow the surgeon to precisely identify the location of the lesion and facilitate its complete removal while preserving healthy liver tissue as much as possible.
The liver tumor treatment can be performed selectively in chosen patients by administering radical radiotherapy which allows to increase the chances of local tumor control significantly.
iTAcC has the most advanced technology for precise radiotherapy treatments. With TrueBeam STX © system we can carry out stereotactic body radiotherapy (SBRT) or intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). These techniques give us the ability to deliver high doses of radiation to the tumor with sub-millimeter accuracy. The system detects the breathing movements of the patient which allows for treating the tumor while preserving the highest possible percentage of healthy liver tissue. These techniques are non-invasive, done outpatient, painless and allow for the patient’s rapid return to normal life.
The main indications for chemotherapy are based on both a reduction of the tumor size as well as controlling the disease prior to local treatment in order to decrease the chance of recurrence. Systemic treatment may include administration of biologic drugs to increase the rate of tumor control.
Sorafenib is a drug which has shown to have the far greatest impact on disease control.
Intra-arterial therapy (chemoembolization)
This technique is primarily used in patients who cannot undergo other treatments. It consists in the identification of the blood vessels supplying the tumor and a chemotherapeutic agent (adriamycin or cisplatin) is injected obstructing the blood flow and increasing the antitumor effect.
Radiofrequency consists in heat ablation of the tumor. This is achieved by increasing the temperature generated by the passage of current. It can be performed by laparoscopy, open surgery or percutaneously by injecting ultrasound guided vectors through the abdominal wall. The procedure is performed in the operating room under anesthetic sedation and controlled by ultrasound.
iTAcC promotes a strong interest in research within the context of exhaustive clinical protocols. This allows for the development of new therapies and the improvement of existing ones with the goal to increase the survival rate as well as improve the quality of life for liver cancer patients.
A multidisciplinary team establishes a customized control plan according to the needs of each patient and the biology of the disease after treatment. This is done to rule out or for the early detection of any recurrence. The follow-up is carried out based on a complete control of the tumor by imaging tests and liver function analysis.
Follow up is done as in all oncological activity at iTAcC, in a personalized manner with cooperation of doctors who have been involved in the diagnosis and treatment of each case. iTAcC is an open institution and works closely them.