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Ellis Fischel Cancer Center 115 Business Loop 70 W. Columbia, MO 65203 (573) 882-2100 About Clinical Trials Directions Disease Sites Ellis Fischel Gala Ellis Magazine E-mail a Patient E-mail Us Employment Gift Shop Guest House Index A to Z Make a Gift Margaret Proctor Mulligan     Breast Health Center Phone Numbers Physician Information Support Groups Treatment Programs Submit Comments

Hepatocellular Carcinoma (Hepatoma)

Hepatoma is one of the most prevalent malignancies worldwide. Although relatively uncommon in the Western world, an estimated 300 cases will present annually in Missouri. Surgical resection is the treatment of choice for patients with hepatoma and can be curative, provided the tumor is confined to the liver and is completely removed. Patients with suspected hepatoma should be evaluated by a surgeon experienced in liver surgery to assess resectability. Unfortunately, many patients are not candidates for resection due to large tumor size, multiple tumors or severe cirrhosis of the liver. When severe cirrhosis precludes resection, orthotopic liver transplant (OLT) has been used with some success in selected patients.

Since the majority of patients with hepatoma have unresectable disease, numerous alternative treatments have evolved. These include hepatic arterial embolization, percutaneous intratumoral injection of alcohol, cryosurgical ablation, and radiofrequency ablation RFA. Hepatic arterial embolization is a technique whereby the arteries nourishing the tumor are selectively occluded, leading to tumor necrosis. Embolization is applicable to both large and multiple tumors, and can be repeated if indicated. Direct injection of absolute alcohol has been demonstrated to induce necrosis and ultimately fibrosis of small hepatomas. This procedure is done percutaneously by CT or ultrasound guidance, although the technique is limited to tumors less than four centimeters.

Cryosurgical techniques also have shown applicability to treating hepatocellular carcinoma. A probe containing circulating liquid nitrogen is introduced directly into the primary liver tumor and the lesion is frozen using ultrasound guidance. Cryosurgery can be applied to tumors up to six centimeters in size but, unlike ethanol injection, requires an open surgical procedure.

Radiofrequency ablation is a newer technique that is particularly well-suited for destruction of hepatocellular cancers. A 14 gauge needle is directed into the tumor by ultrasound or CT guidance and an alternating current is applied, similar to microwave. The heat generated exceeds 100 degrees Celsius and destroys the tumor. RFA appears to be safer than cryosurgery, although it's effectiveness compared to cryosurgery is less clear. RFA can be done using minimally invasive techniques such as percutaneously (through the skin) or laparoscopically using a video camera system. For larger, more difficult tumors, a more traditional surgical approach may be needed. In our experience at Ellis Fischel Cancer Center, tumors smaller than 4 cm can be effectively ablated in over 85% of cases.