Center for Advanced Liver Diseases and Transplantation

Minimally Invasive Treatments

Radiofrequency Ablation or RFA

During this non-invasive procedure, a special needle is guided through the skin into the tumor using imaging and placed within the lesion. Then, radiofrequency current is delivered to the tumor site. The intense heat "cooks" the tumor just as food is cooked in a microwave oven.

Radiofrequency ablation works best on smaller tumors (2-3 cm in diameter) and tumors that are located deep in the liver and away from major blood vessels. However, there is no guarantee that the cancer will not come back. To minimize the discomfort during the procedure, RFA is done under general anesthesia and patients may stay overnight in the hospital.

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A needle is placed through the skin directly into the liver tumor, and a bouquet of very thin electrodes is then extended from the end of the needle into different portions of the tumor. This will allow heating of the entire tumor.

By the end of the ablation procedure the tumor has been heated to a temperature sufficient to cause death of the tumor cells.

Microwave Coagulation Therapy (MCT)

Similar to RFA, MCT is usually performed under ultrasound or CT guidance. Once the needle is in the tumor, MCT is

used to burn and kill the tumor. Microwave ablation burns better and faster and is used for larger tumors. This technique may be used to downstage the tumor to meet transplant guidelines, making the patient eligible for liver transplant.

Chemoembolization

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In this minimally invasive technique, resembling a cardiac catheterization procedure, chemotherapeutic agents are delivered directly to the artery in the liver that feeds the tumor. Not only is chemotherapy sent right to the place it is needed, the artery feeding the tumor is also blocked, limiting blood flow to the tumor and choking it by depriving the tumor cells of oxygen. Unlike traditional chemotherapy given through an IV in the arm, chemoembolization rarely causes the generalized side effects known to be associated with chemotherapy such as nausea, vomiting, hair loss, etc.

While chemoembolization is not a cure for liver cancer, it can keep tumors from growing and prolongs life span considerably. Chemoembolization is most often done under intravenous sedation and sometimes patients stay overnight for observation.

Alcohol Injection

Ironically, while excessive alcohol use may cause liver cirrhosis, it can kill cancerous tumors when it is injected into the liver tumor. Similar to RFA (see above) it is most

successful in smaller sized tumors. Alcohol is injected through a thin needle passed through the skin and positioned into the tumor. Because of the pain caused by alcohol's effect on tissues, this procedure is done under either heavy sedation or general anesthesia.

Chemotherapy

Systemic chemotherapy (that which travels through the bloodstream) does not cure liver cancer, but it can reduce the size of a tumor and also relieve pain. However, the medications currently available for treating liver cancer are not as effective as medications available to treat other common cancers such as breast, colon and prostate.

Chemotherapy is often used in conjunction with other treatments and after other treatment options have been exhausted.

Radiation

Liver cancer is generally not responsive to radiation therapy, but similar to chemotherapy, it can shrink the tumor and relieve pain.