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Liver cancer incidence is rising, for a variety of reasons including viral infections and lifestyle. Primary liver cancer is a challenging condition to diagnose and treat, in part because many cases of liver cancer are diagnosed when the condition is already advanced and surgical treatment no longer offers a cure.

That is when Yale Medicine becomes involved. The doctors at Yale Interventional Radiology and Interventional Oncology at Smilow use cutting-edge image guidance for precise, minimally invasive treatments of liver cancer. According to Kevin Kim, MD, chief of Yale Medicine Interventional Radiology and Interventional Oncology at Smilow Cancer Hospital, "The majority of patients with liver cancer benefit, in terms of overall survival and quality of life, from precision-targeted interventional treatments."

What are the risk factors for liver cancer?

Primary liver cancer, or cancer that originates in the liver, occurs more frequently in patients with a history of viral infections of the liver or increased alcohol intake. More recently, unhealthy, high caloric diets and obesity have been identified as emerging causes of primary liver cancer. The incidence rate (number of patients who are newly diagnosed every year) is rapidly growing, mainly because of the epidemic of hepatitis C infections.

How is primary liver cancer diagnosed?

Liver cancer is difficult to diagnose. Often, the cancer will grow inside the liver only, without invading other organs or causing any real symptoms. Doctors end up diagnosing liver cancer incidentally, either because of an abnormal lab test, or an imaging study performed for another reason.  

“As a result, liver cancers are typically diagnosed at a later stage when surgical options will not benefit the patient. It underscores the importance of prompt precision interventional treatments for liver cancer,” Dr. Kim says.

Why is early detection of liver cancer importantt?

Because we know that earlier diagnosis and prompt anti-cancer treatments result in better survival rates, we are working to improve the surveillance programs that detect cancer. 

Researchers are continuing to find additional ways of delivering drugs precisely to the tumor, as well as developing new ablations, drugs and radiation that work well at maximizing toxicity to the tumor, while minimizing toxicity to nearby regions.

Why is liver cancer so difficult to treat?

When treating liver cancer, physicians usually face the challenge of having to deal with two diseases at the same time because liver cirrhosis, a degenerative chronic condition caused by toxic or viral liver injury, is the underlying cause of cancer.

Thus, physicians have to address both the presence of cancer and the functional impairment of the organ itself. This limits the choices of therapy and in some cases may exclude surgical options. In addition, liver cancer is difficult to diagnose and not easily detectable in early stages. Because of that, many patients already have advanced cancer by the time they seek treatment and can no longer be surgically treated.

What are the image-guided treatment options for patients with primary liver cancer?

We offer curative ablative anti-cancer therapies including radiofrequency ablation, microwave ablation, cryotherapy and irreversible electroporation therapy. With ablative therapies, interventional radiologists or oncologists insert a small, needle-like probe directly into the tumor using live image guidance to identify its precise location. Depending on the type of therapy, monitored heat, cold, or electrical energies are then passed through the probe to destroy the liver tumor.

We also offer anti-cancer transarterial therapies. With these, interventional radiologists or oncologists employ live image guidance to advance a small tube, called a micro-catheter, through a tiny incision in the patient's groin or wrist until it reaches the blood vessel that supplies the liver tumor. Once in place, the micro-catheter is used to deliver high doses of either chemotherapy or radiation to the exact location. (This helps patients avoid most of the common systemic side effects of conventional chemotherapy or local side effects of radiation therapy.) When delivering microspheres with chemotherapeutic drugs, this therapy is called transarterial chemoembolization (TACE). When delivering microspheres that contain a radiation source, the therapy is called transarterial radioembolization (TARE) or Y90 radiotherapy.

“These precision therapies ensure maximum destruction of the tumors and avoid harm to other healthy liver tissues, which is what separates the image-guided local or regional interventional therapies from other ones,” says Dr. Kim.

What is the treatment experience like for the patient?

At Yale Medicine, patients first meet with interventional radiologists and interventional oncologists to discuss potential treatment options. These options are ones suggested by a multi-disciplinary team of liver cancer experts such as hepatologists, medical oncologists, surgical oncologists and transplant surgeons who meet regularly to discuss liver cancer cases. Once the best, individualized therapeutic plan is developed with the patient, treatment is scheduled promptly.

On the day of treatment, patients are prepared for the treatment in a suite equipped with precision image-guidance technology. This equipment helps doctors pinpoint where to place special probes, micro-catheters, that need to be close to the tumor. Under light sedation, most patients remain awake throughout the procedure, which takes no more than two hours.

Recovery time is usually short, and typically there are no significant side effects. Most patients are cared for as out-patients and go home the same day.

What are the benefits of interventional radiology treatments for liver cancer?

One of the enormous benefits of image-guided therapy is its reduction in side effects, compared to systemic chemotherapy or conventional radiation. Because tumor ablative therapy targets tumors precisely, healthy organs will be relatively unaffected, and patients will be protected from more serious and uncomfortable side effects. 

Our precision interventional treatments are so well tolerated that they are mostly outpatient procedures. For interventional treatments, occasional side effects might include fatigue, flu-like symptoms and inflammation due to a rise in liver enzymes. But those side effects tend to pass quickly, within one to two weeks after treatment. Patient can quickly return to normal daily life.

What’s makes Yale Medicine’s approach to primary liver cancer unique?

We offer a comprehensive Liver Cancer Program. We have dedicated faculty, key leaders in an array of specialties, committed researchers, ongoing clinical trials, and state-of-the-art equipment.  

“We work together for the best possible care for our patients,” Dr. Kim concludes.