Ablative therapy is commonly used for one or few hepatocellular carcinoma lesions that are < 5 cm. Ablation is performed by the insertion of a needle or a probe into the liver tumor through the skin and delivering a form of high energy to destroy the tumor cells. It is typically used in patients when surgery is not a good option such as in patients with poor general health or decreased liver function. Ablative therapy can be done in different ways including the following:
Radiofrequency Ablation (RFA), which uses a high-frequency current that is passed through the tip of the probe to heat and destroy the tumor.
Microwave Thermotherapy, which uses microwaves that are transmitted through the probe to heat and destroy the tumor.
Embolization includes the placement of a catheter into an artery through a cut in the inner thigh or wrist and then threading the catheter up into the artery that feeds the liver tumor (hepatic artery) to inject micro beads that will block blood flow to the tumor. The same procedure can also be used to deliver chemotherapy (trans-arterial chemoembolization or TACE) or radiation therapy (trans-arterial radioembolization or TARE) directly to the cancer cells.
Embolization is an option for patients with tumors that cannot be removed by surgery or those that are too large to be treated with ablation therapy (larger than 5 cm). It can also be used with ablation. The ablative therapies are often used while patients are awaiting liver transplantation.
The transplant surgery team will evaluate the patient for surgical resection of a liver mass. In the case of liver cancer, this may be the best treatment when the liver has normal function. The ideal patient for resection has a solitary liver lesion confined to the liver that shows no radiographic evidence of invasion of the liver vessels, no evidence of increased pressure in the liver (portal hypertension), and has well-preserved liver function.
Although many surgeons only perform resection in patients with tumors ≤5 cm in diameter, there is no general rule regarding tumor size for selection of patients for resection. Patients with a single liver cancer tumor without invasion of the liver vessels have a similar survival probability regardless of tumor size, although patients with smaller tumors tend to have a better outcome. Proper assessment of overall liver function is important when selecting patients who are eligible for resection.
The transplant surgery team will evaluate whether a patient is eligible for liver transplantation. Liver transplantation is a suitable option for patients with cirrhosis who would not tolerate liver resection and who have tumors amenable to transplantation. Some transplant centers, such as ours, have extended criteria to widen the indications for liver transplantation.
Patients with liver cancer tumors that are within transplant criteria are eligible to receive Model for End-Stage Liver Disease (MELD) exception points at set time intervals. The goal is for these patients to be transplanted before their tumor burden exceeds transplant criteria. Patients with hepatocellular carcinoma who are within transplant criteria are offered MELD exception points that are used to prioritize patients on the liver transplant list. Therefore, the higher the MELD score, the higher the patient is on the liver transplant list.
Our transplant program also offers living donor transplantation for both children and adults, making it one of the few in Texas to offer this advanced procedure. This significantly cuts down wait times.