Liver Tumours

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Interventional radiological techniques have had an established role in the treatment of liver cancers for several years now. 

Liver cancers are the sixth most common cancers in the world. They can be primary liver cancers (hepatocellular carcinoma) and secondary spread of cancers from another site (often from colorectal cancers or other cancers in the body). The majority of primary liver tumours are hepatocellular carcinomas (HCC) and this section predominantly concentrates on HCC.  

Risk factors associated with development of HCC are 

• Liver cirrhosis (the effect of longstanding liver disease leading to replacement of liver tissue by  scar tissue and regenerative nodules);  
• Alcohol use; 
• Hepatitis B and C infection; 

The clinical presentation of HCC tends to be of slow onset and includes symptoms such as fever of unknown origin, abdominal pain, malaise, weight loss and liver enlargement. Jaundice (yellow discoloration of the skin and eyes) is unusual. 

Occasionally the clinical presentation of hepatocellular carcinoma (HCC) can be acute and includes bleeding or hepatic rupture. 

Alpha-fetoprotein (AFP) levels may be elevated; however, this is an insensitive marker because AFP levels may be normal in more than one third of patients. 

They are commonly diagnosed using ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scans. These will provide information about the number, size and characteristics of lesions in the liver and back ground liver parenchyma. 

If there is a question about whether these are malignant (cancerous) lesions then a biopsy may be required which involves the sampling of tissue via the introduction of a fine needle into the liver under Ultrasonography or CT scan guidance. 

Surgery may be either liver resection or liver transplantation. 

Surgical resection aims to remove a tumour together with surrounding liver tissue while preserving enough remaining liver for normal body function. This treatment offers the best prognosis for long-term survival, but unfortunately only 10-15% of patients with HCC are suitable for surgical resection. This is often due to extensive disease or poor liver function. Liver surgery in cirrhotic patients carries high morbidity and mortality.   

Liver transplantation may also be considered in any patient with cirrhosis and a small (5 cm or less single nodule or up to three lesions of 3 cm or less) HCC. Liver transplantation aims to replace the diseased liver with a cadaveric liver (from a deceased patient) or a living donor graft.  

• TACE: Trans Arterial Chemo Embolisation can produce tumour necrosis (tissue death) and has been shown to affect survival in highly selected patients with good liver reserve. TACE is also effective therapy for pain or bleeding from HCC. 
• RFA: Radiofrequency ablation has been shown to produce necrosis (tissue death) of small HCCs. It is best suited to peripheral lesions, less than 3 cm in diameter.