Liver Cancer: The Latest Data on Its Treatment
Malignant liver tumors are divided into primary and secondary (liver metastases). The main primary malignant liver tumors are hepatocellular carcinoma and cholangiocarcinoma.
Hepatocellular Carcinoma (HCC)
HCC is a malignant tumor that originates from the functional liver tissue (hepatocytes). In the development of hepatocellular carcinoma, the following play an important role:
- Liver cirrhosis
- Viral hepatitis B and C
- Non-alcoholic fatty liver disease
Cholangiocarcinoma (CHL)
The pathogenesis of CHL is complex. Extracellular factors, such as proinflammatory cytokines, as well as genetic aberrations with dysregulation of intracellular signaling pathways are involved in carcinogenesis, growth, and metastasis.
Liver Metastases
Liver metastases are daughter tumors (metastases) of malignant tumors that are localized in the liver. Liver metastases were considered until a few years ago as a palliative condition, with no hope for cure. With the introduction of multifactorial, multidisciplinary protocols and modern surgical techniques, surgery for the resection of metastases has evolved rapidly, giving hope to patients with metastatic disease, with serious hopes for cure.
Diagnosis
The diagnosis of all malignant liver tumors is made imaging-based and requires the combination of three methods which constitute the main pillars of the diagnostic phase:
- Liver Ultrasound
- Computed Tomography (CT)
- Liver Magnetic Resonance Imaging (MRI)
Surgical Treatment
Malignant liver tumors, if and as long as they are technically resectable, should be treated surgically through surgery. Surgical removal of malignant tumors is the appropriate treatment for patients within the framework of the therapeutic approach to the disease. The liver is divided into eight anatomically delimited segments. Some of these parts, one of the two lobes of the liver or even larger parts of the organ, in selected patients without underlying diseases of the liver parenchyma (fibrosis, cirrhosis), can be safely removed, because the remaining parenchyma is able to fulfill the vital functions of the liver.
In cases of major hepatectomies (Right/Left Hepatectomy, Extended Right/Left Hepatectomy), it is advisable to apply techniques to increase the residual liver parenchyma that will remain after the operation, either through Two-Stage Hepatectomy (ALPPS: “Associating Liver Partition with Portal vein ligation for Staged hepatectomy”), which can also be performed robotically, or after preoperative portal embolization. This approach significantly reduces the risk of postoperative liver failure.
Minimally invasive techniques
The range of liver surgeries is very wide and includes minimally invasive techniques (laparoscopic and robotic), as well as open methods. Minimally invasive techniques require only millimeter holes in the skin and abdominal wall. In case of extensive oncological disease, open surgery is necessary. In many cases, surgeries are accompanied by chemotherapy and immunotherapy and radiotherapy. The combination of these treatment methods is often necessary to achieve the optimal oncological result.
In the case of extensive or multiple localizations, which are complex and in extremely demanding cases, the therapeutic approach must be interdisciplinary, consisting of surgical, oncological, radiotherapy and radiological/minimally invasive approaches, constituting multifactorial and personalized therapeutic protocols, where more local oncological treatments and systemic chemotherapy with immunotherapy/antibody therapy are combined.
In the context of robotic hepatectomies, special techniques for hepatectomies have been developed, offering significant advantages to patients with liver metastases and primary malignant liver tumors, such as fewer complications, lower mortality, shorter hospital stay and better quality of life.
