Advanced Technology and Treatments for Liver Conditions
Many new technologies and treatments are helping patients with liver disease live longer and healthier.
New drug research is helping people with Hep C, the leading cause of Chirrosis (scarring of the liver that prohibits the organ's normal functions and often leads to cancer), find a cure. A decade ago, only one in 20 were cured from Hep C, while today, the cure rate is one in two.
New technologies have meanwhile also helped treat liver cancer from within to prolong quality of life.
TheraSpheres and SirSpheres are two variations of cancer treatments developed in the last few years and are referred to as radioembolization.
Radiation particles "piggyback" on beads the size of a grain of sand (30 microns) as they carry radiation to the tumor. The radiation is known as Yttrium 90 and will slowly emit radiation to treat the tumor over 2-3 weeks. The microspheres lodge themselves in the small capillaries in the liver, or preferentially accumulate in the tumor, and the normal liver tissue is spared. Once the beads are lodged in the tumor, they can then emit their radioactivity and kill the tumor from the inside.
Microspheres are used depending on the size, type and location of the tumor and can only be applied in patients with good liver function. Because the tumors need an arterial blood supply to grow, the microspheres are administered through an angiographic catheter in the femoral artery - a procedure done by an interventional radiologist.
- Are used for primary liver cancers
- Carry more radiation - known as being "hotter" - so a smaller amount of beads are applied (e.g. 1 million)
- Are used for metastasized tumors (other cancers that migrate to the liver)
- Carry less radiation and more beads are used (e.g. 40 million)
- Was the first interventional radiology treatment developed for treating metastases in the liver
- Uuseful in patients who have become unresponsive to chemotherapy - e.g. chemo refractory - and when a liver resection is not an option
LC Bead chemotherapy treatment
The LC Bead is a new generation in embolic technology using low compression microspheres that are negatively charged to adhere chemo agents at the site of the tumor. As a treatment for primary liver cancer, LC Beads are administered as off-label or investigational use.
Both microspheres and the LC Bead are applied through a small, flexible catheter inserted through the femoral artery from a needle in the patient's groin. Interventional radiologists use x-ray guidance to snake the catheter into one of the major liver blood vessels and then into the branch that supplies the cancerous tumor. These treatments are often completed as an outpatient procedure, allowing a patient to return home typically the same day or next day.
Used to directly visualize the pancreatic and biliary ducts. This is performed in addition to the ERCP procedure, described below. A tiny camera fiber is guided into the pancreatic and/or common bile duct to allow for a more in-depth view and more precise tissue sampling. The gastroenterologist uses this technique when the X-ray image does not give enough information about what is going on in the biliary or pancreatic ducts.
ERCP, or Endoscopic Retrograde Cholangiopancreatography
Provides an endoscopic view of biliary and pancreatic system and is used to help diagnose problems either by visualization or by obtaining tissue samples in the liver, gallbladder, bile ducts, and pancreas by injecting the common bile duct and/or the pancreatic duct with dye. This provides visualization of abnormalities via an X-ray image. Certain ductal problems (such as strictures, obstructions and gallstones) can be addressed during ERCP. Structures can be dilated and diagnosed, obstructions can be removed and/or diagnosed, stones within the duct can be removed and stents can be placed to facilitate drainage of bile through obstructed or structured areas.
Endoscopic Ultrasound or EUS
EUS uses both endoscopy and ultrasound to obtain images and information about the liver and pancreas; both the endoscope and ultrasound (one tool) are inserted into the patients mouth for diagnosis. EUS allows the gastroenterologist to examine the lining and the walls of your upper and lower gastrointestinal tract, and is used to study internal organs that lie next to the gastrointestinal tract such as the gall bladder and pancreas. EUS is also used to evaluate an abnormality such as a growth that was detected at a prior endoscopy or by X-ray. This procedure provides a detailed picture of the growth, which can help determine its nature and decide upon the best treatment, especially when other tests are inconclusive. EUS helps determine the extent of certain cancers by allowing the physician to accurately assess the cancer's depth and whether it has spread to adjacent lymph glands or nearby vital structures such as major blood vessels. In some patients, EUS can be used to obtain tissue samples (through Ultrasound-Guided Fine-Needle Aspiration, described below) to help the physician determine the proper treatment.
Ultrasound-Guided Fine-Needle Aspiration
During the EUS procedure a technique called fine-needle aspiration can be used to safely withdraw cells from a suspected cancer within the gallbladder or pancreas.
Interventional Radiology Treatments
Arterial Embolization with Radiation or Chemotherapy
Used to target tumors more directly from the inside of the liver or pancreas, interventional radiologists use embolization to cut off the blood supply to the tumor (embolization), deliver radiation to a tumor (radioembolization), or combine this technique with chemotherapy to deliver the cancer drug directly to the tumor (chemoembolization).
Radiofrequency Ablation (RFA) offers a localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient's overall health and most people can resume their usual activities in a few days. RFA can be used for multiple tumors and can be performed by an interventional radiologist using non-surgical techniques (directly through the skin with X-ray guidance) or by a surgeon (through a laparascope or a traditional surgical incision). A small needle is guided into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. The FDA has approved RFA for the treatment of liver tumors.
Complex Biliary Drainage
Usually performed by an interventional radiologist with the help of X-ray guidance. Drains are placed to improve bile drainage that has been compromised by benign or malignant tumors. In some patients, such as those with liver cancer or individuals who have had an injury to the liver, the bile ducts become blocked and bile cannot drain from the liver. The interventional radiologist places a catheter through the skin and into the bile ducts to drain the bile. In some cases, a small metal cylinder, called a stent, is placed in the liver to hold the blocked area open. A catheter may also be placed to drain bile in patients.
TIPS or Transjugular Intrahepatic Portosystemic Shunt
Seen most frequently in patients with liver disease such as cirrhosis or hepatitis, portal hypertension is a condition in which the normal flow of blood through the liver is slowed or blocked by scarring or other damage. Patients with the condition are at risk of internal bleeding or other life-threatening complications.
A minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments. Chemoembolization delivers a high dose of cancer-killing drug (chemotherapy) directly to the organ while depriving the tumor of its blood supply by blocking, or embolizing, the arteries feeding the tumor.
Using imaging for guidance, an interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of chemotherapy drug to be used, because less of the drug is able to circulate to the healthy cells in the body. Chemoembolization usually involves a hospital stay of two to four days. Patients typically have lower than normal energy levels for about a month afterwards.
Chemoembolization is a palliative, not a curative, treatment. It can be extremely effective in treating primary liver cancers, especially when combined with other therapies. It has shown promising early results with some types of metastatic tumors. Although the individual materials used in this treatment are FDA approved, the treatment itself is not approved for intra-arterial therapy of liver tumors.