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Treatment of hepatocellular carcinoma

Picture of HCC
Picture of HCC

The ideal therapy for a localised hepatocellular carcinoma is an operation to remove the tumour completely. If the patient is fit, has a healthy liver and the tumour is not too large so as to leave behind enough liver to work well, then an operation should work well.


However, most patients with HCC have unhealthy livers and are not fit enough to go through major surgery.


Liver transplant has been used to treat some patients, but there are very strict criteria governing which patients are suitable.


If an operation is not possible or safe, then Sorafenib or chemotherapy is considered. Chemotherapy is usually given intravenously but intra-arterial chemotherapy, when the chemotherapy is given into the blood vessel goes directly to the liver, has also been used. This may give a higher dose of chemotherapy to the tumour and can be combined with an embolisation  procedure that blocks the artery leading to tumour. This has the effect of keeping the chemotherapy in the tumour for longer and at higher concentration. This is called 'trans arterial chemoembolisation' (TACE).


More recently, a tablet form of therapy that attacks the molecluar mechanisms that promote growth of this tumour type (sorafenib) has replaced standard intravenous chemotherapy for cases that are not suitable for local therapy (surgery, TACE or radiofrequency ablation)  usually because they are too extensive within the liver or have spread outside the liver. Sorafenib has now been firmly established as a well-tolerated form of therapy that can prolong life in patients with advanced disease.


Single, smaller tumours may be treated with techniques such as 'radiofrequency ablation' (the use of a probe put directly into the tumour which heats the tumour up in a similar way to the way a microwave oven works). Other techniques that destroy the tumour in a targeted way are under development, including the CyberKnife which can give highly focussed radiotherapy very accurately.



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