Liver Cancer (cont.)
Ablation techniques
Radiofrequency ablation (RFA) therapy
In the U.S., RFA therapy has become the ablation (tissue destruction) therapy
of choice among surgeons. The surgeon can perform this procedure
laparoscopically (through small holes in the abdomen) or during open exploration
of the abdomen. In some instances, the procedure can be done without opening the
abdomen by just using ultrasound for visual guidance.
In RFA, heat is generated locally by a high frequency, alternating current
that flows from the electrodes. A probe is inserted into the center of the tumor
and the non-insulated electrodes, which are shaped like prongs, are projected
into the tumor. The local heat that is generated melts the tissue (coagulative
necrosis) that is adjacent to the probe. The probe is left in place for about 10
to 15 minutes. The whole procedure is monitored visually by ultrasound scanning.
The ideal size of an liver cancer tumor for RFA is less than 3 cm. Larger tumors may
require more than one session. This treatment should be viewed as palliative
(providing some relief), not curative.
Percutaneous ethanol (alcohol) injection
In this technique, pure alcohol is injected into the tumor through a very
thin needle with the help of ultrasound or CT visual guidance. Alcohol induces
tumor destruction by drawing water out of tumor cells (dehydrating them) and
thereby altering (denaturing) the structure of cellular proteins. It may take up
to five or six sessions of injections to completely destroy the cancer. The
ideal patient for alcohol injection has fewer than three liver cancer tumors, each of
which is:
- well defined (distinct margins)
- less than 3 cm in diameter
- surrounded by a shell consisting of scar tissue (fibrous encapsulation)
- not near the surface of the liver
Additionally, patients with liver cancer undergoing alcohol injection should have no
signs of chronic liver failure, such as ascites or jaundice. (Patients with
liver failure would not be able to tolerate the alcohol injections.)
The most common side effect of alcohol injection is leakage of alcohol onto
the surface of the liver and into the abdominal cavity, thereby causing pain and
fever. It is important that the location of the tumor relative to the adjacent
blood vessels and bile ducts is clearly identified. The reason for needing to
locate these structures is to avoid injuring them during the procedure and
causing bleeding, bile duct inflammation, or bile leakage.
Next: Proton beam therapy »
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