Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
When do surgeons do radiofrequency ablation (RFA)?
In the U.S., radiofrequency ablation (RFA) therapy has become the ablation (tissue destruction) therapy
of choice among surgeons for treating liver cancer (HCC). 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.
How is RFA done and how does it
work?
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.
What size tumor is treated by RFA?
The ideal size of an HCC tumor for RFA is less than 3 cm. Larger tumors may
require more than one session.
What is the benefit of RFA therapy?
This treatment should be viewed as palliative (providing some relief), but
not curative.
REFERENCES:
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D.
Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies.
J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases.
Management of hepatocellular carcinoma.
Hepatology. 2005 Nov;42(5):1208-36.
Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW.
Guidelines for resection of colorectal cancer liver metastases.
Gut. 2006 Aug;55 Suppl 3:iii1-8.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
A carcinoid tumor is a tumor that develops from enterochromaffin cells. The important characteristic of carcinoid tumors that sets them apart from other gastrointestinal tract tumors, is their potential to cause the carcinoid syndrome. Local symptoms may include abdominal pain, intestinal bleeding, and intestinal obstruction. However, often symptoms of the carcinoid syndrome can be more devastating than the local symptoms. There are many options for the treatment of carcinoid tumors and carcinoid syndrome.
Paroxysmal supraventricular tachycardia (PSVT) is an abnormal conduction of electricity in particular areas of the heart. PSVT was referred to at one time as paroxysmal atrial tachycardia or PAT, however, the term PAT is reserved for as specific heart condition. Symptoms of PSVT include weakness, shortness of breath, chest pressure, lightheadedness, and palpitations. PSVT is treated with medications or procedures that return the heart to its normal electrical pattern.
Liver resection is the surgical removal of a portion of the liver. This
operation is usually done to remove various types of liver tumors that are
located in the resected portion of the liver. The goal of liver resection is to
completely remove the tumor and the appropriate surrounding liver tissue without
leaving any tumor behind.
Which patients with liver cancer undergo liver
resection?
In patients with liver cancer (Hepatocellular Cancer, HCC), this treatment
option, liver resection, is limited to patients with one or two small (5 cm or
less) and confined to the liver with no invasion of the blood vessels. As a
result of these strict guidelines, in practice, very few patients with HCC can
undergo liver resection. The biggest concern about resection is that following
the operation, the patient can develop liver failure. The liver failure can
occur if the remaining portio...
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