Liver Cancer Treatments Offer Longer, Healthier Life

Most people who contracted hepatitis C were unaware of their condition until testing methods were created and widespread screening became available in the 1990’s. Today many of those who have been confirmed with hepatitis C find themselves at risk for a still more lethal and previously rare disease – primary liver cancer. According to statistics from the National Institutes of Health, more than 4 million Americans are infected with hepatitis C virus (HCV). Of this group, the majority experience chronic infection, defined as detection of the virus in blood over at least a 6-month period.

Transmission of hepatitis C occurs primarily by injection drug use, high-risk sexual behaviors, occupational exposures such as accidental needle sticks, and from mothers to infants. Persons at high risk for acquiring hepatitis C include recipients of blood clotting products made before 1987 and hemodialysis patients; others at moderate risk include those who received blood transfusions or whole organ transplants before 1992. People diagnosed with hepatitis C should avoid alcohol and obtain Hepatitis A and B immunizations to avoid further liver damage.

“We’re already seeing a substantial increase in those who developed cirrhosis of the liver, which puts them at risk for liver cancer,” says interventional radiologist William S. Rilling, MD, an Associate Professor of Radiology and Surgery at the Medical College of Wisconsin. “And we expect to see more cases over the next decade as this group matures.” People who developed liver cirrhosis from alcohol abuse are also at risk, he says, but their numbers have remained relatively stable.

Although primary liver cancer is a significant health problem worldwide, Dr. Rilling says, it is still fairly uncommon in the United States. Since liver cancer is unusual and its symptoms mimic many other conditions, there is often a delay in making the diagnosis while the cancer grows larger. Unfortunately, by the time the diagnosis is made, most patients have advanced disease.

The good news is that newer therapies that prolong survival and enhance patients’ quality of life are now available at major medical centers, among them Froedtert Hospital and Froedtert & Medical College Clinics.

Chemotherapy and Radiation Less Effective for Some Cancers
Two therapies often used to treat cancer – systemic chemotherapy and radiation therapy – have had limited success in patients with certain types of liver cancer. And by the time the disease is diagnosed, patients are often not candidates for surgery, either, because of the size of their tumor or the severity of their underlying liver disease.

Today, however, Dr. Rilling and his colleagues are using relatively new treatments, such as chemoembolization and radio frequency ablation, which provide better patient outcomes.

During chemoembolization, doctors deliver a potent dose of chemotherapy directly into the artery supplying a specific tumor, then plug it. This not only turns the tumor into a closed pocket of potent, cancer-killing agents, it also cuts off the tumor's blood supply. Using equipment like that used for angioplasty, the chemotherapy and plug are delivered through a tiny catheter, which is introduced via a groin artery and guided all the way to the artery that nourishes the tumor. Patients typically are hospitalized overnight after the procedure.

Chemoembolization was developed in Japan about 20 years ago, Dr. Rilling says, and it has become a standard of care in the United States for unresectable primary liver cancer over the last few years. Some of the early clinical research was performed in 1996 at Northwestern Memorial Hospital, during the time Dr. Rilling was doing a fellowship in vascular and interventional radiology.

With radio frequency ablation, which can be done as an outpatient procedure, the physician uses a special probe to kill the cancer cells with heat. “We use ultrasound or CT to guide the probe to the edge of the tumor.” The heat is applied to destroy the tumor and its surrounding margins.

Both procedures can be used alone or in combination with other therapies, Dr. Rilling says. “The trend is toward using multiple therapies in combination,” he says. Another therapy in the arsenal for treating liver cancer is cryosurgery. Like radio frequency ablation, physicians use ultrasound to pinpoint the tumor, then guide a probe to the site and destroy the tumor cells by freezing.

A Multidisciplinary Approach
Despite these advances, primary liver cancer remains a deadly disease that often defies a cure. Nevertheless, the newer therapies have enabled patients to live longer and in greater comfort than ever before. Dr. Rilling recommends that patients diagnosed with liver cancers be treated at facilities like Froedtert Hospital and Froedtert & Medical College Clinics.

“We take a multidisciplinary approach,” he says. “We discuss the care of each patient at a team conference to ensure that the patient can be directed to the best specialists for a particular diagnosis. We have a lot more weapons to use in this fight, and our toolbox keeps getting bigger.”

For the past three years, Dr. Rilling and his Medical College colleagues have conducted research into the efficacy of the newer treatments. “We’re finding excellent results for the quality of life of our patients,” he says.

Barbara Abel
HealthLink Contributing Writer

For more complete information on hepatitis C, see the CDC/NCID's Viral Hepatitis C information page.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.