The management of primary liver cancer is not the same as that of metastatic cancer. In all cases, therapeutic decisions are made during multidisciplinary consultation meetings where doctors discuss the best treatments to implement based on recommendations for good practice.
Treatment of primary liver cancer
If the tumor is small and localized, the surgeon will perform a partial removal of the liver . The destruction of the tumor by radiofrequency is also an alternative. This fairly recent technique consists of diffusing heat via an implanted electrode in contact with the tumour.
If the tumor is large or disseminated in several places of the liver, a total ablation followed by a transplant can be envisaged.
But surgery is not always possible. If the tumor grows on an already diseased liver, as is often the case, there may not be enough healthy tissue left to allow the organ to regenerate and function normally after partial removal. Chemoembolization remains the reference therapeutic route. It will make it possible to slow down the progression of the tumor and, thus, to prolong the life of the patient. Performed under local anesthesia by a radiologist, this procedure consists of injecting a chemotherapy drug treatment directly into the liver while blocking the blood that feeds the tumor (embolization). As a possible alternative, radiotherapy (destruction of the tumor by X-rays) also aims to slow down the development of the cancer.
Treatment of metastatic cancer
The treatment of hepatic metastases is, as much as possible, local. It is essentially based on surgery. A very complete assessment is carried out in order to draw up a precise map of the metastases and to determine whether or not the patient can benefit from surgery. Only 10% of patients are immediately operable. The rest receive chemotherapy to reduce the size or number of liver metastases so that surgery can be performed. During the intervention, the surgeon makes sure that there are no other lesions that would not have been identified by the initial assessment. Then he removes the metastases, with a safety margin of one centimeter if possible.
The development of radio frequency, or inter ventional radiology , also makes it possible to perform interventions that were unthinkable in the past. Thanks to this process, it is in fact possible to remove a lobe of the liver presenting numerous metastases and to preserve the other lobe which would present only one metastasis. This is then destroyed without harm to the patient by the heat emitted by an electrode implanted during the operation.
Another progress is targeted therapies. These molecules such as cetuximab and bevacizumab block the growth of certain cancerous tumours. To do this, they interact with a molecular target, necessary for tumor growth. It all depends on the nature of the tumour, which is why a lot of research is aimed at developing new targeted therapies.
Liver cancer in key figures
The number of metastatic liver cancers, secondary to a tumor located on another organ, is 20 to 50 times higher than the number of primary cancers.
Alcohol is the main cause of primary liver cancer.
The prevention of primary liver cancer requires a better lifestyle (moderate alcohol consumption, balanced diet, no tobacco) and protection against the hepatitis B virus (vaccination, protected sexual intercourse) and Hepatitis C.
Primary and secondary liver cancers can be treated with the entire therapeutic arsenal against cancer: surgery, chemotherapy, radiotherapy, etc. Each of these strategies benefits from constant progress, always with the objective of better efficacy for fewer side effects. .