B14. Radiotherapy, surgical and pharmacological treatment of liver tumours Flashcards Preview

Oncology > B14. Radiotherapy, surgical and pharmacological treatment of liver tumours > Flashcards

Flashcards in B14. Radiotherapy, surgical and pharmacological treatment of liver tumours Deck (24):

What is the fundamental principle of treating liver tumors

-In hepatocellular carcinoma it is surgical resection.
-May present with cirrhosis indicating liver transplant for curative treatment


How are liver tumors treated if radical surgery is not suitable?

-Radiofrequency ablation (RFA)
-Percutaneous ethanol injection (PEI)
-High-intensity focused ultrasound (HIFU)
-chemotherapy given through afferent circulation of the liver (HAI)
-transarterial chemoembolisation (TACE)

In the case of metastatic cancer, chemotherapy may be given


Basic principle of surgical treatment for liver tumors

Radical resection that retains a sufficient amount of liver volume for survival and regeneration.
-liver is not cirrhotic
-sufficient remaining liver volume is 30%
-provided blood supply
-bile duct drainage are intact


How does intrahepatic bile duct tumor surgeries do not differ from hepatocellular cancer surgery? What is also required in both cases?

They are technically the same. Portal lymphadenectomy is required.


Surgery done for hilar cholangiocarcinomas (Klatskin tumors)?

Resection of bile duct system with clear surgical margins; which leads to partial hepatectomy of a liver love; the connection of the bile duct is usually reconstructed using a transplanted segment


Surgery for liver bed tumors

Resection of the liver bed wall


Surgery for liver siphon

Intraoperative frozen section analysis of the cystic stump; if it turns out positive: surgery should be extended to large bile ducts


1-2 liver segment involvement surgery



HCC surgery

Liver transplant


One or few nodules in liver surgery

Ablation techniques


What percent of the cases are unresectable for HCC

60-80% (majority of cases)


Surgical option

Resection, cryoablation, transplantation


Non surgical treatment for direct liver lesions in liver cancer

-Percutaneous ethanol injection
-radiofrequency ablation
-transarterial chemoembolisation


Non-surgical systemic treatment for liver cancers

-targeted molecular therapy
-endocrine therapy


How does chemotherapy affect hepatocellular cancer?

Has little effect, rarely given in adjuvant setting or as palliative.


Intra-arterial chemotherapy (when used) for liver tumor uses cytotoxic drugs like

Anthracycline, mitomycin-C, and cisplatin


Targeted biological therapies. First line? Second line?

-First line: Sorafenib, per os multikinase inhibitor (inhibits VEGF, PDGF, RAF)
-Second line: Regorafenib (VEGFR)


Is radiotherapy used for liver tumors

The liver is highly radiosensitive organ, while its tumor (especially HCC) have low radiosensitivity. So radiotherapy is not typically used except stereotactic ablative radiotherapy (SABRT)


Clinical indication for liver transplant

-Decompoensated cirrhosis (ascites, esophageal variceal hemorrhage, spontaneous, hepatic encephalopathy, coagulopathy, progressive jaundice, severe fatigue)
-unresectable primary liver cancers
-fulminant hepatic failure

End stage liver disease with life expectancy<1 year and if no other therapy is appropriate


MELD score (model for end-stage liver disease)

6-40 points used to prioritize liver allocation


Child-Turcotte-Pugh Score

Classification system to asses the prognosis and mortality of liver disease; patient must have >7 points (Class B)


CI to a liver transplant

-Active alcohol/substance abuse
-extrahepatic malignancy within 5 year
-advanced cardiopulmonary disease
-active uncontrolled infection


Post op complications of liver transplant

-rejected liver, need new transplant
-vascular: hepatic artery or portal vein thrombosis, IVC obstruction
-biliary complication: fever, increasing bilirubin and ALP
-complications related to immunosuppression: HTN, renal disease, DM, obesity, hyperlipidemia, osteoporosis, malignancy, neurological complications, infection (leading cause of mortality following transplant)


Prognosis of liver transplant

Patient survival at 1 year (85%)
Graft survival at 1 year >80%