Other treatments for secondary cancer in the liver
The following treatments may only be available for certain cancers and as part of a research trial.
If your doctor feels that any of these may be helpful in your situation, they can refer you to a hospital that carries out the treatments. It’s usually necessary to use them in combination with other treatments such as chemotherapy and/or surgery. They are only available in some specialist hospitals, so you may have to travel a long way for treatment.
This is similar to radiofrequency ablation but uses laser energy rather than radio waves. A high-powered light is used to destroy the cancer cells by heating them to very high temperatures.
A sedative drug is given to make you feel drowsy and a local anaesthetic is used to numb the skin of your abdomen. Sometimes laser ablation is given using a general anaesthetic. The doctor will gently insert a flexible tube, which carries the laser, through the skin over the liver and into the centre of the tumour. They’ll usually use a CT or ultrasound scan to make sure the tip of the tube is in the right place. The laser heats the tumours and destroys them.
This technique takes about 10-15 minutes and can be used to treat tumours up to 5cm (2in) in size. Usually a person is able to go home a few hours after they’ve had this treatment.
Side effects of the treatment include pain and a high temperature (fever) for a short time.
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During cryotherapy treatment, a device called a cryoprobe is inserted into the centre of the tumour during an operation. Liquid nitrogen is then passed through the probe. This freezes the surrounding area and destroys the cancer cells. Sometimes the area is thawed for 10-15 minutes and then frozen again.
Cryotherapy is only suitable for liver tumours smaller than 4cm (1½in). The procedure takes 30-60 minutes and usually involves a short stay in an intensive care unit, followed by a stay of around two days in a specialist liver treatment ward.
This treatment may be painful. The pain only lasts for a short time after the treatment and you’ll be given painkillers to help. Some people have a fever afterwards. This can also be relieved with medicines.
Selective internal radiotherapy treatment (SIRT)
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This treatment involves having millions of very tiny ‘beads’ (microspheres) injected into the liver. Each bead is coated with a radioactive isotope that gives off radiation. The treatment gives a dose of radiotherapy specifically to the liver over a period of a few days.
Before having the treatment, a test called an angiogram is done. A fine tube (catheter) is put into a blood vessel in the groin area and passed up into a blood vessel taking blood to the liver (hepatic artery). The angiogram looks at the blood flow to the liver to make sure that the microspheres don’t go anywhere else in the body when the treatment is given.
For the treatment itself, another angiogram is done. The microspheres are injected through the catheter, where they become stuck in the small blood vessels around the tumour. The radiation given off by the microspheres damages the cancer cells and stops them growing. It also damages the blood vessels to the tumour so that it can’t get the nutrients it needs.
The amount of radiation given off by the microspheres is small and lasts for about 10-14 days. The microspheres remain in the liver permanently and are harmless.
The treatment involves staying in hospital for 1-4 days.
It’s important that anyone having this treatment doesn’t come into contact with anyone younger than 15, or anyone who is pregnant.
Side effects include having a high temperature and abdominal pain straight after the injection. These can last for a few days. Other side effects include feeling sick (nausea), being sick (vomiting), and diarrhoea.
Depending on how effective it is, the treatment can sometimes be repeated.
This treatment destroys cancer using heat. Needle electrodes are placed into the liver tumours, under a local or general anaesthetic. The cancers are then destroyed using microwave energy given through the needles directly into the tumours.
This is a very new treatment, and it’s not yet clear how useful it will be in treating secondary liver cancer. It’s only being used as part of cancer research trials.
This treatment uses sterile alcohol to destroy the cancer cells. The technique is only suitable for small tumours (4-5 cm). A small needle is inserted into the liver tumour under local anaesthetic. The doctor will usually use a CT scan or ultrasound to make sure the needle is in the right place. The alcohol is then injected directly into the tumour.
Alcohol treatment is only effective if there is one small tumour in the liver or a limited number of small separate tumours.
The injection can be painful, so you’ll be given painkillers to take for a while afterwards. Some people have a feeling of being drunk for 10-15 minutes after the injection. You may be kept in hospital for a few hours after your treatment in case you have any bleeding or pain. This treatment can be repeated some time later if necessary.
Hepatic artery chemoembolisation
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While using x-ray pictures, a thin plastic tube (catheter) is placed into a blood vessel in the groin. This is passed upwards until the tip is in the artery that takes blood to the liver (hepatic artery). A chemotherapy drug mixed with an oily liquid is then injected into the liver and the catheter is removed.
The oily liquid creates blood clots in the blood vessels that carry blood to the tumour. This stops oxygen and nutrients getting to the tumour. The chemotherapy stays in the tumour in high concentrations, which can kill some of the cells and shrink the tumour.
How long the procedure takes, and the side effects it causes, will depend on the type of chemotherapy used. Some people may temporarily experience pain, feel sick or be sick, and have a high temperature. Chemoembolisation is usually carried out under a local anaesthetic.
High intensity focused ultrasound (HIFU) treatment
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This is a newer treatment that uses high-energy, high-frequency focused sound waves to produce high temperatures inside the tumour cells and destroy them. It may be carried out under a local or general anaesthetic.
HIFU may be used to treat secondary liver cancer that can’t be removed by an operation. It can help to control the cancer. It’s currently only used as part of a research trial or as a private treatment.
Side effects of this treatment are generally mild and include pain in the liver area, swelling and minor skin blisters.
The treatment may need to be done more than once.
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This is a new way of giving radiotherapy that may sometimes be used if surgery or RFA aren’t suitable.
Stereotactic radiotherapy treatment is given using a specially adapted radiotherapy machine, sometimes called CyberKnife, which delivers beams of radiotherapy from many different angles. The beams overlap at the tumour. The radiotherapy dose to the tumour is therefore very high, but the dose to surrounding tissues is very low.
Treatment with CyberKnife is only available in a small number of hospitals in the UK. Your specialist can give you more information.