Hepatocellular carcinoma medical therapy

Revision as of 19:03, 11 September 2015 by Mohamad Alkateb (talk | contribs)
Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [3]

Hepatocellular carcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes of Hepatocellular carcinoma

Differentiating Hepatocellular carcinoma from other Diseases

Epidemiology & Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

Diagnostic study of choice

History and symptoms

Physical Examination

Lab Tests

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hepatocellular carcinoma medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hepatocellular carcinoma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hepatocellular carcinoma medical therapy

CDC on Hepatocellular carcinoma medical therapy

Hepatocellular carcinoma medical therapy in the news

Blogs on Hepatocellular carcinoma medical therapy

Directions to Hospitals Treating Hepatocellular carcinoma

Risk calculators and risk factors for Hepatocellular carcinoma medical therapy

Overview

Patients with hepatocellular carcinoma are treated with ethanol injections, transcatheter arterial chemoembolization (TACE), sealed source radiotherapy, radiofrequency ablation (RFA), intra-arterial iodine-131-lipiodol administration, high intensity focused ultrasound (HIFU), hormonal therapy, and chemotherapy.

Medical Therapy

Medical therapy for hepatocellular carcinoma

Percutaneous ethanol injection

Percutaneous ethanol injection (PEI) well tolerated. It's preferred in small (< 3 cm) solitary tumors.

Transcatheter arterial chemoembolization (TACE)

  • Transcatheter arterial chemoembolization (TACE) is usually performed in the treatment of large tumors (larger than 3 cm and less than 4 cm in diameter), most frequently by intraarterially injecting an infusion of antineoplastic agents mixed with iodized oil (such as Lipiodol).
  • Combined PEI and TACE can be used for tumors larger than 4 cm in diameter.

Sealed source radiotherapy

Sealed source radiotherapy can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue). TheraSphere is an FDA approved treatment which has been shown in clinical trials to increase survival rate of low-risk patients. This method uses a catheter (inserted by a radiologist) to deposit radioactive particles to the area of interest.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses high frequency radio-waves to ablate the tumour.

Intra-arterial iodine-131–lipiodol administration

Intra-arterial iodine-131–lipiodol administration demonstrated some efficacy in unresectable tumors, especially in patients with portal vein thrombus. This treatment is also used as adjuvant therapy in resected patients. It is believed to raise the 3-year survival rate from 46 to 86%.

High intensity focused ultrasound (HIFU)

High intensity focused ultrasound (HIFU) is a new technique which uses much very powerful ultrasound to treat the tumour. Still at a very experimental stage. Most of the work has been done in China. Some early work is being done in Oxford and London in the UK.

Hormonal therapy

Hormonal therapy with Antiestrogen therapy and tamoxifen can be used in hepatocellular treatment.

Chemotherapy

  • Oral synthetic retinoid for 12 months after resection/ablation maybe helpful in the treatment of hepatocellular carcinoma.[1]

Interventional radiology

Intervention radiology may help in hepatocellular carcinoma treatment.

Contraindicated medications

Hepatocellular carcinoma is considered an absolute contraindication to the use of the following medications:


The effectiveness of medical therapy is related to the following:

  • Size
  • Involvement of liver vessels
  • Presence of a tumor capsule
  • Presence of extrahepatic metastases
  • Presence of daughter nodules
  • Vascularity of the tumor

References

  1. [1] American Society of Clinical Oncology, 2005 Annual Meeting, Abstracts on Hepatobiliary Cancer


Template:WikiDoc Sources