Treatment

Our philosophy is to treat any disease of the liver aggressively as soon as we can, to reduce the number of possible cancer cells (sometimes called cyto-reduction) to a minimum using the most effective treatments we have available. This multi-modality cyto-reductive strategy offers the patient the best long term chance of disease control, symptom control and prolonged survival. The treatments that we offer for this disease group include:

Surgery

We always remove the primary tumour where possible and remove liver and lymph gland secondary tumours whenever we can. Often we can remove liver and bowel tumours laparoscopically (key-hole surgery). Sometimes it is worth doing very major open operations to clear out advanced tumours even if they are involving several organs or have spread around inside the abdomen. For further information on liver surgery, view our frequently asked questions before| and after| liver surgery.

Embolisation

This technique involves a fine catheter (plastic tube) being inserted into one of the arteries at the top of the leg and maneuvered up the arterial system until the tip lies inside the arterial blood vessel supplying the liver. Small protein beads, glue, pieces of sponge or fine metal coils are then released into the artery supplying the liver tumour, which partly blocks off its blood supply and causes it to shrink. Embolisation is particularly useful for tumours with a very rich blood supply such as neuroendocrine or carcinoid tumours. In some cases it can even be effective for very large or widespread liver tumours.

A similar technique injects chemotherapy agents into the liver tumour at the same time. This is known as Transarterial chemo embolisation (T.A.C.E.) and is a very effective treatment for Hepatocellular carcinoma (HCC).

Radio frequency ablation

This is a relatively new technique that uses radiofrequency electrical energy emitted from a probe placed into the tumour. This causes the tumour to heat up and kills the cancer cells. It is very effective for some small tumours such as Hepatocellular Carcinoma and is particularly useful for patients who also have cirrhosis of the liver. We also recommend it for patients who have small tumours but are not fit enough to withstand more major surgery. The procedure still requires a general anaesthetic in most cases. 

Octreotide

These are long acting injections to slow tumour growth and counter act the symptoms caused by hormone secretion.

Radio-Isotope treatment

We use radio-labelled octreotide or a chemical called MIBG (Meta Iodo Benzyl Guanidine) molecules to bind onto tumour cells and deliver radiation directly to the cancer cells to kill them and shrink the tumours.

Chemotherapy

This is most useful treatment for faster growing tumour types, particularly those arising in the pancreas. Chemotherapy is the administration of strong drugs to the human body, usually either by injection or tablet, with the intention of killing cancer cells. This is most useful for secondary liver tumours, such as colorectal cancer secondary tumours. It may be given a few months before surgery to shrink a tumour to make it easier to operate on (called neo-adjuvant treatment) or after an operation to reduce the chance of the tumour coming back in the future (adjuvant treatment). We also use chemotherapy in cases where we are unable to operate, in order to try and slow down the rate of growth of the tumour (palliative treatment) and thus improve the length and quality of life of the individual. Find out more about chemotherapy|.

SIRS (or SIRTEK)

This is selective intra-hepatic radiotherapy with micro-spheres. It is a very new technique that combines radioactive material with embolisation spheres that are injected into the arteries inside the liver. At present, this is an experimental technique that is only performed in a very few centres worldwide. We only suggest patients consider it as a last resort if they have a cancerous disease confined to the liver and are not able to have other more conventional treatments.

All of these treatments can have risks and side effects, but these are minimised by picking the best time for each treatment and using them in a sequence of treatments or in conjunction with each other to get best effect. If we recommend a complex or higher risk treatment strategy we will explain the risks, benefits, alternatives and their results to you in advance so that you can assess whether you are prepared to follow this line of treatment.