Even as liver cancer rates surge, better treatments are bringing new hope to those battling the disease.
The American Cancer Society says that liver cancer incidence rates have tripled in the U.S. over the past four decades. But Carlos Romero-Marrero, MD, division chief of gastroenterology and director of the Liver Center at Cleveland Clinic Martin Health, says that new or improved transplant procedures, chemotherapy combinations, and ablations are among the treatments improving quality of life and longevity.
Dr. Romero, as he prefers to be called, explains that hepatocellular carcinoma is the most common form of liver cancer. “It’s an aggressive (fast-growing) cancer most common in people with advanced liver disease, like cirrhosis of the liver. It accounts for some 90 percent of all primary liver cancers,” he says.
“Primary means that the cancer starts in your liver.”
Liver cancer can be treated using a variety of approaches, depending on the stage and progression of the disease.
“Early diagnosis is important and often allows us to begin treatment with less invasive therapies. Ablation uses ultrasound to insert probes through the skin to destroy tumors using heat, cold or other techniques,” says Dr. Romero.
Memorial Sloan Kettering Cancer Center says that ablation for treating liver cancer targets only the tumor and a small margin of normal tissue right around the tumor. This helps reduce side effects and the risk of cancer coming back. You do not need to stay in the hospital to have this procedure.
It is recommended that you have ablation if you have three or fewer liver tumors, each smaller than 3 centimeters in size.
Dr. Romero says, “The number of combinations of chemo and immunotherapies used to treat liver cancer has increased dramatically since 2018.
“Until 2018 there was basically only one type of chemotherapy, but since then there have been a number of major breakthroughs that have increased the survival rate.”
Hepatic arterial infusion chemotherapy now delivers chemotherapy drugs directly to the liver through a pump in the abdomen. This technique, used in combination with traditional chemotherapy, has been shown to dramatically increase survival for patients with liver cancer.
“Another one of the most exciting advances in treating liver cancer is a new machine that greatly increases the amount of time we have to preserve a liver for transplantation,” says Dr. Romero.
“Machine perfusion is an advanced organ preservation technique that circulates oxygenated blood or other fluids through the donor organ before transplantation.”
UCLA Health explains the differences between this method and one that was previously used.
Livers from deceased donors were traditionally transported via cold storage, which meant being placed in a cooler and maintained at a temperature of 4 degrees Fahrenheit during transit.
Livers can last up to 10 to 12 hours outside of the human body. After that, the lack of blood circulation and resulting lack of oxygen and nutrients increases the risk of damage.
The timing of a donor’s death and a recipient’s operation timeframe made getting viable livers to patients a challenge. With machine profusion, more livers are making it to the operating table in time.
MD Anderson Center lists some other treatments currently being used to treat liver cancer patients:
- Embolization: Material is injected into the artery that carries blood to the tumor. Chemotherapy or radiation therapy are directed at the tumor instead of through the whole body. In some cases, blood vessels going to the tumors can be blocked.
- Radiation therapy: New radiation therapy techniques allow doctors to target liver tumors more precisely, using the most radiation with the least damage to healthy cells. Therapies include Stereotactic body radiation therapy, MRI-guided radiation therapy, and Proton therapy.
- Targeted therapies: Designed to interfere with, or target, disease molecules or the cancer-causing genes that create them.
- Histotripsy: Uses a robotic machine to target cancerous tumors with precise sound waves, breaking them apart without the need for surgery, needles or radiation.
Dr. Romero says that ideally, the hospital where you are receive treatment will have a Liver Tumor Board, as Cleveland Clinic Florida does, or similar body to ensure you’re getting the best and most up-to-date care.
“Doctors and other medical professionals who comprise such a board would include, ideally, medical oncologists, liver surgeons, radiation oncologists, diagnostic and interventional radiologists, hepatologists, pathologists and nurse practitioners.”
Dr. Carlos Romero-Marrero completed his medical training at the University of Puerto Rico, which also included a residency in internal medicine and a fellowship in gastroenterology. He completed an advanced fellowship in liver transplantation at Mayo Clinic, specializing in gastrointestinal and liver diseases. His office is in Tradition HealthPark Two, 10080 SW Innovation Way, Port St. Lucie, next to Cleveland Clinic Tradition Hospital. Call 877-463-2010 for an appointment.
