By Dr Vincent Lai Wai Kwan, Gastroenterologist
In our previous post, Dr Vincent Lai introduced the causes, symptoms and detection of Hepatocellular Carcinoma (HCC), the most common type of primary liver cancer.
Here, Dr Lai discusses the potential cures for HCC.
Treatment options for HCC
Broadly, it can be divided into curative or palliative treatment. The chance of curative treatment is only possible if the cancer is still only in the liver and the liver has good enough function to tolerate the treatment. Unfortunately, most patients with liver cancer also have underlying cirrhosis. Hence, the treatment options have to take into consideration how good the function of the cirrhotic liver is.
In the past surgery offered the only curative treatment in terms of resection (cutting out the cancer) and if the liver function was bad then liver transplant offered to remove the underlying diseased liver and replace it with a new liver. In doing so, it removed the cancer and a failing liver.
However, if the patient has a cancer detected early and is small, locoregional therapy like radiofrequency ablation or trans-arterial chemoembolization may achieve a cure. In patients who present late or are not suitable for surgery, then locoregional therapy may be used, including selective internal radiation therapy. In some advance cases, oral chemotherapy may be used.
In the near future, there is potential improvement of survival in patients with advanced liver cancer with immunotherapy.
As majority of the HCC are caused by HBV or HCV in Asia, adequate management of these underlying risk factors will lead to a decreased risk of cancer developing. There are now good antivirals that can suppress the HBV virus for a long term, hence preventing progression of the liver disease to cirrhosis and subsequent liver failure. Suppressing the virus has also been shown to reduce the risk of HCC.
Similarly, there are now very good antivirals available that can effectively cure hepatitis C, in so preventing the progression of liver damage and again reducing the risk of HCC.
Hence, identifying the underlying liver disease and good management can prevent the progression to cirrhosis, liver failure and reduce the risk of HCC.
In selecting at-risk individuals to undergo regular 6-monthly screening, we can detect early cancer, hence increasing the chance of cure.
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