"Any centre that seeks to be at the vanguard of hepatocarcinoma treatment must be equipped with radioembolisation, although because of its sophistication it is reasonable that there should be reference centres for this treatment".
DR. BRUNO SANGRO
DIRECTOR. HEPATOLOGY UNIT
Hepatocarcinoma is the most common primary liver tumor.
It is the fifth cause of death by cancer in the world and, in Spain, there are between 5,000 and 8,000 new cases every year.
Nowadays we have a wide range of treatments: liver transplantation, resection surgery, radiofrequency ablation, chemoembolization or radioembolization. In addition, in recent years drugs have been developed that are capable of acting systemically on different stages of the disease.
The Clínica Universidad de Navarra has more than twenty-five years of experience in the treatment of this tumor. Our objective is to offer the best treatment and to develop lines of research which will help us to find new therapies. Our center is at the forefront of research in this area.
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What are the symptoms of hepatocarcinoma?
In many cases, hepatocellular carcinoma does not present any symptoms until very late in its development. This is because the inside of the liver does not sense pain and can hold a large tumor without any symptoms presenting.
In exceptional cases, small tumors may cause symptoms by obstructing the bile duct and causing jaundice or by rupturing and bleeding.
If you have any symptoms, you should see a specialist.
When tumors increase in size without leading to problems, they end up causing severe fatigue, lack of appetite, unintentional weight loss, pain in the upper right quadrant or itching.
Do you have any of these symptoms?
You may have hepatocellular carcinoma
What causes hepatocarcinoma?
In Spain and elsewhere in industrialized Western nations, hepatocellular carcinoma almost always appears due to long-standing liver disease: in most cases, chronic hepatitis. Most patients are over the age of 40.
The hepatitis B and C viruses sometimes cause cirrhosis, and some patients with cirrhosis develop liver cancer. Cirrhosis due to other causes, such as alcohol or metabolic disorders, also predisposes individuals to hepatocellular carcinoma.
In areas where liver cancer is more common (Southeast Asia and Africa), it occurs far more frequently without there necessarily being any prior liver cirrhosis. In these regions, patients usually fall ill at an earlier age (under 40 years of age).
How is hepatocarcinoma diagnosed?
The Clínica offers various techniques that can be used to diagnose liver cancer, including hepatocellular carcinoma.
Liver elastography: novel, non-invasive, simple and fast. This technique improves the diagnosis and the long-term progress of patients with hepatic fibrosis. The test takes just 15 minutes, requires no anesthesia and is painless.
Other techniques used to detect possible liver cancers include ultrasound, CT scan, MRI and liver biopsy.
How is hepatocarcinoma treated?
The aim of chemotherapy is to destroy cancer cells in order to reduce the disease; chemotherapy does this by combining a variety of drugs to make them work more effectively.
Cancer cells grow and divide quickly. Chemotherapy stops or slows their growth, bringing about a reduction in disease relapses and an increase in survival rates.
The frequency and duration of chemotherapy depends on the cancer type, treatment goals, the drugs to be used and how the body responds to them.
During or after treatment, the oncologist will order tests to see how the tumor responds to chemotherapy: whether it has disappeared or decreased, whether it remains stable or whether it has continued to grow.
Arterial embolization involves injecting gelatin microspheres into an artery in a highly selective manner in order to block off certain small vessels. This leaves the tumor(s) without a blood supply. The treatment is usually repeated every six weeks as many times as necessary, which is usually three or four times.
Although arterial embolization does not require an operating room or anesthesia, an admission of two to four days is common: this is the time needed to control side effects such as pain, nausea and fever. Although not a particularly risky treatment, patients are often tired or have a mild fever over the days following the procedure.
Embolization is a treatment that can be used when other more resolute treatments, such as surgery or radiofrequency ablation, are not possible.
Applying this treatment offers patients higher survival rates and can even be curative. It should be borne in mind that the treatment can be applied only when liver function is particularly good.
Radiofrequency ablation is a simple, safe and well-tolerated therapeutic technique.
It is based on the application of intense heat to liver tumors, whether these are primary or secondary tumors (liver metastases).
To transmit this intense heat to tumors, needles are inserted into the liver through the skin, using a procedure that does not require general anesthesia, but rather deep sedation is used to make it less uncomfortable. Specialists use ultrasound to guide and position the needles in the tumor.
Once in place, heat-generating energy is applied for a few minutes. All tissue surrounding the needle, up to a maximum diameter of around 5 cm, is burned away. Therefore, this treatment is only suitable for tumors of 5 cm or less in diameter.
When the tumors are not visible on the ultrasound or when there are several tumors and the procedure will be lengthy, it can be carried out in an operating room through open or laparoscopic surgery.
Hospitalization time is usually 24 hours.
Yttrium-90 is a radioactive microsphere that is applied directly to the liver.
This treatment targets liver tumors and delivers millions of microscopic radioactive beads (radio- or microspheres) directly to the liver.
These microspheres contain the radioactive element yttrium-90, which irradiates over a very short distance (about 2.4 mm). Placing these spheres near the cancer areas ensures good control of the radiation area, thus avoiding damage to healthy areas.
The Clínica has one of the leading survival rates: over 90% of patients survive after one year following the surgery, and the approximate survival rates at five and ten years are 70% and 60%, respectively.
The Navarre University Hospital’s team of surgeons and hepatologists has performed over 400 liver transplants, with more than twenty living donors. This makes the Navarre University Hospital one of the leading Spanish hospital centers with expertise in liver transplants using living adult donors.
This is the only curative treatment for serious diseases such as cirrhosis, some cancers, congenital liver defects or metabolic disorders where the liver is deficient. It involves removing the diseased liver, entirely or in part, and replacing it with a healthy liver from a deceased or living donor.
What clinical trials do we have on hepatocarcinoma?
Where do we treat it?
IN NAVARRE AND MADRID
The Liver and Pancreatic Tumors Area
of the Clínica Universidad de Navarra
The Liver and Pancreas Tumors Area is a multidisciplinary area exclusively for the comprehensive approach of tumor pathology of the liver, pancreas and biliary tract, as well as living donor liver transplantation.
Patient care will be coordinated by a single reference person who is an expert in these pathologies and who will be in charge of informing and coordinating consultations, tests, treatments, surgeries, etc., in less than 24 hours.
Why at the Clinica?
- Integral evaluation of the patient.
- Possibility of beginning personalized treatment 24 hours after the first consultation.
- Minimally invasive surgery for the best recovery of patients.
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