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Malignant Liver Tumours


In modern liver surgery the extent of resection varies. Moreover, through the possibility of total hepatectomy(removal of the liver) and liver transplantation in cases of malignomas, a higher percent of resections could be reached.


Hepatocellular Carcinoma


Of all malignant liver tumours, the liver cell carcinoma (HCC) - 5 cases out of 100,000 people - has the highest rank. The most common cause of this carcinoma is cirrhosis of the liver brought about by alcohol or viruses (hepatitis B, C). HCC manifests itself with pressure pains in the right upper abdomen and emaciation. Blood testing shows an increase of alpha fetoprotein (AFP) of over 15 mg/l. Diagnostic imaging plays a key role in the recognition of the tumour and is crucial in determining the treatment.


The most commonly chosen treatment is surgical removal of the primary liver malignoma while saving as much as possible of functional liver tissue. Partial liver removal is the most commonly chosen treatment for small hepatocellular carcinomas without cirrhosis. If a patient has both liver tumours and cirrhosis, surgical success is doubtful. In such a case the best treatment would be liver transplantation.


Surgical Therapy

In addition to an operation, the following alternative procedures are possible:


Percutaneous Alcohol Injection Therapy (PEI or PEIT)

In this therapy the carcinoma is punctured with a needle through which alcohol is injected into the tissue of the tumour. Injections of ethanol currently achieve the best results for of all non-surgical therapies of small hepatocellular carcinoma. The limitations of this procedure are demonstrated in cases of a large number of treatments involving a danger of the tumour spreading along the injection cannels, as well as tumours reappearing in other parts of the liver, and in carcinomas having septa within the tumour which limit diffusion of the alcohol.


Transarterial Chemoembolisation (TACE)

In transarterial chemoembolisation the radiologist finds the artery leading to the tumour which is cathererised. Following this, medication which should destroy the tumour, is injected into this catheter. Transarterial chemoembolisation of small hepatocellular carcinomas, i.e. selective occlusion of vessels within the tumour generally using oily substances or gelatine (cisplatin,anthrazyline), is performed on patients for whom resection or transplantation is not possible. TACE has become the most wide spread therapy for inoperable carcinomas.


Radiofrequency Ablation (RF)

Radio frequency ablation, (RF) is a modern therapy which hinders the growth of the tumour and at the same time causes the tumour to die, with customised radiation (using radio frequencies).

Each of these alternatives has their individual importance in the treatment of tumours, depending on the stage of development of the tumour. They are mainly used to change an inoperable tumour into a stage where it can be operated. Despite all promising results, surgery has demonstrated to be the only therapy with a potential cure.


Cholangiocellular Carcinoma (CCC)

With only 5%-30% of the cases, bile duct cancer (cholangiocellular carcinoma = CCC) occurs more seldomly . This malignant tumour is only recognized in a very late stage during painless yellow fever with an enlargement of the gall bladder which can be easily felt by the doctor. Important methods of diagnosis are ultrasound, computer tomography (CT), and magnetic resonance imaging (MRI). Small tumours can be treated with a combination of radio-chemotherapy and surgery. In advanced stages, chemotherapy and measures to maintain the flow of bile (stent - a mesh tube - insertion). 



Secondary tumours, called metastases, are most commonly found in the liver. 75% of intestinal tumours cause metastases in the liver. In the case of a single metastasis, the affected part of the liver can be removed with good long term results. If, however, several metastases are present, generally the only choice is chemotherapy or one of the above described procedures.