ADVANCING LIVER CANCER CARE: THERMAL ABLATION FORHEPATOCELLULAR CARCINOMA

Liver cancer often develops after long-term liver inflammation. This inflammation can lead to

cirrhosis (liver scarring). Common causes include heavy alcohol use, chronic hepatitis B or C, and fatty liver disease. People with these risk factors need regular monitoring. Monitoring occurs every 6 months as needed. An ultrasound is performed to provide a visual look at the liver. Lab work monitoring includes an alpha-fetal protein test, which is a tumor

marker for the liver. The blood work includes a CBC and blood chemistry to monitor how the

individual's health is dealing with liver disease. If nothing is seen on the ultrasound and the blood work is normal or near normal, monitoring continues.

If the blood tests and ultrasound show changes, then further testing is needed. An MRI is usually done to confirm the presence of a tumor and to define its type and location. After all the diagnostic tests are completed, the results are presented to a tumor board. This board includes a medical oncologist, hepatologist, interventional radiologist, radiologist-oncologist, and an oncology nurse. These providers will have input into the decision on how to manage the tumor. Treatment care seeks to find the least invasive and most effective option. The referring provider provides information on the person's overall health, then on what the diagnostic tests show.

A CT scan is usually performed to ensure the disease has not metastasized to the lungs. After the decision on how to manage the tumor is made, the patient is consulted and informed of the board's decision.

The treatment can vary based on all the data. If the tumor is less than or equal to three

centimeters in diameter and in a favorable location, a microwave ablation (MRA) can be

performed by an interventional radiologist.

The patient is given pre-procedure instructions. When the patient arrives at the hospital, they are taken to the procedure room. The patient is then prepared for the procedure, as for any operation.

An IV is started, and anesthesia is administered. The intervention radiologist who will perform

the procedure prepares the patient in the correct position. He uses an ultrasound or a CT scan to guide the probe/needle as near the center of the tumor as possible. After placement, heat is applied to kill the cancer cells without damaging the surrounding tissue. The tumor will change color on the monitor. The needle is retracted, and blood vessels are cauterized to prevent any bleeding.

The patient is then taken to the recovery area and monitored until they are fully awake. Pain

medication and anti-nausea medication are given as needed. After the patient is fully awake and pain medication has controlled any discomfort, the patient can usually be discharged home. Patients must have someone with them who will drive them home, verbalize understanding of the discharge instructions, and be with them overnight. This procedure is minimally invasive, requires no incision, and results in minimal post-procedure pain. Research studies show that 90% of patients are tumor-free after this method is used. An MRI is done at four weeks to be sure that the margins of the tumor are clear. Also, monitoring continues every three months with blood work and MRI testing.

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