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Interventional Radiology Treatments for Liver Cancer during Covid-19 Crisis

by Dr. Santosh B. Patil (consultant Neuro and Vascular Interventional Radiologist at The Vein Center.)
Jul 30, 2021
Interventional Radiology Treatments for Liver Cancer during Covid-19 Crisis, Article, KonexioNetwork.com

The COVID-19 pandemic has rightfully occupied the minds and efforts of almost everyone in healthcare for the past year, but liver cancer (hepatocellular carcinoma) has not disappeared and is still causing harm. Liver cancer is at this time, the fourth leading cause of cancer-related death, with three times increase in the occurrence of new cases during the past 40 years. 

What is liver cancer? Who are more likely to get it?

This is a type of cancer that starts in the liver. Primary liver cancer typically affects individuals who already have advanced liver disease or cirrhosis (usually as a result of hepatitis B or C virus infection), alcoholic liver disease or fatty liver disease. Secondary liver cancers can develop as a result of spread from cancers of other parts of body such as bowel, lungs, breasts, etc.

Why is liver cancer so difficult to treat?

When treating liver cancer, physicians have to address both the presence of cancer and the functional impairment of the liver itself due to underlying diseases. These limit the choices of therapy and in some cases may exclude surgical options. In addition, liver cancer is difficult to diagnose and not easily detectable in early stages. Because of that, many patients already have advanced cancer by the time they seek treatment and can no longer be surgically treated.

What are the treatment options for liver cancer?

Surgical resection remains the first-line treatment for patients with solitary tumors and preserved liver function. For patients who are not candidates for surgical resection, liver transplantation is the first-line treatment if the tumor characteristics are within transplant criteria. Unfortunately, only 10–20 percent of patients are candidates for resection/ transplant due to tumor burden, the presence of extrahepatic spread or the extent of underlying liver disease. Novel non-invasive interventional radiology treatment methods provide a ray of hope to the rest of the patients of liver cancer.

What are the newer minimally invasive treatment options for liver cancer?

Ablative anti-cancer therapies: include radiofrequency ablation, microwave ablation, cryotherapy and irreversible electroporation therapy. With ablative therapies, interventional radiologists insert a small, needle-like probe directly into the tumor using live image guidance to identify its precise location. Depending on the type of therapy, monitored heat, cold, or electrical energies are then passed through the probe to destroy the liver tumor.

Trans-arterial anti-cancer therapies: With these, interventional radiologists or oncologists employ live image guidance to advance a small tube, called a micro-catheter, through a tiny hole in the patient's groin or wrist until it reaches the blood vessel that supplies the liver tumor. Once in place, the micro-catheter is used to deliver high doses of either chemotherapy or radiation to the exact location. When delivering microspheres with chemotherapeutic drugs, this therapy is called transarterial chemoembolization (TACE). When delivering microspheres that contain a radiation source, the therapy is called transarterial radioembolization (TARE) or Y90 radiotherapy.

These therapies can be performed in isolation or as a combination to derive the best result.

What are the benefits of interventional radiology treatments?

One of the enormous benefits of image-guided therapy is its reduction in side effects, compared to systemic chemotherapy or conventional radiation. Because tumor ablative therapy targets tumors precisely, healthy organs will be relatively unaffected, and patients will be protected from more serious and uncomfortable side effects. 

These precision interventional treatments are so well tolerated that they are mostly outpatient procedures without need for general anaesthesia. For interventional treatments, occasional side effects might include fatigue, flu-like symptoms and inflammation due to a rise in liver enzymes. But those side effects tend to pass quickly, within one to two weeks after treatment. Patient can quickly return to normal daily life.

How is COVID-19 pandemic affecting liver cancer care?

With the ongoing pandemic and lockdown, patients are finding it difficult to consult their medical professionals. The surgeries are being deferred due to shortage of healthcare personnel, inavailability of OTs and risk of spread of corona virus during general anaesthesia procedures. Patients who are on long term surveillance for their liver tumors are at risk of landing into advanced stages of cancer undetected without widespread availability of proper surveillance.

How can the liver cancer patients get themselves checked/ treated during COVID-19 pandemic?

If you are receiving treatment for cancer, you should follow your doctor’s guidance. Telemedicine using video consultation is one platform where the patients can now seek medical advice. Some cancer treatments can be safely delayed, whereas others cannot. Newer interventional radiology treatments can be safely offered in eligible patients since these are minimally invasive day-care procedures which do not require anaesthesia. Shorter hospital stay reduces the exposure to corona virus.  

If I have cancer now or had it in the past, should I get a coronavirus vaccine?

People, including those with underlying medical conditions such as cancer, may get vaccinated if they have no contraindications—that is, no history of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine. Clinical trials have shown that the safety and efficacy of the vaccines are similar in people with underlying medical conditions that put them at increased risk for severe illness from COVID-19 and in people without those conditions. And vaccines for other infections, like the flu, are safe and recommended for people with cancer. However, more data are needed on the safety and efficacy of COVID-19 vaccines in people with compromised immune systems due to an underlying medical condition or immunosuppressive therapies. It is possible that these individuals may have a weaker response to the vaccine. People who have received the vaccine should continue to follow all current guidance to protect themselves against COVID-19 exposure.

By Dr. Santosh B. Patil, consultant Neuro and Vascular Interventional Radiologist at The Vein Center.