Surgery is the most preferred treatment in early stages of cancerous or benign liver tumours. For benign tumours, surgery is usually enough to remove the tumoural cells completely but for cancerous or malignant tumours, surgery is accompanied by radiotherapy and chemotherapy series.However, there are circumstances where a patient with cancerous tumour does not get a chance to go for surgery and the disease progresses to an advanced stage where the tumour cover more than 95 per cent of the liver. In cases where there is no metastasis or the disease has not attacked other organs, liver transplant is one of the options to save the life of the patient. But this procedure is expensive and few afford this kind of treatment in the developing world.Another rare but life-saving technique is the embolisation procedure that requires highly qualified personnel to perform. Embolisation is the injection of substances to try to block or reduce the blood flow to cancer cells in the liver.The liver is usually fed by two blood supplies. Most normal liver cells are fed by branches of the portal vein, whereas cancer cells in the liver are usually fed by branches of the hepatic artery. Physicians tend to exploit this mechanism to treat an advanced liver cancer. This is because when the branch of the hepatic artery feeding the tumour is blocked, helps kill off the cancer cells and leaves most of the healthy liver cells not affected because they get their blood supply from the portal vein.Embolisation is an option for patients with tumours that cannot be removed by surgery. It can be used for tumours that are too large to be treated with ablation usually larger than 5cm across. However, embolisation reduces some blood supply to the normal liver tissue, so it may not be a good option for patients whose liver has been damaged by diseases. There are different methods through which these procedures are performed and these include the arterial embolisation, chemo embolisation and radio embolisation. In arterial embolisation, a thin, flexible catheter or tube is put into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver. A dye is usually injected into the bloodstream at this time to help the physician monitor the path of the catheter via angiography, a special X-ray. Once the catheter is in place, small particles are injected into the artery to plug it up. For chemo embolisation, there are small particles coated with chemotherapy drugs before injection or done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery. Another technique is combining embolisation with radiotherapy. This is done by injecting small radioactive beads known as microspheres into the hepatic artery. Brand names for these beads include TheraSphere® and SIR-Spheres®. Once infused, the beads lodge in the blood vessels near the tumour, where they give off small amounts of radiation to the tumour site for several days. These expensive techniques have shown to improve the health status of patients with end stage liver disease. Although they come with complications, the advantages outweigh disadvantages. Dr Joseph Kamugisha is a resident oncologist in Jerusalem, Israel
