Fall 2006
Ask The Expert: Treating Liver Cancer

I have heard that there is a new way to treat liver cancer by killing the tumors rather than by surgically removing them. How is this done, and what are the advantages of this type of treatment?

Surgical oncologist David Pearlstone, MD, FACS (Fellow, American College of Surgeons), responds:

David Pearlstone, MD, FACS

Yes, there are several new methods to treat liver tumors that do not require actually removing the tumor from the liver.

Until the 1990s, the only way to surgically treat a tumor in the liver was to open the patient’s abdomen and cut away the part of the liver containing the tumor. Removing a portion of the liver can have risks, and long-term success was rare. Since the ‘90s, open liver surgery has become safer, but—even better—new techniques have been developed to treat the tumor without actually cutting it out.

One of the most recent developments is RFA: radiofrequency ablation. (Ablation = destruction.) With RFA a surgeon places a small probe—smaller than the diameter of a pencil—into the liver, guided by ultrasound images. The tip of the probe heats up and the heat causes the tumor cells and a small surrounding area of liver tissue to die. The dead cells are then reabsorbed by the liver and eventually the liver re-grows new cells to replace the lost tissue. Multiple tumors can be treated at one time, and the procedure can be repeated multiple times.

The abdomen is often surgically opened to permit placement of the probe into the liver. In certain cases, however, RFA can be done without opening the abdomen. It can be done laparoscopically (laparo = abdomen, scope = instrument for observing): A few very small incisions are made to insert the probe and a tiny video camera.

RFA can also be done percutaneously (per = through; cutis = skin): Just the probe is placed into the abdomen through a small slit in the skin, and the probe placement is guided by an imaging system called a CT (computerized tomography) scan.

Percutaneous and laparascopic RFAs mean less discomfort and a faster recovery for the cancer patient. Both of these procedures are performed at Bridgeport Hospital.