Liver cancer causes no symptoms for a long time, so people with cirrhosis or chronic hepatitis need regular surveillance. This article covers risk factors, diagnosis and the treatments offered in Israel, from surgery to SIRT radioembolisation.
What liver cancer is
Primary liver cancer is most often hepatocellular carcinoma (HCC), which grows from the liver's own cells; cholangiocarcinoma, a tumour of the bile ducts, is less common. Secondary liver cancer means metastases from tumours elsewhere, most often the colon; it is treated according to the primary cancer.
Risk factors
- cirrhosis of any cause;
- chronic hepatitis B and C;
- long-term alcohol use;
- fatty liver disease linked to obesity and diabetes;
- haemochromatosis, aflatoxins in food, smoking.
People with cirrhosis are advised to have a liver ultrasound every six months, which allows a tumour to be found while it can still be cured.
Symptoms
At an early stage there are usually no complaints. Later come weakness, loss of appetite and weight, pain under the right ribs that may spread to the back or shoulder, abdominal swelling, jaundice and dark urine.
Diagnosis in Israel
- Blood tests: liver function, hepatitis markers and alpha-fetoprotein (AFP). AFP is not raised in every patient, so a normal result does not rule out a tumour.
- Multiphase CT or contrast MRI: in patients with cirrhosis a typical appearance on imaging often allows the diagnosis without a biopsy.
- Biopsy when the appearance is atypical or there is no cirrhosis.
- Assessment of liver reserve, which determines which treatments are safe.
Treatment methods
Surgery and transplant
Liver resection is performed when the tumour is limited and liver function is preserved. Some patients with cirrhosis and small tumours are candidates for a liver transplant; for international patients this is possible only from a living related donor and subject to local regulations.
Ablation
Small tumours are destroyed by heat, using radiofrequency or microwave ablation, through a needle placed under ultrasound or CT guidance.
Intra-arterial treatments: TACE and SIRT
In chemoembolisation (TACE) a drug is delivered into the artery feeding the tumour, which is then blocked. In radioembolisation (SIRT) yttrium-90 microspheres are delivered through a catheter into the hepatic artery and irradiate the tumour from within. These methods are used when a tumour cannot be removed and is confined to the liver, including metastases; they do not act on disease outside the liver.
Drug therapy and radiotherapy
For advanced HCC, first-line treatment is combination immunotherapy, with targeted drugs as further options. Stereotactic radiotherapy is used for individual lesions when other local methods are unsuitable.
The plan is drawn up by a team of oncologists, surgeons, interventional radiologists and gastroenterologists and hepatologists. The outlook depends on the stage and the state of the liver, so no result can be guaranteed.
Planning treatment in Israel
Send the clinic your reports, blood tests, CT or MRI discs and the biopsy result if one was done. The work-up takes a few days. The hospital stay is one to two days after ablation or embolisation and about a week after resection. Check when follow-up scans are needed and where they can be done, and ask for a written estimate listing what is included.
Frequently asked questions
Can liver cancer be found early?
Yes, if people at risk have an ultrasound every six months.
Is a biopsy always needed?
No. With cirrhosis and a typical appearance on CT or MRI the diagnosis is made without one.
Who is suitable for SIRT?
Patients with inoperable tumours confined to the liver and adequate liver function; this is checked during a preparatory angiogram.
Are liver metastases treated?
Yes: depending on the primary tumour, surgery, ablation, intra-arterial methods and drug therapy are used.
Need a second opinion or liver cancer treatment abroad? Send a request and Clinics Direct medical coordinators will help you choose a clinic and find out the cost of tests and treatment free of charge.
