Liver Cancer

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Liver Cancer

What is liver cancer?

The liver is a vital organ with many functions. It produces bile, filters blood, stores glucose and produces substances that are essential for maintaining balance within the body.
In 90% of cases, primary liver cancer appears as hepatocellular carcinoma or hepatocarcinoma. This type of cancer generally originates in the cells that make up most of the liver. The main causes of hepatocellular carcinoma are cirrhosis of the liver - mostly caused by excessive alcohol consumption, hepatitis B and C or the accumulation of fat in the liver cells (20% of cases). Cirrhosis develops over several years, culminating in a genuine precancerous state.
Liver cancer can also occur in the cells lining the bile ducts within the liver. This is then known as bile duct cancer or cholangiocarcinoma.
An estimated 10,580 new cases of liver cancer were diagnosed in France in 2018, nearly 75% of which involved men*.

Diagnosis of liver cancer

As the symptoms of hepatocellular carcinoma are not that specific, a series of examinations is needed to assess the condition of the liver and confirm liver cancer diagnosis.
Gustave Roussy is involved in the diagnosis and treatment of liver cancer, but also manages patients whose diagnosis has been confirmed.
Hepatocellular carcinoma usually appears in a liver already weakened by cirrhosis, regardless of the cause. Once cirrhosis has been diagnosed and managed, biannual screening includes ultrasound scans, which allows curative treatment to be introduced more frequently.
Unlike other cancers, the diagnosis of hepatocellular carcinoma can be confirmed on simple imaging with CT or MRI scans provided that the appearance is typical of an established or obvious clinical context. Elevated alpha-fetoprotein levels in the blood also corroborate the diagnosis of hepatocellular carcinoma. Liver biopsies of tumour- and non-tumour-infiltrated sections of the liver are recommended in order to assess the underlying liver disease and devise the optimum treatment strategy.
All the disciplines involved in the treatment of hepatocellular carcinoma are available at Gustave Roussy. Expert liver surgery, interventional radiology, radiotherapy and digestive oncology teams have access to the state-of-the-art technical facilities (PET scan, MRI, hybrid operating room and robotic surgery, etc.), and can offer the most appropriate treatment for each patient.
Treatment pathway decisions are taken during multidisciplinary meetings. These meetings involve several doctors from different disciplines including gastrointestinal oncologists, liver surgeons, radiotherapists and interventional radiologists who have access to the latest technical equipment. A meeting report is also compiled for each patient.

Liver cancer treatments

The prognosis of hepatocellular carcinoma is not only related to tumour spread but also to the severity of the cirrhosis. At Gustave Roussy, different strategies can be introduced to treat the condition:
Surgical resection
Surgical resection involves the removal of all or part of the liver in which the tumour has developed. This procedure can only be performed if there is just one lesion and provided that there are no cirrhosis-related complications. Moreover, the patient must display good liver function. Minimally invasive surgery using a laparoscopic or robotic-assisted approach is now available for most patients in order to improve post-operative follow-up. Nowadays, the advent of robotic surgery allows therapeutic indications to be extended through greater procedural dexterity and 3D visualisation.
Percutaneous destruction
Percutaneous tumour destruction is an alternative to surgery. It consists of a minimally invasive, image-guided technique that destroys the tumour using heat (radiofrequency) or cold (cryotherapy), thereby significantly reducing the risk of complications. The procedure is performed through the skin and is carried out under general anaesthesia by an interventional radiologist specialising in image-guided treatments.
Chemoembolization or radioembolization
Chemoembolization or radioembolization are so-called "locoregional" treatments. They are intended for patients with hepatocellular carcinoma limited to the liver. They involve injecting particles of varying size into the hepatic artery. These particles are either radioactive or contain a chemotherapy drug.
Gustave Roussy is a pioneer in loco-regional treatments with an expert and internationally acclaimed interventional radiology team. Access to all these treatments and the latest innovations is guaranteed via a technical platform – the first of its kind in Europe (intra-tumour immunotherapy, hepatic intra-arterial immunotherapy, robot-assisted guidance, multimodal therapeutic combinations, etc.).
Liver transplantation
Also referred to as a liver graft, liver transplantation has the advantage of treating both cirrhosis and hepatocellular carcinoma. Nevertheless, this treatment can only be offered to very few patients (less than 5%) because of age, comorbidities, restrictive criteria in terms of tumour spread and the shortage of grafts. As liver transplantation is highly centralised in France, it is limited to two centres operating in the Paris region. Gustave Roussy works closely with these centres.
Other types of treatment for hepatocellular carcinoma are available at Gustave Roussy. However, these treatments are aimed at slowing down tumour progression if surgery or percutaneous destruction are not feasible, or pending a liver transplant.
Radiation therapy
Stereotactic radiotherapy may be indicated especially for patients with localised disease who may not be suitable for curative treatment due to their size/height and/or liver function.
Targeted therapies
Targeted therapies are drug-based treatments that target specific mechanisms in cancer cells. Currently, the main targeted therapy drug approved for use in the treatment of hepatocellular carcinoma is Bevacizumab in combination with immunotherapy. It slows cancer progression by impacting the growth rate of cancer cells and preventing the development of blood vessels that feed the tumour. Other molecules are being assessed in ongoing clinical trials.
The efficacy of immunotherapy is tried and tested in the management of advanced hepatocellular carcinoma and has been granted marketing authorisation for this indication. It is a treatment that is generally well tolerated, even in cases of chronic, often tumour-related liver disease. Immunotherapy does not directly target the cancer cells, as in the case of conventional chemotherapy, but acts indirectly by stimulating the patient's immune defences against the specific tumour cells.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy can invite patients to participate in clinical trials. The advanced therapy medicinal products arising from these protocols give patients access to new molecules and precision medicine based on the molecular characteristics of each tumour. If appropriate, patients will be referred to a therapeutic trial during treatment by their referring oncologist, giving them access to innovative treatments.

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