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Hepatocellular Cancer (HCC)

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Hepatocellular Cancer (HCC)

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For adults, this is the most typical form of primary liver cancer. Hepatocellular cancer (HCC) has different growth patterns, with some tumors starting off individually and growing larger. Other patients may have several small cancer nodules throughout the liver, instead of just a single tumor. Later in the disease, tumors can spread to other areas of the liver.

Hepatocellular carcinoma generally affects patients with some type of chronic liver disease. Chronic liver disease can cause inflammation of the liver, which can lead to scarring, also known as cirrhosis. The most common causes of chronic liver disease are viral hepatitis, such as chronic hepatitis B or C. All adults should be tested to see if they have an infection with hepatitis B or C. This can be done with blood tests. Other common causes are alcohol-related liver disease or steatotic (fatty) liver disease. Ask your doctor if you are at risk for cirrhosis or any form of chronic liver disease.

Very rarely, HCC can occur in patients without liver disease. Fibrolamellar is a rare subtype of HCC, and less than 1 percent of all HCCs. It's a type most often seen in women under the age of 35, and many times, the remainder of the liver is healthy. This subtype of cancer typically has a more positive outlook than other forms of HCC.  

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Multidisciplinary care teams with nationally recognized expertise. Collaboration saves lives. Your care team is made up of experts in your exact type of cancer, and every single aspect of it.

Advanced radiation oncology tools. Sylvester was the first medical center in Florida, and the fourth in the country to offer resonance magnetic-guided radiation therapy. Our team is a leader in that domain. Our RapidArc® radiotherapy system delivers intensity-modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting and less damage to surrounding healthy tissue. Finally, our radiation oncology department also offers proton beam therapy in our state-of-the-art Dwoskin Proton Therapy Center.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with the very newest ways to treat and potentially cure your cancer.

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Treatments


Hepatocellular cancer has a wide variety of different treatments that can be used individually or in combination with other treatments to produce the best outcome for your specific cancer. That's why careful diagnosis and staging are so important. Your specialist will explain your treatment choices, how successful they expect them to be, and the risks and side effects with each option.

  • Surgery

    Surgery is performed for primary tumors that start in the liver and secondary tumors (called metastatic) that have traveled to the liver from a different organ such as the colon, lung, or breast.

    • Partial hepatectomy: This procedure removes part of your liver. The remaining liver tissue functions as if it were whole and will regrow in most cases to the size of the original liver.

    • Staged partial hepatectomy: For large or multiple tumors, this surgery can be performed in two stages. A multidisciplinary team that includes a surgeon and an interventional radiologist works together. 

    • Liver transplantation: For certain patients with primary liver cancer that originated in the liver (and is confined to the liver) your surgeon may recommend removing the whole liver and replacing it with a healthy donor liver.   
       

  • Ablation

    When surgery may be too risky, ablation uses different techniques to destroy abnormal liver tissue, including:

    • Radiofrequency ablation: High-energy radio waves heat the tumor, killing cancer cells.

    • Ethanol (alcohol) ablation: Concentrated alcohol is injected into the tumor to kill cancer cells. This procedure is also known as percutaneous ethanol injection (PEI).

    • Microwave ablation: Microwaves are applied directly to the tumor, producing heat that damages/kills cancer cells, or makes them more responsive to radiation or medical therapy.

    • Cryoablation: Freezes and destroys cancer cells under ultrasound guidance.

  • Embolization 

    Embolization is an option for some patients whose larger tumors cannot be removed by surgery or ablation. Embolization tries to block or reduce the blood flow to cancer cells in the liver.

    • Chemoembolization: Delivers concentrated chemotherapeutic drug(s) to the tumor along with a blood vessel blocking agent, starving the tumor of its blood supply.

    • Radioembolization: Similar to chemoembolization but with radiation instead of drugs.

    • Portal vein embolization: Often used for borderline liver resection candidates. The blood supply is blocked on one side of the tumor, allowing the other side to grow to a fully functional size for surgery.

  • Radiation Therapy 

    Advanced technology tools working for you include RapidArc®, an external beam (delivered from a machine outside the body) technology delivering intensity modulated radiation therapy (IMRT). IMRT shortens treatment times to one-half to one-eighth that of conventional radiation therapy, resulting in better tumor targeting and less damage to healthy tissue.

  • Chemotherapy (Systemic Medical Therapy)

    Chemotherapy can be administered intravenously (infusion needle) or by a pill and is usually a combination of cancer-fighting drugs. Chemotherapy is also sometimes given to surgical patients, after the procedure, to eliminate remaining cancer cells and reduce the chances that cancer will return.

    • If you require infusion chemotherapy, you can receive it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. It's a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. Or, you can also have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, or Deerfield Beach locations.     

  • Targeted Therapy 

    These treatments are designed to attack the molecular changes that make cancer cells grow and spread. Some of these medicines are given along with other chemotherapy medicines, while others are used individually. The purpose is to prevent cancer from growing and spreading. It may also be used to help chemotherapy get inside the tumor and be more effective.     

Tests


Determining treatment options and the best chances of recovery depend on the stage of cancer — this means whether the cancer is confined to the liver or has spread. Choices are also recommended based on cancer that returned after a treatment program and your general health. Beyond a careful and thorough medical history and physical examination, procedures for diagnosing liver cancer may include the following:                     

  • Serum Tumor Marker Test

    This blood test checks the levels of specific substances released into the blood, such as alpha-fetoprotein (AFP). Elevated levels of this protein may be a sign of liver cancer or a noncancerous condition. In some cases, the AFP level is normal even when there is liver cancer.

  • Liver Function Tests

    Also called liver enzyme tests, this group of blood tests detects inflammation and damage to the liver. They can also check how well the liver is working.

  • CT (CAT) Scan of the Abdomen

    This scan creates a series of detailed pictures of areas inside the abdomen, taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.

  • MRI (Magnetic Resonance Imaging)

    An MRI uses a combination of radio waves, a magnet, and a computer to produce a series of elaborate images of the liver. Dye is injected into a vein to create in-depth pictures of blood vessels in and around the liver.

  • Ultrasound Exam

    This technique relies on high-energy sound waves (ultrasound) that are bounced off internal tissues or organs to create a picture of body tissues.

  • Biopsy

    Often, a sample of suspicious cells is surgically removed for viewing under a microscope. Tissue can be obtained by fine-needle aspiration, core needle, or laparoscopy (a minimally invasive procedure).

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