Advances in Interventional Radiology in the Treatment of Primary and Metastatic Liver Cancer

Cormac Farrelly, Mark Ryan
2007 European Oncology & Haematology  
Hepatocellular carcinoma (HCC), a primary malignancy of the hepatocyte, is increasing in incidence worldwide. Chronic liver damage is the most important risk factor. The incidence of HCC is directly related to that of hepatitis B and C infection, and cirrhosis is present in 80% of cases. 1 It is the fifth most common primary malignancy worldwide, and the third most common cause of cancer-related death. 2 In Europe, metastatic liver disease is much more common than HCC, with 30-70% (depending on
more » ... the primary site) of patients who die from cancer having liver metastases at autopsy. 3 Not only is the liver a likely target for metastatic disease because of its rich, dual blood supply, but the fenestrations in the sinusoidal endothelium also allow arriving tumour emboli to lodge in the space of Disse. The liver is a primary target organ of gastrointestinal cancers and may be the only organ involved in colorectal primaries, HCCs and neuroendocrine tumours. 3 Even when extrahepatic spread is present, many patients die due to hepatic failure and portal hypertension. Colorectal cancer is the second leading cause of cancer-related death in Europe, with liver metastases being the most common cause of death in these patients. Although surgical resection and liver transplantation can be effective radical treatments for HCC and for liver metastases, most patients do not benefit from this due to the location or number of liver lesions, poor hepatic reserve, extrahepatic spread, co-morbid medical conditions or a shortage of donors. For example, 80% of colorectal carcinoma liver metastases are un-resectable and most resected tumours recur, with only a 30-40% five-year survival rate. 4,5
doi:10.17925/eoh.2007.0.2.68 fatcat:cphavzqmqndptgurleqv355ptm