What Are MIIPs? / Liver cancer
What is the liver?
The liver is an organ in the right upper abdomen. It has many jobs. The liver makes juices to help digest food. It uses nutrients from food to make energy. The liver also cleans the blood.
What is liver cancer?
Liver cancer is a tumor that either starts in the liver or spreads to the liver from cancer that started from another part of the body.
Above: Animation showing Minimally Invasive, Image-guided Procedure (MIIP) liver tumor treatment using Radioactive beads. Animation is on loan from Sirtex Medical (www.sirtex.com)
How is liver cancer treated?
Liver cancer can be treated in different ways, depending on the size and number of the tumors and the patient’s general health.
Treatment options with the best chance for cure:
Treatment options that can control the cancer:
- Liver transplant, where the patient receives a new liver from a donor
- Surgery to cut out the tumor
- Minimally invasive, image-guided procedure (MIIP) to destroy the tumor through a pinhole, without cutting it out
- MIIP that kills the tumor by feeding it tiny beads soaked in chemotherapy
- MIIP that kills the tumor by feeding it tiny radioactive beads
- Radiation therapy
How can tumors be destroyed without surgery?
A MIIP to destroy tumors inside the body without having to cut them out with surgery is called ablation. Ablation can cure a tumor.
A specialized doctor places a skinny wand through the skin and into the tumor then uses it to destroy the tumor in minutes using heat, freezing or alcohol. The dead tumor turns into a scar over time. Patients with just a few, small tumors in safe locations can be treated with ablation.
What other MIIPs can be used to treat liver cancer?
Ablation may not be an option for patients with many tumors, bigger tumors, or tumors in sensitive areas. Two MIIPs can treat tumors directly through the blood vessels:
- A MIIP to feed the tumors tiny beads soaked in chemotherapy poison is called chemoembolization.
- A similar MIIP to feed the tumors even tinier radioactive beads is called radioembolization.
How are tumors treated through the blood vessels?
An artery is a blood vessel that carries blood from the heart to the rest of the body. Arteries form networks inside the body like highways. A specialized doctor can use a tiny tube to travel the body's arteries and reach the liver arteries directly feeding the tumor.
After numbing the skin, the doctor enters an artery in the groin or wrist through a pinhole. Using moving x- rays to see inside the body, the doctor then sends a tiny tube over soft wires to the liver arteries feeding the tumor. The doctor uses this tube to feed the tumor tiny beads soaked in chemotherapy. These beads kill the tumor over days to months by blocking the tumor’s blood supply and soaking it in poison.
This MIIP is called chemoembolization. It has advantages over giving the chemotherapy to the entire body through an IV. It allows the doctor to give 10 times higher doses directly to the tumor and avoid most side effects to the rest of the body.
A similar MIIP is called radioembolization. It kills liver tumors using radiation energy instead of poison. The specialized doctor sends very tiny radioactive beads directly into the liver arteries through a tiny tube. The radiation can only travel 1/4 inch away from the beads so it concentrates in the liver.
These beads are so small that they do not plug up the liver arteries very much. Radioembolization can be safer in patients where blocking the liver arteries could hurt their liver.
Radioembolization is different from giving radiation from the outside. Radioembolization treats the liver from the inside and limits damage to areas around the liver.
What do these words mean?
- Microwave ablation and radiofrequency ablation are 2 common types of ablation that use heat to destroy the cancer.
- Chemoembolization is also called TACE (TransArterial ChemoEmbolization).
- Radioembolization is also called TARE (TransArterial RadioEmbolization) or SIRT (Selective Internal Radiation Therapy).
- Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Cholangiocarcinoma is another type.
- Examples of cancers that can spread to the liver: colon cancer, pancreatic cancer (including neuroendocrine cancer), breast cancer, lung cancer, melanoma and others.
What are the risks and side effects of these MIIPs to treat liver cancer?
Because these MIIPs to treat liver cancer are performed through pinholes, there is a lower risk of side effects. All procedures carry a small risk of bleeding, infection and damage to other tissues. If the liver is very sick, there can be a risk of liver failure. Your doctor will discuss all the risks that are relevant to you so you can make an informed decision about your treatment.
For more information:
About TACE and embolization:
About MIIPs for liver cancer: