All to increase awareness of breast cancer and raise money to treat it.

While people across the Western world are aware of this disease and a handful of other cancers, liver cancer is not on their radar. But that may soon change.
It is less prevalent here than in countries where chronic hepatitis B and C, leading causes of the disease, are more widespread. However, according to the Canadian Cancer Society Statistics 2015, incidence as well as mortality rates for liver cancer are on the rise.

Surgical resection and liver transplantation are the best treatment options for liver cancer.  However, surgery is not always possible due to the size of the cancer or it spreading to other parts of the body. Other options include,  embolization, ablation chemotherapy (often a drug called sorafenib), external bean radiation, and internal radiation therapy, which is also known as radioembolization. 

“In radioembolization a catheter is used to deliver small radioactive beads directly to the tumour in the liver.”

In a treatment known as embolization, a substance is put into the artery carrying blood to the tumour. This substance blocks the blood flow, which makes it harder for the tumour to grow and sometimes causes all or part of it to die. Ablation consists of inserting a needle or probe into the tumour and destroying it by delivering extreme heat, cold, or concentrated alcohol (ethanol).

Recent Advances

Healthcare providers started adding a chemotherapy drug to embolization in the 1970s (chemoembolization) and, in the past decade, have been combining embolization with radiation treatment (radioembolization).

In a radioembolization procedure, a catheter is used to deliver microscopic radioactive beads directly to the tumour in the liver. The beads, which are glass, become lodged in the tumour and, over the course of several weeks, emit radiation that can destroy it. Few people realize that there is a radioembolzation treatment and it has already been used in over 19,000 patients worldwide. Many interventional radiologists have endorsed this procedure, citing its many benefits.

“The treatment targets the tumour and leaves surrounding tissue unharmed. That means you can deliver radiation without killing the liver, something that would be very difficult to do otherwise,” says Dr. Richard Owen, an Interventional Radiologist and an Associate Professor in the Department of Radiology and Diagnostic Imaging at the University of Alberta in Edmonton.

“In many instances patients have been too unwell to tolerate established treatments,” adds Dr. Sean Cleary, a surgeon at Toronto General Hospital, “so chemoembolization and radioembolization techniques have been considered because they can be delivered with fewer side effects and risks.”

Radioembolization can be used to shrink large tumours down to the point where they can be surgically removed, and to treat tumours that are not responsive to other treatments.

"Although the treatment is costly, it is less expensive than other liver cancer treatments and is publicly funded only in British Columbia and Alberta. It’s available in just six provinces — British Columbia, Alberta, Saskatchewan, Ontario, Nova Scotia, and Quebec."

Dr. Rob Beecroft, an Interventional Radiologist at Princess Margaret Hospital in Toronto, says he has used the procedure to treat patients who would not have tolerated sorafenib because they were older and more fragile — he reports that it worked remarkably well. “In my opinion, in certain patients with advanced liver cancer, radioembolization can be more effective than sorafenib,” he says, “and have fewer side effects.” Side effects include fatigue, pain, and nausea. The majority of adverse effects are mild to moderate in severity and are manageable or resolve over time.

Just as many healthcare providers have voiced their approval of this new therapy, they have expressed concern over its lack of availability.

New treatment not funded for many Canadians

Although the treatment is costly, it is less expensive than other liver cancer treatments and is publicly funded only in British Columbia and Alberta. It’s available in just six provinces — British Columbia, Alberta, Saskatchewan, Ontario, Nova Scotia, and Quebec. Many Canadian patients seeking the treatment have to go to the United States to get it, which often costs them tens of thousands of dollars. Qualifying patients may also opt for enrollment into radioembolization clinical trials available in Nova Scotia, British Columbia, Alberta, Quebec, and Ontario. More information on these trials can be found at www.btgplc.com.

“For many patients radioembolization is clearly the best treatment,” says Owen. “However, for the majority of Canadians it’s just not available.”

Dr. Owen would like to see this “made in Canada” treatment available in all major centres in conjunction with transplant programs. He says treatment would have to be overseen by a team of specialists from various disciplines.

Without a doubt, more public funding would help the growing number of Canadians battling liver cancer. With established treatments improving and new treatments being developed, physicians will be able to target liver cancer with even more precision and greater success.