Risks of Alcohol Injection for Elderly Liver Cancer Patients - Oncology

Dr. Chen Sirong reply Oncology

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Rita: Based on the report, it should be liver cancer, so there is no need for a biopsy since the doctor has already informed you that surgery or embolization is not possible.
Of course, he may have already discussed what treatment options he recommends.
Below, I provide a piece of online news for your reference.
Regarding advanced age, we also need to consider the patient's overall health, whether there are other treatment options, the experiences of different doctors, etc.
The most important thing is to communicate well with the attending physician.
Alcohol Injection: A Powerful Tool for Liver Tumor Patients
(Reported on 2008/03/17 by Huang Wen-chi, Tainan)
For treating liver tumors, surgical resection and chemotherapy are the more common methods.
For patients with liver tumors who are not suitable for surgery, if the tumors are small in diameter and few in number, alcohol injection is another treatment option.
The nursing department of National Cheng Kung University Hospital states that the principle of alcohol injection for liver tumors is to use alcohol with a purity of over 95%, which is directly injected into the liver tumor under ultrasound guidance.
This causes the proteins within liver cells to coagulate and degenerate, leading to the necrosis of liver tumor cells.
This treatment must be repeated and often has complications such as wound pain.
The nursing department indicates that patients must fast for at least six hours before undergoing alcohol treatment; blood tests must be conducted to check coagulation function, platelet count, and bleeding time (via ear prick).
If coagulation function is impaired, fresh frozen plasma will be injected; if the platelet count is below 80,000, platelet supplementation will be administered.
Patients are advised to practice holding their breath briefly beforehand to facilitate more accurate alcohol injection by the physician.
Prior to the treatment, nursing staff will administer a painkiller, and family members will assist in transporting the patient to the ultrasound room for treatment.
After treatment, patients generally need to lie on their side (depending on the injection site) and apply pressure to the wound with a sandbag for six hours (during which they should not turn over or get out of bed).
If they need to urinate or defecate while the sandbag is in place, they should use a urinal or bedpan in bed and are strictly prohibited from getting out of bed.
Nursing staff will closely monitor vital signs (such as blood pressure and pulse) within six hours post-treatment.
After the sandbag is removed, nursing staff will change the dressing and observe the wound.
Patients may then sit up, turn over, and use the restroom, but should still rest in bed as much as possible until the next day.
Upon returning to the ward after treatment, if there are no discomfort symptoms, they should eat according to the physician's instructions.
If symptoms such as nausea, vomiting, abdominal distension, abdominal pain, dizziness, or rapid heartbeat occur after treatment, please inform the attending nurse or doctor immediately, and the medical staff will provide appropriate assistance.
Early Liver Cancer Alcohol Injection Treatment
Dr.
Lin Hsi-ming, Attending Physician, Department of Hepatology, Linkou Chang Gung Memorial Hospital
Hepatocellular carcinoma (HCC) is a primary cancer that arises from liver cells, primarily caused by chronic infections with hepatitis B or C viruses, and to a lesser extent, by long-term exposure to risk factors for liver cancer such as alcohol abuse and aflatoxins, leading to chronic hepatitis, cirrhosis, and ultimately liver cancer.
Taiwan is a high-incidence area for hepatitis B, and cases of hepatitis C are also increasing annually, resulting in many deaths from complications, particularly liver cancer, which often ranks as the leading cause of cancer death in men and the second or third in women.
The reason is that early liver cancer typically presents no specific symptoms; by the time symptoms such as right upper abdominal pain, general fatigue, loss of appetite, ascites, or jaundice appear, it often indicates that the cancer is in its advanced stages or has progressed to decompensated cirrhosis and liver failure, at which point the response to various treatments is poor.
Therefore, patients with chronic hepatitis B, C, or other causes should undergo liver cancer screening every 3 to 6 months, including liver function tests (GOT/AST, GPT/ALT), alpha-fetoprotein (AFP), and abdominal ultrasound examinations.
High-risk groups for liver cancer, such as (1) patients with cirrhosis, (2) those with a family history of liver cancer among first- or second-degree relatives, (3) chronic hepatitis B or C patients over the age of 35-40, and (4) those with a history of liver cancer who have been cured, should also be screened every 3 to 6 months to detect small liver cancers.
Small liver cancer is defined as having three or fewer tumors, each with a diameter of 3 cm or less.
If the liver function is good (no ascites, jaundice, or hepatic encephalopathy), treatment outcomes are generally better.
Treatment options include surgical resection (for solitary liver cancer, resectable multiple liver cancers, or large liver cancers over 5 cm that can be resected).
If resection is not possible, ultrasound-guided injection of pure alcohol, acetic acid, or radiofrequency ablation (RFA) can be considered, all of which have considerable efficacy, with a five-year survival rate of up to 50%.
Additionally, for patients with four or more tumors or those larger than 5 cm who are not suitable for surgery, transarterial chemoembolization is also a viable treatment option.
Our hospital has been administering 99.5% pure alcohol injections under ultrasound guidance to liver cancer patients who are not suitable for surgery or refuse surgery for the past ten years, with one to two injections per week.
Results show that the four-year survival rate for cirrhotic patients with liver cancer smaller than 5 cm is 39%, with no significant side effects.
Five years ago, we also began administering 25% or 50% acetic acid injection therapy.
Compared to pure alcohol injection, the number of acetic acid injections is fewer, with a similar rate of complete tumor necrosis, but it may cause complications such as cholangitis, bile duct stricture, and liver abscess.
Two years ago, we also started performing wireless radiofrequency ablation (RFA), which requires fewer treatment sessions than alcohol or acetic acid injections, achieving over 90% complete tumor necrosis, but may result in complications such as hemothorax and bile duct stricture.
All three treatments are most effective for liver cancer patients with tumors smaller than 3 cm (ideally under 2 cm) and good liver function.

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Reply Date: 2008/12/16