From the Guidelines
Transarterial embolization (TAE) is the most appropriate treatment for a suspected bleeding hepatocellular carcinoma (HCC) or metastatic tumor in the liver with signs of active bleed.
Treatment Options
- TAE with bland embolic particles alone is a recommended treatment option for bleeding HCC or metastatic tumors in the liver, as it can effectively control bleeding by occluding the tumor-feeding arteries 1.
- Transarterial chemoembolization (TACE) can also be considered, especially for HCC patients with a good performance status without major vascular invasion or extrahepatic spread who are ineligible for hepatic resection, liver transplantation, or local ablation therapies 1.
Key Considerations
- The choice of treatment depends on various factors, including the patient's performance status, tumor characteristics, and liver function.
- TAE and TACE should be performed by experienced interventional radiologists in a superselective manner to minimize complications and ensure effective treatment.
- In cases where TACE is not effective or feasible, 90Y transarterial radioembolization (TARE) can be considered as an alternative treatment option, especially when the remnant liver function is expected to be sufficient after TARE 1.
From the Research
Diagnosis and Treatment of Bleeding Liver Tumors
The treatment for a suspected bleeding hepatocellular carcinoma (HCC) or metastatic tumor in the liver with signs of active bleed involves a multidisciplinary approach.
- The first step is to diagnose and control the bleeding, which can be achieved through an abdominopelvic CT scan as soon as the patient's hemodynamics allow 2.
- When active bleeding is visualized, arterial embolization is the preferred treatment, targeted as selectively as possible, to avoid surgery unless there is severe hemodynamic instability or failure of interventional radiology 2.
- Surgery may be necessary in some cases, and when it is, an abbreviated laparotomy (damage control) with perihepatic packing is recommended 2.
Determining the Etiology and Treatment of the Underlying Tumor
- After controlling the bleeding, the next step is to determine the etiology and treatment of the underlying tumor 2.
- Liver MRI can be used to diagnose the tumor, although analysis can be difficult due to the presence of a hematoma 2.
- For HCC, prompt resection is indicated, while for adenoma with no suspicion of malignancy, it is best to wait for the hematoma to resorb completely before undertaking appropriate therapy 2.
- The treatment strategy for patients with liver metastases should be determined case by case in a multidisciplinary setting, with surgical resection being the treatment of choice for resectable colorectal and neuroendocrine liver metastases 3.
Current Status of Treatment Options for HCC
- The treatment landscape for HCC has experienced significant advances over the last two decades, with curative therapies such as liver transplantation and surgical resection available for patients with early-stage HCC 4.
- Locoregional therapies, including transarterial chemoembolization and transarterial radio-embolization, are standard therapies for patients with intermediate-stage disease 4.
- For patients with advanced HCC, there are now multiple first- and second-line options that can prolong survival by up to 2 years when used sequentially 4.