Estimated reading time: 7 minutes

If you are attending this lecture or attending this lecture after the app, this is equivalent to reading this standard textbook, right, book is the complex, and if you are covering this lecture, this means you are covering A to Z of the syllabus. So, if you are covering A to Z of the syllabus daily, you are definitely 100% prepared for a NEET SS.

So, again, this is my guarantee that if you are reading this lecture, you don’t need to go back to the books. This is more than enough, right. So, we start the lecture, so this is what I am going to cover.

In the previous lecture, I covered the surgical treatment or we covered the resection transplant for hepatocellular carcinoma. Today, I am going to cover the other various modes like ablations and all. I am also going to cover distinct variations of hepatocellular carcinoma, HCC, and apart from HCC, intrahepatic cholangiocarcinoma is also a type of primary solenoid meridian neoplasm.

So, first is, we are going to continue the HCC treatment. So, we are going to start with the pre-test. I would request students, please, that the more you interact in this, the more you will remember.

You know, there is a basic principle of our psychology that if we are doing things wrong and if someone corrects us there, it goes into the long-term memory. I always believe in this. So, just feel free to answer this, right.

So, the first pre-test of treatment of HCC is, which patients are ideal candidates for trans-arterial therapy? Patients with preserved LFT and asymptomatic multinodular tumours without vascular invasion, patients with severe portal hypertension, patients with extrahepatic metastasis, and patients with cirrhosis and large tumours. Trans-arterial therapy is the best. Question number two, what limits the use of external beam radiation therapy for HCC? Cost is a limiting factor, it damages the normal liver parenchyma and surrounding organs is a limiting factor, lack of ability of EBRT or it is ineffective for large tumours.

So, which is the thing that limits the use of EBRT? Question number three, what is the promising modality for delivering localized radiation to HCC?

 Iodine-1, 3, 1 or Yttrium-19 glass microsphere, standard EBRT, whole-body irradiation or none of the above. So, which is the best way to give radiation? Again, guys, pre-test means that today on the 7th and 8th of December, how much do I know about this topic before starting? How much do I know before starting and how much do I know after starting? The second thing is that these MCQs are not taken from a guide. I have taken them from a line.

So, these are the original MCQs. Question number four, what is the role of systemic chemotherapy in hepatocellular carcinoma? It is highly effective with a durable response. It has limited effectiveness with a response rate of less than 20%.

It is effective for all tumor sizes and it is a standardized first line of treatment. Question number five, what distinguishes PEI? PEI means percutaneous. It is a non-injection from acetic acid injection.

It is a non-injection. What is the difference for HCC? Acetic acid has a stronger necrotizing stability. PEI is more effective for larger tumours.

Acetic acid is ineffective for septic tumours. PEI causes a higher complication rate. 

Question number six, which method is recommended for advanced HCC with maculopascular involvement? Sorafenab, surgical resection, radiofrequency ablation or none of the above.

So, guys, we will start the topic here. In the previous lecture, I discussed the surgical part. So, this lecture is all about the non-surgical part.

And in the liver, hepatocellular carcinoma, the non-surgical part is very important. So, the first non-surgical method is percutaneous. It is a non-injection, PEI.

So, via three mechanisms, it destroys the tumour. Basically, through the UAG guidance, we are injecting ethanol into the tumour through a needle. It will distract the tumour by cellular dehydration.

It will cause cognitive necrosis. And it will cause vascular thrombosis. So, with these three mechanisms, it could destroy the hepatocellular carcinoma.

So, what is HCC? For a small tumour, it is very good. You can ablate a tumour in a single setting, which is very good. Long-term, if it is a larger size, you will need multiple injections.

Long-term survival for tumours less than 5 is 24 to 40 per cent. And as such, there is no RCT, which compares it with the resection, right? So, there can be a variation in PEI percutaneous ethanol injection. In place of ethanol, we can use acetic acid.

So, it is similar to ethanol injection, but more effective for septic tumours due to its stronger necrotizing properties. So, it is a little more destructive. So, it is more effective for larger tumours and septic tumours.

Acetic acid is more effective. So, the next non-surgical treatment for HCC is the thermal ablative technique. Guys, again, I am saying it again.

Non-surgical techniques for SCC are very important. And these advances can be asked in the paper as well. So, cryotherapy is a part of thermal ablative techniques, in which we use very low temperatures.

So, this low temperature causes freezing and thawing, and this causes necrosis. So, if you are using cold, you can use it at the time of laparoscopy, or you can do it percutaneously. So, there is ice ball formation, which we monitor via ultrasound.

So, what is the limitation of cryotherapy? It has a piercing effect. For example, you are applying a cold low temperature to a tumour. But if there is vascularity, all that low temperature will go into the vessels.

It goes into the blood and goes into the body. So, there will be a heat sink. The blood vessels will absorb the cold away from the tumour.

So, that is a heat sink effect. And this is for both cold and hot. If there is coldness at a low temperature, the blood flow will absorb the coldness.

That is a heat sink effect. The heat sink effect is a limitation. It reduces the efficacy.

And this is because of the major blood vessels near the tumour. The complication rates are also high in cryotherapy. These are the limitations.

The survival rate is 60-70%. And again, the same for normal injections. For cryotherapy, we don’t have any data available from a direct resection.

So, the next modality is radiofrequency ablation. Here, we use heat. So, we are using high-frequency alternative current heat tissue to more than 60 degrees Celsius.

140 degrees Fahrenheit, which causes MDA cell death. For advancement, new probes can ablate tumours up to 7 centimetres. We can use RFA up to 7 centimeters.

So, what are the limitations? For tumours more than 3 centimetres, less efficacy due to local recurrence. And again, this will also have a heat sink effect. If a blood vessel passes, it will absorb the heat.

So, the protective effect of the blood vessel reduces the efficacy near the vascular structure. Again, the heat sink effect. Advantages.

It can be performed via percutaneous with a low complication rate. So, there was some data which compared with a resection. So, it found out that resection is obviously better.

It gives better disease-free and lower survival for HCCs. So, this is very, very important topic now. Treatment of hepatocellular carcinoma via trans-arterial therapy.

Trans-arterial therapy means that you are doing some treatment modalities through the hepatic artery. Which could be chemotherapy or via embolization. You can do a lot of things.

So, what is the principle of the trans-arterial therapy route for HCC? The blood supply of hepatocellular carcinoma comes from the hepatic artery. 70% of normal liver tissue comes via the portal vein. But the cancer, like Dr. Vikesh and Dr. Ritu…

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