Liver surgery and regeneration. These are the two conditions that allow us to look with cautious optimism when it comes to liver tumors. “We have to say right away that we have two different types of liver cancer. We have primary tumors that arise directly in the liver and secondary ones, which are instead metastasis, ie cancer cells that reach the liver but have developed in other organs ”. Luca Aldrighetti is head of the Complex Operative Unit of Hepatobiliary Surgery of the IRCCS San Raffaele Hospital and Associate Professor of the Vita-Salute San Raffaele University.
Liver cancer in Italy
Estimates speak of about 13,000 new diagnoses of primary liver tumors every year. Men generally affect men more with a ratio of about 2 to 1. Secondary tumors are significantly more numerous, which as mentioned are the metastasis that colonize the liver from other organs. This happens because the liver has among its functions that of filtering the organism. Receiving blood from almost the entire body, it becomes a breeding ground for metastasis.
What are the therapies used for liver cancer?
“The good news is that we have many therapeutic options for this cancer. In general, the best treatment that can be offered to these patients is excision or destruction. There are also chemotherapy programs and medical drug therapies, but surgery and destruction remain the cornerstone of the treatment of liver tumors ”.
Excision and ablation: what do they consist of?
“Surgical removal can be performed with techniques that are progressively becoming less and less invasive. The other is ablation, that is, the possibility of destroying these tumors. How? With needles that are driven into the tumor. Thanks to microwaves or waves at a certain frequency, these needles are able to destroy tumor nodules. The necessary condition is that the dimensions are relatively small, let’s say up to a maximum of about 3 centimeters. Otherwise we must proceed with the surgery “.
The importance of early diagnosis
“It goes without saying that as with all cancers, early diagnosis is essential. And not only for the quality of life which remains a very important point, but also for the possibility of healing in the sense that this tumor can be cured. So the sooner the tumor is discovered, the smaller the tumor mass, the more therapeutic choices we have ”.
“Having said that, fortunately, the various technologies and knowledge acquired allow us to work aiming at healing even for more advanced tumors. So I would say that the real novelty is that even when unfortunately the disease is discovered at a more advanced stage, we can intervene, aiming to obtain the patient’s recovery or a very long survival “.
Liver regeneration and the myth of Prometheus
“This was possible thanks to a technical improvement and new biological knowledge. The liver is in fact able to regenerate itself. We all know the myth of Prometheus, who was condemned by Zeus to have an eagle that ate his liver during the day. The liver then regrown during the night. He had been condemned for stealing fire from the gods to give it to humanity. Well, in an extraordinary way and which always amazes me this which is a Greek myth actually coincides with the truth ”.
Liver regeneration accelerated by stem cells
“The liver is the only solid organ capable of regenerating. And this regeneration is extremely important from the point of view of the possibility of removing tumors, because it means that we can also remove large quantities of liver. In recent years we have the ability to stimulate this liver regeneration. Through various experiments, the aim is to stimulate liver growth with particular molecules. An example above all is the use of stamina cells. They are injected into the patient’s liver and new cells are created capable of regenerating the liver. In this way we are able to enhance our caring skills. The small size of the liver after surgery is actually no longer a big problem today for these reasons “.
How long does it take for the liver to regenerate?
“So we’re a little slower than Prometheus’s liver, we can’t do it overnight. But in an extraordinary way I can say that today within seven to ten days you are able to substantially increase the size of the liver by up to 30 percent. Natural regeneration would take several months. Through stimulation, a few days or a few weeks can be enough ”.