Living Longer: Very Early Stage Liver Cancer (BCLC 0)

Introduction

Most of the time, very early stage (BCLC 0) liver cancer is discovered incidentally during routine medical check-up.

With better surveillance programme in Japan, 30% of liver cancer there are diagnosed at this stage (as compared with 5-10% in the West).

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Barcelona Clinic Liver Cancer (BCLC) staging system
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Child Pugh Class A: Good liver function

BCLC 0

Very early stage liver cancer (BCLC 0) is when:

  • Single and small liver tumor < 2cm
  • Good liver function (Child Pugh A)
  • Good performance status

Both resection OR ablation of liver tumor is recommended for BCLC 0

Resection of Liver Tumor

With anatomical resection of liver tumor (bisectionectomy, hemihepatectomy, and trisectionectomy), results are very promising.

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Types of liver resections

5-year survival is 70% after resection of liver cancer and on average, those with BCLC 0 survive around 75 months after liver cancer resection (Roayaie, 2013).

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BCLC 0: Average survival time (75 months) and 5-year survival rate (70%) after resection of liver cancer.

Preoperative mortality (death, regardless of cause, occurring within 30 days after surgery in or out of the hospital) for BCLC 0 patients undergoing hepatic resection is around 1% at centre of excellence.

  • Pros: Lower local recurrence
  • Cons: More invasive

Tumor Ablation

Tumor ablation is to induce tumor cell dying via:

  • chemical ablation with percutaneous ethanol injection (PEI)
  • thermal ablation; hyperthermic treatments (heating of tissue at 60–100 C) using radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation or cryoablation (freezing of tissue at 20 C and 60 C).

RFA is much better than PEI in terms of survival and local recurrence.

May need more than one session of RFA to induce complete radiological necrosis.

RFA is comparable with resection of liver tumor but with less complications for patients with BCLC 0 (Chen MS, 2006; Livraghi, 2008).

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5-year survival was 68.5% and preoperative mortality was 0% (Livraghi, 2008)
  • Pros: Less invasive, lower perioperative mortality
  • Cons: Higher local recurrence but amenable to liver resection if recurrence occur.

Which treatment to choose?

Both options are comparable.

Other than discussing with your oncologist, you should also seek more information from hepatobiliary surgeon and interventional radiologist to assist you in making an informed decision after taking into account the risks and benefits of each modality.

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