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Liver Cancer

Liver Cancer Management

Enabling better outcomes​ for patients with liver diseases​

Liver cancer - in particular, hepatocellular carcinoma (HCC) - is a complex disease, often detected in later stages, which leads to poorer patient outcomes. It is the third deadliest cancer in the world, killing 840,000 people each year1. Most patients with HCC have signs of advanced fibrosis, which is caused by chronic liver diseases, such as nonalcoholic fatty liver disease, alcoholic liver disease or viral hepatitis. 

Although viral hepatitis is still the leading risk factor for HCC, it is expected that soon non-alcoholic fat liver disease (NAFLD) will become the leading cause for HCC2. Due to insufficient awareness within the general population, healthcare providers need to seek ways to detect disease earlier and ultimately improve outcomes.   

With solutions along the entire patient pathway – from risk stratification, to diagnosis, treatment and survivorship – Siemens Healthineers sees as its mission to take up the fight against the world’s most deadly diseases. 

Clinical Pathway

As your partner in liver cancer management, Siemens Healthineers helps you accelerate the path from risk stratification, diagnosis, therapy and survivorship. In addition to driving speed and precision, our solutions seek to streamline workflows and empower cancer care teams to improve performance and meet unique and evolving patient needs.

A comprehensive portfolio of solutions along the entire cancer patient pathway

Combining your expertise with ours 
Together we can enhance the clinincal pathway for your organization, your staff and your patients - in radiology and beyond.

Clinical Pathway - Liver Cancer

Overcoming the challenges in liver cancer diagnosis and treatment

At the ECR 2023, Valérie Vilgrain, Chair of the Radiology Department at Beaujon Hospital in Paris, sat down with André Hartung, President of Diagnostic Imaging at Siemens Healthineers. In the video interview, they discuss how imaging can address the challenges in liver cancer diagnosis and treatment today.

Risk stratification & Early detection

Liver disease is a silent killer

Often called a silent killer, liver disease has become more prevalent in recent years. Non-alcoholic fatty liver disease (NAFLD) is a spectrum of conditions that range from simple fatty liver (steatosis) to non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis, and hepatocellular carcinoma (HCC). The incidence of NAFLD-related HCC is projected to increase dramatically by 2030, with increases of 82%, 117% and 122% from 2016 in China, France and the USA, respectively4. 
To identify and monitor steatosis, all major guidelines recommended ultrasound and after the diagnosis, monitor those patients for developing fibrosis is highly indicated using FIB-4, ELF test and Ultrasound elastography5. Professional societies recommend HCC surveillance in high-risk individuals using ultrasound, including those with cirrhosis and patients with chronic HBV infection.6,7 
Given the under-implementation of screening, incidental diagnosis has been estimated to occur in 50% of cases globally, many of them in advanced-stage7. Early detection of HCC enables patients to access curative therapies that can improve patient survival8. With Siemens Healthineers you can improve value, efficiency and excellent patient care.

simple blood test

A simple blood test.
Any patient. Any provider.

Enhanced Liver Fibrosis (ELF) Test

Assess the risk of NAFLD/NASH progression and liver-related events with a simple blood test

New benchmark for quantifying liver assessment

A New benchmark for quantifying liver assessment including hepatic steatosis

Ultrasound Derived Fat Fraction (UDFF) quantifies fat in the liver:
There was a need for a new, noninvasive, easily available, accessible, cost-effective test.

Ultrasound Elastography: Virtual Touch Elastography
Studies have shown an increase in stiffness due to liver disease, as measured with Ultrasound Elastography, to be rapid, reliable, and reproducible.

LiverLab

Comprehensive liver analysis with superb soft tissue contrast

LiverLab

  • Fully integrated evaluation of liver fat and iron deposition
  • Reproducible and non-invasive assessment of metabolic abnormalities

Diagnosis & Therapy decision

Accurate diagnosis is key for treatment decision

Diagnosis of HCC can be confirmed with imaging tools and in many cases doesn’t even require biopsy7. Multidisciplinary management of HCC with comprehensive review of radiological and pathological findings helps to tackle the complexity of liver disease9. 
Major guidelines worldwide recommend using multiphasic computed tomography (CT) or magnetic resonance imaging (MRI) to diagnose HCC10. Contrast-enhanced Ultrasound (CEUS) is recommended for incidental findings of focal liver lesions in non-cirrhotic patients, in patients with renal insufficiency or as subsequent modality before biopsy in case of inconclusive findings at CT or MR11. 
Siemens Healthineers provides imaging technology and the smart imaging value chain that enable reliable therapy decision.

abdomen assist

Workflow solutions to support MRI daily clinical practice.

myExam Abdomen Assist:

  • Automatic FoV and coverage
  • Automatic protocol adaptations to patients individual breathhold capability Automatic bolus detection

Injector-MR scanner coupling:

  • Minimizes potential timing errors  
  • Improves reproducibility
  • Enhances confidence

Expand patient population eligible for liver MRI.

Compressed Sensing GRASP-VIBE:

  • Free-breathing liver dynamics
  • Combines hight spacial resolution with robustness towards motion
Redefining clinical decision-making by providing all relevant CT results with one single scan.

Redefining clinical decision-making by providing relevant CT results with one single scan.

CT NAEOTOM Alpha® with Quantum Technology:

  • Spectral maps are available in high detail – enabling functional evaluation with high precision.
  • Even at the highest scan speed, NAEOTOM Alpha offers full spectral imaging options.

Treatment planning & Delivery

Provide the right treatment at the right time for every patient.

Management of HCC has substantially improved over the past decade. Many institutions assign the treatment according to tumor stages following the Barcelona Clinic Liver Cancer (BCLC) staging system12. Early- stage HCC tumors are the preferred candidates for resection, transplantation and loco-regional ablation. Some studies have demonstrated similar recurrence rates between patients undergoing surgical resection and ablation13. Intermediate stages are first candidates for Transcatheter arterial chemoembolization (TACE) and those with advanced disease will first receive systemic therapies12. Several new molecular targeted agents have demonstrated benefits in survival of HCC as adjuvant therapy to resection or ablation14, calling for Oncology Information Systems which help to streamline departmental workflows. 

Siemens Healthineers and Varian provide solutions for precision therapy. Our portfolio includes tools and devices for planning, guidance and verification of procedures and empower consistent outcomes.


SOMATOM X.ceed with myNeedle Companion for CT-guided thermal ablation

Simplifies routine and complex procedures and helps achieve operational efficiency.


SOMATOM X.ceed with myNeedle Companion for CT-guided intervention.

  • myNeedle Laser: World’s first integrated CT lasers for CT-guided interventions. Enables targeted needle placement even in complex anatomy.
  • myNeedle Companion: The first Siemens Healthineers solution that harmonizes percutaneous needle procedures across various Siemens CT scanners and Angio systems along the interventional workflow. From imaging to procedure.
eTRAX

To meet all your needs in interventional imaging.


ACUSON Sequoia - Anatomic precision on CT or MRI combined with live Ultrasound

  • Fusion Ultrasound & Cryoablation: Anatomic  precision on CT or MRI combined with live  Ultrasound for ablation therapy guidance.
  • eTRAX Needle Tracking: Real-time display of  needle tracking and orientation
ARTIS Icono

Precision in tumor embolization


Precision in anatomic assessment

  • ARTIS icono provides 2D and 3D imaging with highlevel of detail to visualize small arteries supplying the tumor
  • Prerequisite for profound therapy decisions

Follow-up & Survivorship

Evidence-based care and patient experience

Post-treatment recurrence is as high as 50% within the first two-years of follow-up, even in patients with curative intend (BCLC stage 0 and A)13. Early recurrence is associated with low overall survival and the prediction of recurrence with digital pathology after resection could be used as predictor15. Periodic follow-ups are key to monitor therapy response and detect recurrence of cancer early. 
Siemens Healthineers’ advanced imaging portfolio has full potential to support evidence-based care. Longitudinal side-by-side comparison of images provides confidence for care teams.

Contrast-enhanced ultrasound

Ultrasound

Contrast-enhanced ultrasound it is a cost-effective tool provides blood flow and tissue perfusion information in real-time.

Magnetic Resonance Imaging

syngo.MR OncoTrend

syngo.MR OncoTrend allows the assessment and intuitive visualization of changes in functional imaging parameters, i.e. diffusion characteristics (ADC values) under therapy.

Spectral imaging CT

Computed tomography

Spectral imaging CT - Overlay iodine map/ virtual non-contrast enhanced CT image

Innovation

How could your digital self help you survive cancer?

Step into the future
Doctor using decision support software that suggests different treatment options.

Imagine an avatar,

a digital “you” so accurately mapped to your physical self that it could be used to personalize your healthcare, to predict and even prevent disease. It’s called a Digital Twin. And in the near future it’s going to become reality. Step into the future and read about how Anna’s Digital Twin saved her life. 

Watch Tony's story

"Early detection is invaluable," Villiotti says. "That's the single biggest thing a patient can do. If you're aware of it early, you can take action early and hopefully stop the progression."

1

Global burden of primary liver cancer in 2020 and predictions to 2040, 05, 2022. DOI:https://doi.org/10.1016/j.jhep.2022.08.021 

2

Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease: From Epidemiology to Diagnostic Approach. Grgurevic, at all. Cancers 2021, 13(22), 5844; https://doi.org/10.3390

3

Singal, A. G., Lampertico, P., & Nahon, P. (2020). Epidemiology and surveillance for hepatocellular carcinoma: New trends. Journal of Hepatology, 72(2), 250–261. https://doi.org/10.1016/j.jhep.2019.08.025 

4

Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention. Daniel Q. Huang, Hashem B. El-Serag & Rohit Loomba.  Nature Reviews Gastroenterology & Hepatology volume 18, pages223–238 (2021)

5

EASL Guideline, JOURNAL OF HEPATOLOGY 2021;75:659-689

AACE Guideline, Cusi et al, ENDOCR PRACT 2022;28:528

APASL Guideline, Eslam et al., HEPATOLOGY INTERNATIONAL 2020;14:889

6

Ahn et al. HEPATOMA RES 2022;8:10)

7

Hepatocellular carcinoma. Llovet JM, et al. Nature Reviews, Disease Primers, 2021, 7:6

8

Current and Emerging Tools for Hepatocellular Carcinoma Surveillance Nia Adeniji and Renumathy Dhanasekaran. Hepatology Communications 2021;5:1972-1986. 

9

The Multidisciplinary Management of Hepatocellular Carcinoma. Salgia, Clin Liver Dis (Hoboken). 2021 Jun; 17(6): 405–408.

10

Comparison of the current international guidelines on the management of HCC. Friedrich Foerster, Peter Robert Galle. JHEP Reports, May 2019, http://creativecommons.org/licenses/by-nc-nd/4.0/.

11

Dietrich et al. Ultraschall in Med. DOI:https://doi.org/10.1016/j.ultrasmedbio.2021.04.017.

12

Guiffre et al., Diagnostics 2022, 12, 2517

13

Kudo, Liver Cancer 2020, 9:367-377