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Liver cancer

Creating a world without fear of cancer 

Liver Cancer

Liver cancer is a complex and challenging disease with various clinical forms. Whether it appears as primary or metastatic cancer, the journey from diagnosis to treatment decision is intricate and poses significant obstacles. Unfortunately, many patients are diagnosed at advanced stages, when curative treatments are often no longer viable.1-2

While viral hepatitis and alcohol consumption have historically been primary causes, the obesity epidemic is emerging as a significant contributor, often leading to more aggressive liver cancer.1, 3, 4 The global incidence of hepatocellular carcinoma, the most common primary liver cancer, has been on the rise, and it is expected to reach 1.5 million cases annually by 2030.1-5

Liver cancer in Belgium6:

  • Is the 14th most frequent cancer
  • Is 2.5 times more frequent in men than in women
  • Occurs most often after the age of 55
  • The percentage of patients reaching the 5 years relative survivorship is below 25%

Siemens Healthineers aims to support healthcare providers in addressing liver cancer, offering comprehensive solutions throughout the patient journey, from screening to survivorships.7

Screening

ELF Test

Non-alcoholic fatty liver disease (NAFLD) is a condition in which excess fat is stored in the liver and leads to progressive chronic liver disease. 25% of the global population has NAFLD; the big majority is unaware and are silently progressing towards liver fibrosis and more severe liver diseases such as cirrhosis and even liver cancer. Among patients at risk for developing NAFLD are those with type 2 diabetes mellitus and obesity.

While different factors can lead to liver diseases such as excessive alcohol consumption or medication, or hepatitis infections, it’s NAFLD that is projected to become the leading cause of liver-related mortality within 20 years.8

Early identification of liver fibrosis is very important as the disease is reversible up unto a certain stage. The Enhanced Liver Fibrosis (ELF™) Test is an accessible, simple, non-invasive blood test that measures three direct markers of fibrosis. Direct assessment of fibrosis has proven valuable for identifying patients at risk of progressing to cirrhosis and/or liver-related events.

Hear from a NAFLD patient and clinical expert about how the ELF Test has the ability to improve outcomes for patients and transform systems of care.

A simple blood test. Any patient. Any provider.

The ELF Blood-based tests can readily support high-volume testing, does not require patient access to specialized imaging equipment or highly trained operators.

Liver cancer in vitro

Introduction of non-invasive ELF tests in care pathways has the potential to:

  • Increase the early detection of advanced fibrosis and cirrhosis in NAFLD patients
  • Access non-invasive testing with a simple blood test available to all healthcare practitioners and patients, including those with type 2 diabetes mellitus and obesity.9,10
  • Improve patient care by identifying NAFLD patients and stratifying those at risk of progressing to cirrhosis and LREs.11
  • Enhance prognostic patient management with a test that has been shown to outperform liver biopsy for the risk assessment of progression to cirrhosis and LREs.11

ELF is featured in more than 200 peer-reviewed publications and has been evaluated in multiple forms of chronic liver disease

  • Non-alcoholic fatty liver disease (NAFLD)
  • Non-alcoholic steatohepatitis (NASH)
  • Alcoholic liver disease (ALD)
  • Primary sclerosing cholangitis (PSC)
  • Primary biliary cirrhosis (PBC)
  • Chronic HBV infection (CHB)
  • Chronic HCV infection (CHC)
  • Mixed chronic liver disease etiologies   

Multiple NAFLD/NASH International Clinical Guidelines Recommend ELF

The ELF Test is included in multiple international clinical guidelines supporting ELF both as a diagnostic and prognostic marker in NAFLD/NASH.

Diagnosis 

Magnetic Resonance Imaging

Total MR workflow for diagnosis of liver diseases from easy patient setup with light weight Body18 coil and automatic liver centering with Select&Go, through scanning with GRASP-VIBE, LiverLab for monitoring of liver diseases and assess therapy response with syngo.via Oncotrend.

GRASP VIBE

With Compressed Sensing GRASP-VIBE, you can expand the patient population eligible for abdominal MRI. Patients with limited breath-hold capability or are unable to follow breathing commands, e.g., patients with dementia, hearing impairment, children or multi morbid patients, can now undergo high-resolution dynamic abdominal imaging under free-breathing with one continuous, push-button exam.
With its intelligent reconstruction and processing framework, Compressed Sensing GRASP-VIBE instantly recognizes different phases of liver dynamics, will automatically label those and output only the clinically relevant information. This allows bringing the advantages of Compressed Sensing GRASP-VIBE to daily clinical routine.

  • Perform push-button, free-breathing liver dynamics
  • Overcome timing challenges in dynamic imaging and respiratory artifacts
  • Expand the patient population eligible for abdominal MRI

Evaluating the iron and fat content of the liver is an important step in monitoring early stages of liver diseases.
LiverLab enables non-invasive identification of patients with fatty liver and iron overload already at an early disease stage. This helps to minimize the need for biopsy.

The clinical package comprises a fat and iron screening part (First look Dixon), plus two methods for evaluation, HISTO (voxel based) and Multi-echo Dixon VIBE (image based), and provides a clinical report.

  • Non-invasive evaluation method for liver fat and iron content
  • Fast and reproducible results without post-processing
  • One robust and fast clinical workflow
  • Time and cost savings   

GRASP-VIBE: even though the data acquisition is free breathing the results are simply breathtaking!


"The free breathing technique allows us to scan every patient regardless of breath holding capacities. Continuous 4D acquisition gives us all the dynamic information (with not one but 3 good arterial phases) we need to detect and characterise liver lesions. The robustness of acquisition and reliability of the dynamic contrast phases is an ideal combination to detect and follow liver lesions in - often challenging- cancer patients. Think of HCC lesions and LI RADS criteria in our cirrhotic liver patients e.g."

<p>Dr. Dehem, Yperman ziekenhuis Ieper</p>

Dr. Dehem, Yperman ziekenhuis Ieper

Therapy

Liver surgery

With the advent of minimally invasive approaches, liver surgery has changed significantly. The ongoing search for new organ-sparing treatments has produced approaches that combine interventional techniques with open surgery, endoscopy, and procedures requiring robotic assistance. As a result, liver surgeons increasingly need to coordinate imaging, intervention, and surgery – all in one room.

Our imaging systems with procedural intelligence allow you to integrate new therapeutic options in the Hybrid OR. From liver embolization, to endoscopic treatments, to ablation and resection, every possible approach or combination can now be performed in your Hybrid OR, with the hospital’s resources centered around the patient. Sophisticated planning and guidance enables you treat many more patients with curative intent, increasing their survival from months to years.

Stereotactic radio frequency ablation (SRFA)

Ablation is a promising approach to curatively treat various types of liver cancer. Our imaging systems offer the sophisticated 3D planning and guidance needed to achieve multiple overlapping necroses, supporting surgeons in ablating tumors larger than 5 cm. Intraprocedural assessment makes sure margins are complete.

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DynaCT

With syngo DynaCT the myNeedle Companion can be used to plan multiple trajectories for needles, accounting for the structures that might be on the needle path, to avoid damaging them. myNeedle Companion provides the insertion point and needle trajectory by using the cross laser beam for easy needle positioning.

DynaCT
Tumor ablation
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Image-guided Laparoscopic Liver Surgery (ILLS)

Liver resection is the gold standard for radical treatment of liver metastases and in many cases the main treatment of primary tumors. Making full use of our imaging systems, the new ILLS technique maximizes the amount of healthy liver left behind while ensuring adequate oncological margins. This potentially increases the number of patients who can be resected.

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Endovascular approaches

In essence, every vessel that feeds the region to resect can be identified. This is useful for endovascular approaches

Endovascular approaches
Neede companion
Results
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Follow-up

Computed Tomography

Contrast Enhanced CT is a routinely performed for the visualization and follow up of liver lesions. However, in practice, it can be very challenging in patients suffering from moderate to severe chronic renal damage, due to the concern of contrast-induced nephrotoxicity.

On the one hand, reduction of concentration and volume has to be considered when applying contrast agent to these patients; on the other hand, the required lesion enhancement should be achieved for differential diagnosis.

Although it is known that enhancement can be improved through lower kV settings, limitations on tube current output often prevents its application in clinical routine. Siemens Healthineers’ CT systems use their unique power reserves at low (70, 80 or 90) kV settings to significantly enhance the lesions through a better Contrast-to-Noise ratio (CNR). At the same time, use of these low kV ranges positively impacts the radiation dose as well.

Dual Energy CT plays a pertinent role in oncological imaging by virtue of its ability to assess the amount of iodine uptake in suspicious lesions. This could be associated with tumor vascularity and could become useful in therapy monitoring & follow up. With this technology, iodine maps can for instance be created, enabling iodine uptake evaluation in hepatic lesions.

The significant differences in the iodine concentration evaluated in the lesions helps to differentiate between e.g. benign hepatic cysts and metastatic lesions. Furthermore, the “virtual” unenhanced images (VNC) generated from the contrast-enhanced Dual Energy CT dataset, can be used for analyzing CT attenuation values of organs (e.g. liver, adrenal gland) in the absence of a true unenhanced image. Therefore, one might consider to exclude the typically performed second “true” unenhanced scan, by which the corresponding radiation dose is avoided to be delivered as well.

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Dual Energy CT
Dual Energy CT
Contrast Enhanced CT
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1 Adeniji, N., & Dhanasekaran, R. (2021). Current and Emerging Tools for Hepatocellular Carcinoma Surveillance. In Hepatology Communications (Vol. 5, Issue 12, pp. 1972–1986). John Wiley and Sons Inc. https://doi.org/10.1002/hep4.1823

2 Kudo, M. (2018). Management of Hepatocellular Carcinoma in Japan as a World-Leading Model. Liver Cancer, 7(2), 134–147. https://doi.org/10.1159/000484619

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 Llovet, J. M., Kelley, R. K., Villanueva, A., Singal, A. G., Pikarsky, E., Roayaie, S., Lencioni, R., Koike, K., Zucman-Rossi, J., & Finn, R. S. (2021). Hepatocellular carcinoma. Nature Reviews Disease Primers, 7(1), 6. https://doi.org/10.1038/s41572-020-00240-3

5 Horn, S. R., Stoltzfus, K. C., Lehrer, E. J., Dawson, L. A., Tchelebi, L., Gusani, N. J., Sharma, N. K., Chen, H., Trifiletti, D. M., & Zaorsky, N. G. (2020). Epidemiology of liver metastases. Cancer Epidemiology, 67(June), 101760. https://doi.org/10.1016/j.canep.2020.101760

6 Cancer Fact Sheets, Registre du Cancer, Année d'incidence 2020, Bruxelles 2022, België, 2012-2016. Belgian Cancer Registry, Brussels, 2037

7 Lurje, I., Czigany, Z., Bednarsch, J., Roderburg, C., Isfort, P., Neumann, U. P., & Lurje, G. (2019). Treatment Strategies for Hepatocellular Carcinoma – a Multidisciplinary Approach. International Journal of Molecular Sciences, 20(6), 1465. https://doi.org/10.3390/ijms20061465

8 Day J, et al. J Appl Lab Med. 2019 Mar; 3:815-26

9 Karlas T, et al. Evaluation of transient elastography (TE), acoustic radiation force impulse imaging (ARFI), and Enhanced Liver Function (ELF) score for detection of fibrosis in morbidly obese patients. PLoS One. 2015;10:e0141649

10 Patel P, et al. Hepatol Commun. 2018;2:893–905.

11 Sanyal AJ, et al. Hepatology. 2019;70(6):1913-1927.