Live Discussion with Dr. Shobhit Singh
Questions doctors asked during the Jivo Masterclass on Guided by Imaging, Driven by Innovation: The Evolving Role of Gastro and Hepatobiliary Interventional Radiology, taught by Dr. Shobhit Singh, Consultant, Interventional Radiology, BLK-Max Super Speciality Hospital, New Delhi, India, on . Written by Jivo Healthcare from the transcript of the session, drafted with AI assistance and edited by the Jivo team.
Considering the softness of the liver tissue and the mechanism you explained, is there any risk of collateral damage to the unaffected liver with alcohol ablation, and how frequently have you seen it?
Asked by Dr. Abubakar Muhammad Saidu, Nigeria
There is always a chance of the injected alcohol spilling into the normal liver, which is why the technique is not offered to every patient. It is generally used for small lesions, up to about two centimetres, that have a capsule, since well-defined hepatocellular carcinoma tends to keep the injected alcohol within the tumour. There have been cases where the alcohol went outside into the normal liver and caused pain, because its spread cannot be fully controlled. Over time microwave ablation has largely taken over, and a lesion of about two centimetres would now usually get a single thermal ablation instead of multiple alcohol sessions.
Answered by Dr. Shobhit Singh
For liver transplant candidates whose liver failure is due to cancer, transplant is the option, but the patient may be unwilling or have no matching living donor. In which of these cases are treatments like TACE still viable to bring relief?
Asked by Moderator
Surgery and transplant have criteria, and not every liver cancer patient qualifies. One marker for HCC is the AFP level, measured by blood test. Normally it is under 7 to 10; when it is in the thousands, 10,000 or 20,000, the patient cannot have surgery or a transplant. That is where our role comes in: in selected patients we can offer TACE or TARE, and after treating the tumour, the AFP typically falls below 1,000 within one to two months, bringing the patient within transplant criteria so they can proceed to surgery or transplantation. Similarly, where a donor is not available or there are financial issues and the patient needs time, six months without treatment would let the tumour grow and spread outside the liver. Locoregional therapy as ablation, TACE or TARE can hold the tumour for four or five months, so that when the patient returns they are still within the window for a successful transplant or surgery.
Answered by Dr. Shobhit Singh
How effective have these treatments been at rejuvenating liver function in patients with liver cirrhosis?
Asked by Dr. Isaya Mhando, Tanzania
These treatments are directed at the tumour, not the cirrhotic liver, which is managed by the transplant team, hepatologists or gastroenterologists. The aim is to stop tumour progression, kill the tumour and prevent new tumours forming. Liver function tests may slightly deteriorate for one to two days after the procedure and then improve over time, but they will not return to completely normal because the liver remains cirrhotic. The true treatment for a cirrhotic liver is transplantation, which cannot be offered to every patient, so locoregional therapy is used for those who need time before transplant as a bridge.
Answered by Dr. Shobhit Singh
How do you view the future possibility of a pig liver being transplanted into a human?
Asked by Dr. Isaya Mhando, Tanzania
Research is going on. I read articles a few months ago describing a transplant in which the patient survived for a few days. I cannot go further into this because xenotransplantation, transplantation from another species to humans, is not my field. What I can say is that interspecies transplantation is still in an evolving phase, but research is ongoing.
Answered by Dr. Shobhit Singh
How are liver donations obtained?
Asked by Dr. Isaya Mhando, Tanzania
In India there are only two ways: a liver from a cadaveric donor, where the family permits organ donation, or a living donor. Only related donors, related by blood or a spouse, are permitted, and genetic testing is done to establish the relationship. A cadaveric organ is available only to Indian citizens, unless a foreign citizen is waiting and no Indian citizen is available for the match, so that the organ is not wasted; that situation is very rare. For international patients in India, a living donor who is a blood relative or spouse is the only option, and the criteria are stringent, with genetic testing done as part of the documentation.
Answered by Dr. Shobhit Singh
Could you elaborate on TACE and TARE?
Asked by Dr. Isaya Mhando, Tanzania
TACE and TARE are transarterial therapies offered not only for hepatocellular carcinoma but also for oligometastases from colon tumours and for neuroendocrine metastases. The principle is to go through the femoral artery into the aorta, then the hepatic artery, and very selectively into the vessels supplying the tumour, so that whatever is given goes into the tumour and not into the normal liver or the rest of the body. The agents are very potent and delivered super-selectively: chemotherapy such as doxorubicin, or radiotherapy through radioembolisation with Y-90 spheres, which emit beta particles over a very short range, so the radiation stays largely within the tumour and spares most of the normal liver. The basic principle is that there should be no harm to the normal liver or the rest of the body; that is why these techniques have evolved over the years.
Answered by Dr. Shobhit Singh
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