Hepatic Cancers Overview: Surgical and Chemotherapeutic Options, How Do Y-90 Microspheres Fit in?

Hepatocellular cancer (HCC) is most common primary liver malignancy in adults. Treatment for HCC is a multispecialty undertaking, with surgical, locoregional, and systemic options available. Choice of treatment depends upon patient and disease factors. Surgical therapy, including resection and transplantation, is the primary curative treatment and is best suited to patients with early disease. More advanced disease may be amenable to locoregional therapies to "bridge" to transplantation, downstage disease, or as destination therapy for unresectable cases. These include percutaneous ablation, transarterial therapy, external radiation, and radioembolization with yttrium-90 conjugated beads. Patients with more advanced disease may benefit most from systemic chemotherapeutic or small molecule inhibitor options available, many of which have only been recently FDA approved. Immunotherapy is the newest component of HCC treatment. The Y-90 consultant should be familiar with all modalities of HCC treatment and the interplay between them.