Percutaneous Ethanol (Alcohol) Injection of Liver
Tse-Ling Fong, MD
Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
Leslie J. Schoenfield, MD, PhD
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
How is percutaneous alcohol injection done and how does it work?
In this technique, sterile, 100% alcohol is injected into cancerous growths, or tumors, in the liver to kill cancer cells. This has worked best against growths comprised of hepatocellular carcinoma or primary liver cancer, but has been tried as well against liver metastases from other types of cancer arising elsewhere (secondary cancers). The alcohol is injected through the skin (percutaneously) into the tumor using a very thin needle with the help of ultrasound or CT visual guidance. Alcohol causes tumor destruction by drawing water out of tumor cells (dehydrating them) and thereby altering (denaturing) the structure of cellular proteins. It may take up to five or six sessions of injections to completely destroy the cancer.
Which patients are treated with percutaneous alcohol injection?
The ideal patient for alcohol injection has fewer than three Hepatocellular Carcinoma (HCC) tumors, each of which is:
- well defined (distinct margins)
- less than 3cm in diameter
- surrounded by a shell consisting of scar tissue (fibrous encapsulation)
- not near the surface of the liver
Additionally, patients with HCC undergoing alcohol injection should have no signs of chronic liver failure, such as free fluid build-up around the liver or in the abdominal cavity (ascites) or jaundice. (Patients with severe liver damage and little remaining normal liver function are said to be in liver failure, and would not be able to tolerate the alcohol injections.)
What are the side effects of percutaneous alcohol injection?
The most common side effect of alcohol injection is leakage of alcohol onto the surface of the liver and into the abdominal cavity, thereby causing pain and fever. It is important that the location of the tumor relative to the adjacent blood vessels and bile ducts is clearly identified. The reason for needing to locate these structures is to avoid injuring them during the procedure and causing bleeding, bile duct inflammation, or bile leakage.
Medically reviewed by Jay B. Zatzkin, MD; American Board of Internal Medicine with subspecialty in Medical Oncology
Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006 Aug;55 Suppl 3:iii1-8.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005 Nov;42(5):1208-36.
Medically Reviewed by Paul Oneill, MD, Board Certified Oncology
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