How is liver cancer treated?

Surgery is often the preferred treatment for liver cancer. Advances in surgical tools and techniques, better imagining, and a better understanding of liver anatomy now make it possible for surgeons to remove up to 75% of a diseased liver while leaving the remaining liver to regenerate itself.

There are also other treatment options that may use in combination with surgery or on their own.

Radiofrequency ablation may be used for small tumors. With this technique, a special probe equipped with tiny electrodes that heat and kill cancer cells, is inserted through a tiny incision in the skin and guided to the tumor site by an ultrasound or CT scan.

For larger tumors, chemoembolization, may be used. With this technique, chemotherapy is injected into the hepatic artery via a catheter (narrow tube). The chemotherapy is combined with a substance that blocks off this artery (either permanently or temporarily), cutting off blood flow to the tumor and "starving" it.

Much of the chemotherapy is trapped near the tumor, which works directly on the cancer, while limiting the drug's contact with the rest of the body, therefore causing fewer side-effects than chemotherapies given systemically. The liver can continue getting blood from the other major hepatic blood supply, the portal vein, enabling it to function normally and continue to carry blood from the stomach and intestine.

IMRT and brachytherapy may also be used. In IMRT, precisely tumor-targeted radiation is given to treat the tumor, which spares healthy tissue. With brachytherapy, temporary or permanent radioactive seeds are placed near the tumor to deliver pinpointed radiation to the cancer.

The main treatment for liver cancer or hepatocellular carcinomas (HCC) as well as cancers of the biliary tract is surgery. The tumor must be technically resectable, and the patient must be in good enough condition to undergo this major operation. Unfortunately, many patients aren't able to have surgery for one or both of these reasons. The two main categories of surgery for primary liver cancer are partial hepatectomy (removal of part of the liver) or orthotopic liver transplantation (OLT; liver transplant).

When the tumor is localized and small, physicians may recommend liver transplant. Non-transplant options are often used as a bridge to transplant, while the patient is awaiting a donor organ.

Surgery to remove the entire tumor is effective if the cancer has not spread and if the patient's liver function has not been overly compromised by cirrhosis.

Minimally invasive techniques including laparoscopic surgery and hand-assisted laparoscopic surgery allow for resection of up to 60% of the liver without need for large incisions.

Radiofrequency ablation (RFA), the directing of thermal energy directly to the tumor, is an option for tumors 5 cm or more. The procedure can often be conducted on an outpatient basis with a minimal access approach utilizing ultrasound to guide the ablation probe.

Transcatheter arterial chemoembolization (TACE) involves shutting off blood flow from the hepatic artery to the tumor in combination with delivery of a chemotherapeutic agent to the tumor. The technique spares normal liver tissue, which is not as dependent as the tumor upon the hepatic artery for its blood supply. Effectiveness of TACE, as with other therapies, is dependent upon size and extent of the hepatocellular carcinoma (HCC).

There are a number of ways to treat liver cancer. In this video, transplant surgeon Dr. Tomoaki Kato discusses the effectiveness of local or regional radiation for treating liver cancer.