How is liver cancer treated?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner
There are several treatment options for liver cancer; however there are three main goals of treatment: to get rid of the cancer, to keep it from spreading, and to control symptoms. Possible treatment options may include surgery, radiation therapy, chemotherapy, ablation (heating, freezing, or using alcohol to eliminate cancer cells), embolization (blocking the cancer's blood supply), and targeted therapy (using drugs that stop tumor growth). Treatment is chosen based on the location, size, and number of the tumors, as well as how far the cancer has spread in your body. Oftentimes, several of the treatment options will be combined.
Dr. Jill K. Onesti, MD
Surgical Oncologist

Liver cancer is a potentially life-threatening cancer with a variety of treatments. Once you have been diagnosed with a primary liver cancer, you will meet with a team of doctors to discuss which treatment plan is best for you. This will depend on the size of the cancer, if the cancer invades major blood vessels, and how healthy you and your liver are. Therapy options include liver transplantation, surgical resection, chemotherapy or radiotherapy that is delivered through an artery in your groin, radiation, chemotherapy in the form of a pill or simply measures to keep you comfortable.

Liver cancer is sometimes treated with chemotherapy, or chemo for short. There are many different types of chemo and many different ways of giving it. The most common way is using a technique called chemoembolization. Other treatments are radioembolization, radiofrequency ablation (RFA), and microwave ablation.

It may be possible to treat primary liver cancer surgically. Surgery for liver cancer involves removing part of the liver or, very occasionally, the entire liver might be removed and replaced with a healthy one. Most people with primary liver cancer aren’t suitable for an operation, especially if the tumor is large or if it has spread outside the liver.

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.

Dr. Ajay K. Sahajpal, MD
Transplant Surgeon

The term liver cancer can refer to both primary cancer of the liver such as hepatocellular cancer or cholangiocarcinoma and secondary cancer such as metastases. 

Most people are referring to hepatocellular cancer with the term liver cancer. It is treated with a combination approach using liver transplant or resection depending upon liver function. This is often done in conjunction with some regional therapy such as chemoembolization/radioembolization or ablation. Medical treatment consists of Sorafenib or Nexavar.

Your cancer expert should use a multidisciplinary approach to evaluate these tumors and then decide upon a treatment plan.

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.
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).

Primary liver cancer is typically treated with transplantation. Transplantation is curative and it offers the best long-term survival, since the cirrhotic liver will always be at a high risk of another tumor occurring at a later time. Some people have tumor burden that does not allow for transplantation because it's too extensive. These people can be treated with local, regional therapy, one of which is yttrium-90 radioembolization. People with a more advanced disease can receive a biologic agent called Sorafenib, which is a multikinase inhibitor and does offer some survival benefit as well.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.