Treatment

There are several treatment options for liver cancer, depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.

Treatment for liver cancer has the most favorable outcome when detected and treated in early stages, before it has spread. Cancer of the liver is very hard to control with current treatments. Treatments other than surgery can help control liver cancer and help patients live longer and alleviate symptoms.

Follow-up care for patients with liver cancer depends on the stage of the disease and the treatments they have received. It is very important after surgery because the cancer can return in the liver or in another part of the body.

People who have had liver cancer surgery may wish to discuss the chance of recurrence with their doctor. Follow-up care may include blood tests, x-rays, ultrasound tests, CT scans, angiograms, or other tests. For patients who have had a liver transplant, the doctor will test how well the new liver is functioning. The doctor will watch the patient closely to make sure the new liver is not being rejected.

Liver Cancer Treatments

Surgery
Treatment options for localized resectable cancer, which means there is no evidence that the cancer has spread and lab tests show the liver is functioning well, includes surgery:
  • Partial Hepatectomy - removal of part of the liver where the cancer is present. This can involve the removal of one or more of the eight liver segments, or an entire lobe. The liver tissue remaining after a partial hepatectomy must be healthy enough to continue to perform the liver’s functions for the body. The extent of cirrhosis is also an important consideration.
  • Total Hepatectomy and Liver Transplantation - the entire liver is removed and replaced by a healthy liver from a donor. A donated liver that is a match must be found for this surgery to be performed. Transplantation is done when the cancer is only in the liver, has not invaded major blood vessels in the liver, and is smaller than 5 centimeters. Sometimes other procedures are performed to control the cancer while a patient waits for a donor liver to become available.

Local or Regional Therapies

Unresectable liver cancer (liver cancer that cannot be removed) requires other therapies instead of surgery. These treatments are usually performed by an interventional radiologist. The patient often stays overnight in the hospital after the procedure. They are used for patients with small tumors that are not resectable or sometimes when a patient is waiting for a transplant. Standard local or regional therapies for unresectable liver cancer include:
  • Radiofrequency Ablation
    Ablation is any treatment that destroys tissue. One of the newer forms of treatment for liver cancer is radiofrequency ablation. A probe is placed into the tumor through an incision in the body and tiny electrodes on the probe destroy cancer cells with heat. Other ablation therapies freeze cancer cells or use alcohol to destroy them. 
  • Chemoembolization first delivers a high dose of chemotherapy directly into the tumor through a catheter in an artery and then uses special particles to seal off the tumor and cut off its blood supply. This procedure is also called TACE (transcatheter arterial chemoembolization.) 
  • Radioembolization (selective internal radiation therapy) uses radioactive beads that are injected through a thin catheter threaded into the liver, through an artery and deposited close to the tumor site where they destroy the DNA of the cancer cells.

Targeted Therapy
An exciting new development in the treatment of unresectable or advanced liver cancer is the approval of the targeted therapy, sorafenib or Nexavar*. Unlike chemotherapy, which kills all rapidly dividing cells (both cancer cells and healthy cells), targeted therapies selectively focus on a specific molecule or process in the tumor cell.

The FDA approval of sorafenib was based on a clinical trial that showed positive outcomes for liver cancer patients who were treated with the drug. Sorafenib is an oral medication and is part of a category of drugs that targets vascular endothelial growth factor or VEGF. VEGF is a protein that allows a tumor to grow its own blood vessels. Sorafenib blocks VEGF, as well as other proteins that play an important role in the growth of new blood vessels and in the signaling process in the tumor cell that promotes cancer cell growth and multiplication.

Radiation Therapy
Another option for tumors that cannot be surgically removed is treatment with high-energy rays or radiation therapy. Radiation can be given externally from special equipment that positions the patient and delivers doses of radiation from the outside of the body to very precisely target internal cancer cells. The primary goal of this treatment is the relief of symptoms.

Chemotherapy
Chemotherapy works by killing rapidly dividing cells and can be given as a single drug or as a combination of drugs. Chemotherapy has been effective when delivered as part of the chemoembolization process and can also be given directly into the liver through the hepatic artery.

When chemotherapy is given systematically (by injecting the drug though a vein), liver cancer has been largely resistant to this form of treatment. A few chemotherapy agents have shown potential benefit and clinical trials looking at various combinations of chemotherapy, targeted therapy and radiation therapy are on-going.

Clinical Trials
Because doctors are still trying to find more effective treatments for liver cancer, clinical trials are an important option to consider. Clinical trials are research studies that test whether a new treatment is safe and effective against cancer. Clinical trials also test whether a new treatment is better at treating specific cancers than the best practices available today (also known as the “standard of care”).

Participating in a clinical trial may give you the opportunity to be among the first to benefit from
the most advanced treatment available. Clinical trials are conducted by the National Cancer Institute (NCI), cancer centers, medical universities, and pharmaceutical companies around the world. They are conducted with the highest level of regulation and review to make sure participants are safe. If you are interested in a clinical trial, ask your health care team about studies that you might qualify for.

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