Liver Cancer Treatments
Standard treatments for liver cancer may include:
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.
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.
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 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.
Immunotherapy pushes the body’s immune system to work harder to fight the cancer. Immunotherapy has been approved to treat patients with HCC who have previously been treated with some types of chemotherapy.
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.
Side Effects Management
Side effects experienced for the treatment of liver cancer vary. Your body will need time to recover. Initially, you will have pain and/or discomfort and medication to control the pain. Be sure to communicate openly to your nurse or doctor about your pain.
It is important to remember that acetaminophen (Tylenol*), a common pain reliever, can damage the liver. You should not take acetaminophen unless the doctor treating your liver cancer instructs you to take it.
You may also have abdominal discomfort - a feeling of fullness. Walking can help decrease the discomfort and return your bowel function to normal.
Following are the most common symptoms as they relate to procedures:
Percutaneous Ethanol Injection
Patients may have fever and pain after this procedure.
Because a smaller incision is needed for cryosurgery than for traditional surgery, recovery after cryosurgery is generally faster and less painful. Also, infection and bleeding are not as likely.
Hepatic Arterial Infusion
The drug mainly affects the cells in the liver and only small amounts reach other parts of the body. Chemoembolization and hepatic arterial infusion cause fewer side effects than chemotherapy because the drugs don’t flow through the whole body. Side effects from hepatic arterial infusion include infection and problems with the pump device, which may need to be removed.
This treatment may cause nausea, vomiting, fever, and abdominal pain.
Side effects of radiation to the abdomen depend on dose and may include nausea, vomiting, diarrhea, or other problems with digestion.
Side effects depend on the specific drugs and the dose and include hair loss, loss of appetite, nausea and vomiting, diarrhea, fatigue, and mouth sores.
If you have a liver transplant, you will first go to an intensive care unit after your surgery to recover. You will remain in the hospital for several weeks and may have a drain to help reduce a fluid around the surgery site. Your doctor will be carefully assessing your condition to be sure that your body is accepting the new liver.
Immunosuppressants, drugs that decrease the response of your immune system to the new liver, will be given to reduce the potential for rejection. Ask your nurse or doctor about side effects of the specific immunosuppressants you are taking. If you have a transplant, you will remain on antibiotics for a period of time after your transplant to protect you from infection.
Immediately call your doctor if you experience a fever, redness or pus at your surgery site, bleeding or signs of liver failure - yellowing of the skin or whites of the eyes, dark urine or confusion - after surgery.