Surgery
Ablation
Embolization
Targeted Therapy
Radiation Therapy
Chemotherapy

Treatment options for people with liver cancer are surgery (including a liver transplant), ablation, embolization, targeted therapy, radiation therapy, and chemotherapy. You may have a combination of treatments.

The treatment that's right for you depends mainly on the following:

• the number, size, and location of tumors in your liver
  
  
• how well your liver is working and whether you have cirrhosis
  
  
• whether the cancer has spread outside your liver

Other factors to consider include your age, general health, and concerns about the treatments and their possible side effects.

At this time, liver cancer can be cured only when it's found at an early stage (before it has spread) and only if people are healthy enough to have surgery. For people who can't have surgery, other treatments may be able to help them live longer and feel better. Many doctors encourage people with liver cancer to consider taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of liver cancer. See the Taking Part in Cancer Research section ¹.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat liver cancer include surgeons (especially hepatobiliary surgeons, surgical oncologists, and transplant surgeons), gastroenterologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

Surgery

Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver or only the part that has cancer. If the whole liver is removed, it's replaced with healthy liver tissue from a donor.

You and your surgeon can talk about the types of surgery and which may be right for you.

Removal of part of the liver

Surgery to remove part of the liver is called partial hepatectomy. A person with liver cancer may have part of the liver removed if lab tests show that the liver is working well and if there is no evidence that the cancer has spread to nearby lymph nodes or to other parts of the body.

The surgeon removes the tumor along with a margin of normal liver tissue around the tumor. The extent of the surgery depends on the size, number, and location of the tumors. It also depends on how well the liver is working.

As much as 80 percent of the liver may be removed. The surgeon leaves behind normal liver tissue. The remaining healthy tissue takes over the work of the liver. Also, the liver can regrow the missing part. The new cells grow over several weeks.

It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.

It's common to feel tired or weak for a while. Also, you may have diarrhea and a feeling of fullness in the abdomen.

The health care team will watch you for signs of bleeding, infection, liver failure, or other problems.

Liver transplant

A liver transplant is an option if the tumors are small, the disease has not spread outside the liver, and suitable donated liver tissue can be found.

Donated liver tissue comes from a deceased person or a live donor. If the donor is living, the tissue is part of a liver, rather than a whole liver.

While you wait for donated liver tissue to become available, the health care team monitors your health and provides other treatments.

When healthy liver tissue from a donor is available, the transplant surgeon removes your entire liver (total hepatectomy) and replaces it with the donated tissue. After surgery, your health care team will give you medicine to help control your pain. You may need to stay in the hospital for several weeks. During that time, your health care team monitors how well your body is accepting the new liver tissue. You'll take medicine to prevent your body's immune system from rejecting the new liver. These drugs may cause puffiness in your face, high blood pressure, or an increase in body hair.

Ablation

Methods of ablation destroy the cancer in the liver. They are treatments to control liver cancer and extend life. They may be used for people waiting for a liver transplant. Or they may be used for people who can't have surgery or a liver transplant. Surgery to remove the tumor may not be possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems.

Methods of ablation include the following:

• Radiofrequency ablation: The doctor uses a special probe that contains tiny electrodes to kill the cancer cells with heat. Ultrasound, CT, or MRI may be used to guide the probe to the tumor. Usually, the doctor can insert the probe directly through your skin, and only local anesthesia is needed.
  
  Sometimes, surgery under general anesthesia is needed. The doctor inserts the probe through a small incision in your abdomen (using a laparoscope) or through a wider incision that opens your abdomen.
  
  Some people have pain or a slight fever after this procedure. Staying overnight in the hospital is not usually needed.
  
  Radiofrequency ablation is a type of hyperthermia therapy. Other therapies that use heat to destroy liver tumors include laser or microwave therapy. They are used less often than radiofrequency ablation.
  
  
• Percutaneous ethanol injection: The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells. The procedure may be performed once or twice a week. Usually local anesthesia is used, but if you have many tumors in the liver, general anesthesia may be needed.
  
  You may have fever and pain after the injection. Your doctor can suggest medicines to relieve these problems.

Embolization

For those who can't have surgery or a liver transplant, embolization or chemoembolization may be an option. The doctor inserts a tiny catheter into an artery in your leg and moves the catheter into the hepatic artery. For embolization, the doctor injects tiny sponges or other particles into the catheter. The particles block the flow of blood through the artery. Depending on the type of particles used, the blockage may be temporary or permanent.

Without blood flow from the hepatic artery, the tumor dies. Although the hepatic artery is blocked, healthy liver tissue continues to receive blood from the hepatic portal vein.

For chemoembolization, the doctor injects an anticancer drug (chemotherapy) into the artery before injecting the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.

You'll need to be sedated for this procedure, but general anesthesia is not usually needed. You'll probably stay in the hospital for 2 to 3 days after the treatment.

Embolization often causes abdominal pain, nausea, vomiting, and fever. Your doctor can give you medicine to help lessen these problems. Some people may feel very tired for several weeks after the treatment.

Targeted Therapy

People with liver cancer who can't have surgery or a liver transplant may receive a drug called targeted therapy. Sorafenib (Nexavar) tablets were the first targeted therapy approved for liver cancer.

Targeted therapy slows the growth of liver tumors. It also reduces their blood supply. The drug is taken by mouth.

Side effects include nausea, vomiting, mouth sores, and loss of appetite. Sometimes, a person may have chest pain, bleeding problems, or blisters on the hands or feet. The drug can also cause high blood pressure. The health care team will check your blood pressure often during the first 6 weeks of treatment.

You may want to read the NCI fact sheet Targeted Cancer Therapies ².

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be an option for a few people who can't have surgery. Sometimes it's used with other approaches. Radiation therapy also may be used to help relieve pain from liver cancer that has spread to the bones.

Doctors use two types of radiation therapy to treat liver cancer:

• External radiation therapy: The radiation comes from a large machine. The machine aims beams of radiation at the chest and abdomen.
  
  
• Internal radiation therapy: The radiation comes from tiny radioactive spheres. A doctor uses a catheter to inject the tiny spheres into your hepatic artery. The spheres destroy the blood supply to the liver tumor.

The side effects from radiation therapy include nausea, vomiting, or diarrhea. Your health care team can suggest ways to treat or control the side effects.

You may find it helpful to read the NCI booklet Radiation Therapy and You ³.

Chemotherapy

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat liver cancer. Drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body.

Chemotherapy may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital.

The side effects of chemotherapy depend mainly on which drugs are given and how much. Common side effects include nausea and vomiting, loss of appetite, headache, fever and chills, and weakness.

Some drugs lower the levels of healthy blood cells, and you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. Some side effects may be relieved with medicine.

You may wish to read the NCI booklet Chemotherapy and You ⁴.

Glossary Terms

In medicine, the removal or destruction of a body part or tissue or its function. Ablation may be performed by surgery, hormones, drugs, radiofrequency, heat, or other methods.

A procedure in which the blood supply to the tumor is blocked surgically or mechanically and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

A doctor who specializes in diagnosing and treating disorders of the digestive system.

A temporary loss of feeling and a complete loss of awareness that feels like a very deep sleep. It is caused by special drugs or other substances called anesthetics. General anesthesia keeps patients from feeling pain during surgery or other procedures.

Surgery to remove all or part of the liver.

Having to do with the liver, bile ducts, and/or gallbladder.

A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

The complex group of organs and cells that defends the body against infections and other diseases.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.

Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.

A device that forms light into intense, narrow beams that may be used to cut or destroy tissue, such as cancer tissue. It may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery. Lasers are used in microsurgery, photodynamic therapy, and many other procedures to diagnose and treat disease.

A temporary loss of feeling in one small area of the body caused by special drugs or other substances called anesthetics. The patient stays awake but has no feeling in the area of the body treated with the anesthetic.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Also called microwave thermotherapy.

A nurse who specializes in treating and caring for people who have cancer.

An injection of ethanol (alcohol) through the skin directly into a tumor to kill cancer cells. Ultrasound or a CT scan is used to guide the needle into the tumor. Also called alcohol ablation, ethanol ablation, and PEI.

A doctor who specializes in using radiation to treat cancer.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

A procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity). Radiofrequency ablation may be used to treat cancer and other conditions.

A health professional with special training in the use of diet and nutrition to keep the body healthy. A registered dietitian may help the medical team improve the nutritional health of a patient.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A drug used to treat advanced kidney cancer and a type of liver cancer that cannot be removed by surgery. It is also being studied in the treatment of other types of cancer. Sorafenib stops cells from dividing and may prevent the growth of new blood vessels that tumors need to grow. It is a type of kinase inhibitor and a type of antiangiogenesis agent. Also called BAY 43-9006, Nexavar, and sorafenib tosylate.

A doctor who performs biopsies and other surgical procedures in cancer patients.

A type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells. Targeted therapy may have fewer side effects than other types of cancer treatments.

A doctor who specializes in transplantation surgery. The surgeon replaces a patient's organ with an organ from another person.

A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient).