In order to choose the best treatment for liver cancer, doctors first need to determine the extent or stage of the disease. Staging is an attempt to find out whether the cancer has spread and, if so, to what parts of the body. Liver cancer that has spread may be found in the lungs, bones and in lymph nodes near the liver.
Treatment options include surgery (including a liver transplant), ablation, embolization, targeted therapy, radiation therapy and chemotherapy. Patients with liver cancer may receive a combination of these treatments.
Currently, liver cancer can be cured only when found in an early stage (before it has spread) and only if the patient is healthy enough to have surgery. Other treatments may be able to help people who cannot have surgery live longer and feel better. Doctors often encourage people with liver cancer to consider taking part in clinical trials (research studies) that are testing new treatments.
For people with an early stage of liver cancer, surgical options include liver transplant, or removal of part of the liver.
Liver transplant (total keratectomy) is an option if the tumors are small, the cancer 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.
Removal of 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 or tumors along with a margin of healthy tissue surrounding the tumor. The extent of the surgery depends on the size, number and location of the tumors and how well the liver is working.
After the tumor is removed, the remaining healthy tissue takes over the work of the liver. Over a period of several weeks, the missing part of the liver can grow back.
Methods of ablation destroy the cancer in the liver. They are treatments to control liver cancer and extend life. People waiting for a liver transplant and people for whom surgery is not an option may have ablation.
Methods of ablation include:
Radiofrequency ablation: A probe containing tiny electrodes is used 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 the skin and only local anesthesia is needed. But sometimes, the doctor inserts the probe through a small incision in the abdomen using an instrument called a laparoscope or through a wider incision that opens the abdomen.
Radiofrequency ablation is a type of hyperthermia therapy - a treatment in which body tissue is exposed to high temperatures to kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs. Other therapies that use heat to destroy liver tumors include laser or microwave therapy, but these are used less frequently 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.
For those who cannot have surgery, embolization or chemoembolization may be an option. These procedures block the flow of blood to tumors causing them to die. In embolization, blood flow is blocked by tiny sponges or other particles injected into the hepatic artery through a tiny catheter inserted through an artery in the leg. During chemoembolization, an anticancer drug (chemotherapy) is injected into the artery before the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.
Other nonsurgical treatments sometimes used for liver cancer include targeted therapy (the administering of a drug by mouth that slows the growth of liver tumors and reduces their blood supply); radiation therapy (the use of high-energy rays to kill cancer cells) and chemotherapy (the use of drugs, usually given through a vein, to kill liver cells).