Treatment
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
You may want to ask your doctor these
questions before your treatment begins:
- What is the stage of the disease? Has the liver
cancer spread?
- Do I have cirrhosis?
- Do I need any more tests to determine whether
I can have surgery?
- What is the goal of treatment? What are my
treatment choices? Which do you recommend
for me? Why?
- What are the expected benefits of each kind of
treatment?
- What are the risks and possible side effects of
each treatment? How can side effects be
managed?
- Will I need to stay in the hospital? If so, for
how long?
- How will you treat my pain?
- What will the treatment cost? Will my
insurance cover it?
- How will treatment affect my normal
activities?
- Would a clinical trial (research study) be
appropriate for me?
- How often will I need checkups?
- Can you recommend other doctors who could
give me a second opinion about my treatment
options?
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