Liver Cancer: Treatment Choices

There are many types of treatment for liver cancer. The one that's best for you depends on things such as:

• The type of cancer

• The size of the tumor

• Extent of the disease, called the stage

• Your age

• Your overall health

• How well the rest of your liver is working

• Your personal concerns and preferences, like what side effects you’ll find acceptable

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may want to know how you’ll feel during treatment, how your body will work after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can explain what your treatment choices are, how well treatment is expected to work, what the risks and side effects may be, and what the goal of treatment is.

Your healthcare provider may advise a certain treatment. Or they may offer more than one and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your partner, spouse, family, or friends in this process.

Goals of treatment for liver cancer

For some liver cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, treatment may be used to shrink the cancer or keep it under control. Treatment can also improve your quality of life by helping to control symptoms caused by the cancer. The goal of liver cancer treatment is to do one or more of these things:

• Remove the cancer in the liver (or the entire liver) while doing as little damage as possible to nearby areas

• Kill cancer cells or keep them from growing or spreading

• Keep the cancer from coming back or delay its return

• Ease symptoms of the cancer, such as pain or blockages

Each type of treatment has a different goal. Talk to your healthcare provider about treatment goals so you know what to expect.

Types of treatment for liver cancer

Treatment for cancer is either local or systemic. You may have both.

Local treatments remove, destroy, or control cancer cells in a certain place in the body. Surgery and ablation are local treatments.

Systemic treatments destroy or control cancer cells throughout the body. Immunotherapy, targeted therapy, and chemotherapy are examples.

Commonly used treatments for liver cancer

Here is an overview of the most common treatments for liver cancer.

Surgery

Surgery offers the best chance to cure liver cancer. But only a few people can have surgery. If the cancer is small and in only one part of the liver (and the rest of the liver is healthy enough), the part of the liver with the cancer can be removed. This surgery is called a partial hepatectomy.

Another choice might be to remove the entire liver and replace it with a liver transplant. Again, the cancer must be only in the liver. It can't be in nearby tissues or other parts of the body, and a donated liver must be found.

Tumor ablation and embolization

These methods can be used to treat some tumors in the liver. Ablation involves using heat (radiofrequency ablation or RFA), cold (cryoablation), or other methods to destroy tumors instead of removing them.

Embolization is used to cut off a tumor's blood supply. A substance is injected into the blood vessel going to the tumor. Sometimes this is combined with radiation (radioembolization) or chemotherapy (chemoembolization). In this case, the radioactive particles or chemo are put through the blood vessel into the tumor and then the blood vessel is blocked off. This traps the radiation or chemo in the tumor and cuts off the blood supply. Both of these things kill cancer cells.

Radiation

Radiation uses high-energy X-rays to kill cancer cells. It’s used mainly when surgery can't be done or other treatments aren't good methods. It might be used to treat tumors that have spread and are causing problems in other parts of the body, like the bones or brain.

Targeted therapy

This type of treatment uses medicines that target certain proteins, genes, or cell functions that help cancer cells grow. It’s used mainly for liver cancers that can't be removed with surgery.

Immunotherapy

These medicines help your immune system find and kill cancer cells. Some liver cancer cells use a protein called PD-L1 to keep your immune system from attacking them. Medicines that block PD-L1 can boost the immune system against these cancer cells. CTLA-4 is another protein liver cancer cells use. Medicines can block this protein so the immune system can kill the cells.

Chemotherapy

The goal of chemotherapy (chemo) is to stop cancer from growing or spreading. Strong medicines are used to kill the cells or stop them from dividing. Chemo doesn't work very well for liver cancer, but it may be used to treat advanced liver cancer.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if they think that available treatments are more likely to do you more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat liver cancer. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Before starting treatment, talk with your healthcare provider to find out if there are any clinical trials you should think about.

Talking with your healthcare provider

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and side effects of each choice. Discuss your concerns with your healthcare provider before making a decision.