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Treatment for liver cancer

Treatment depends on the size of the cancer, whether it is contained in one part of the liver and no major blood vessels are involved, and whether you have cirrhosis. Your doctor will also consider your age, your general health and the options available at your hospital.

HCC treatment options by stage

Most people with HCC will have thermal ablation, a treatment that uses heat to destroy the tumour, or transarterial chemoembolisation (TACE), which delivers chemotherapy directly into the cancer. Surgery is used for about 5% of people.

  • Stage 0 (very early) − usually surgery
  • Stage A (early) − usually ablation, TACE, surgery or transplant
  • Stage B (intermediate) − TACE
  • Stage C (advanced) − targeted therapy drugs or palliative treatment
  • Stage D (end-stage) − palliative treatment or clinical trial; some people with liver failure and small tumours may be offered a liver transplant.

The aim of surgery is to remove the part of the liver that contains cancer. This is known as a liver resection or partial hepatectomy. Only a small number of people with liver cancer can have this surgery.

Surgical techniques

Most operations for primary liver cancer are done with a large cut in the upper abdomen. This is called open surgery. However, it is now becoming more common for liver tumours to be removed with several smaller cuts (called keyhole or laparoscopic surgery). The surgeon will insert a thin tube containing a light and camera (laparoscope) into one of the cuts. A tool at the end of the laparoscope can be used to remove tissue.

You will have a general anaesthetic and the surgeon will remove the tumour as well as some healthy-looking tissue around it.

After the surgery

The portion of the liver that remains after the resection will start to grow, even if up to three-quarters of it has been removed. The liver will usually regrow to its normal size within a few months, although its shape may be slightly changed.

Download our booklet ‘Understanding Surgery’

 

Sometimes the surgeon needs to remove so much of the liver that the remaining portion may not be able to function normally. In this case, you may have a portal vein embolisation (PVE) about 4–8 weeks before the surgery.

PVE involves blocking the branch of the portal vein that carries blood to the part of the liver that is going to be removed. This redirects the blood to the remaining part of the liver to help it grow.

A transplant involves removing the whole liver and replacing it with a healthy liver from another person (a donor). This treatment is effective for HCC, but it is generally used only in people with a single tumour or several small tumours. It is not usually recommended for cholangiocarcinoma (bile duct cancer).

For tumours smaller than 3 cm, you may be offered tumour ablation. This destroys the tumour without removing it and may be the best option if you cannot have surgery or are waiting for a transplant. Ablation can be done in different ways, depending on the size, location and shape of the tumour.

This uses heat to destroy a tumour. The heat may come from radio waves (radiofrequency ablation) or microwaves (microwave ablation).

This involves injecting pure alcohol into the tumour. It isn’t available at all hospitals, but is used occasionally if other forms of ablation aren’t possible.

Also known as cryosurgery, cryotherapy kills cancer cells by freezing them. This treatment is not widely available, but is offered occasionally.

Chemotherapy is the use of drugs to kill or damage cancer cells, but traditional chemotherapy is rarely used for primary liver cancer. Instead, transarterial chemoembolisation, or TACE, delivers high doses of chemotherapy directly to the tumour. It is usually used for people who can’t have surgery or are waiting for a liver transplant.

Side effects of TACE

It is common to have a fever the day after TACE, but this usually passes quickly. You may feel some pain, which can be controlled with medicines. Some people may feel tired or report flu-like symptoms for up to a week afterwards.

Download our booklet ‘Understanding Chemotherapy’

SIRT and SBRT radiation therapy is not often used to treat primary liver cancer. However, two techniques may be offered in specific cases.

SIRT − Also known as radioembolisation, selective internal radiation therapy (SIRT) is a type of internal radiation therapy that precisely targets cancers in the liver. SIRT may be offered for HCC when the tumours can’t be removed with surgery.

SBRT − Some centres offer a form of external radiation therapy called stereotactic body radiation therapy (SBRT). You will lie on an examination table, and a machine will deliver a few high doses of radiation very precisely to the liver. SBRT may be offered to some people with small HCC tumours that can’t be removed with surgery. Check costs as this procedure may not be covered by Medicare.

Download our booklet ‘Understanding Radiation Therapy’

 

People who have advanced HCC or are on a clinical trial may be offered a targeted therapy drug. These drugs attack specific particles within cancer cells that allow cancer to grow.

Generally, targeted therapy drugs are continued for as long as there is benefit.

Drug treatment for advanced HCC is changing quickly and new treatments may become available in the near future. These may include immunotherapy drugs, which stimulate the body’s immune system to fight cancer. You can discuss the latest options with your treating specialist.

Download our fact sheet ‘Understanding Targeted Therapy’

If primary liver cancer is advanced at diagnosis or returns after initial treatment, your doctor will discuss palliative treatment for symptoms caused by the cancer.

Palliative treatment aims to manage the symptoms without trying to cure the disease. It can be used at any stage of advanced cancer to improve quality of life. It is not just for people who are about to die and does not mean giving up hope. Rather, it is about living for as long as possible in the most satisfying way you can.

As well as slowing the spread of cancer, palliative treatment can relieve pain and other symptoms. Treatment may include chemotherapy, targeted therapy, other medicines or stent placement.

Download our booklet ‘Understanding Palliative Care’