At this time, surgery offers the only likely chance to cure liver cancer. Surgery is done either to remove the tumor or to do a liver transplant.
Removing part of the liver (partial hepatectomy)
Surgery to remove the part of the liver with the cancer is called a partial hepatectomy. If all of the cancer the surgeon can see at the time of the operation can be removed, you have the best outlook for survival. But complete removal of most liver cancers is not possible. Often the cancer is large, is found in many different parts of the liver, or has spread beyond the liver. Also, many people with cirrhosis do not have enough healthy liver left to make this kind of surgery an option.
Risks and side effects: People with liver cancer often have damage to the other parts of their liver. Surgeons have to remove enough of the liver to try to get all of the cancer, yet leave enough behind for the liver to work the way it needs to.
Bleeding after surgery is a major concern. On top of this, the liver makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to possible bleeding problems. Another concern is that because the remaining liver still contains the damage that led to the cancer, a new liver cancer may develop later.
Liver transplant
A liver transplant is an option for some people with small liver cancers. For now, transplant is usually saved for those with a few small tumors that cannot be totally removed, either because of where they are or because not enough normal liver would be left.
Not many livers are available for transplant for patients with cancer because they are most often used for more curable diseases. Patients often must wait a long time – often too long – for a liver to be found. For this reason, some doctors suggest other treatments while a person is waiting for a new liver. Or a person may get a partial hepatectomy first and then a transplant if the cancer comes back.
Another option that has been used in recent years is having a living donor give a part of their liver for transplant to a close relative. This can work, but it carries risks for the donor. About 250 living donor transplants are done in the United States each year, but only a small number of them are for people with liver cancer.
Possible risks and side effects of a liver transplant: People who get a liver transplant have the same surgery risks as listed above. They also have to be given drugs to help suppress the immune system and prevent the body from rejecting the new organ. These drugs have their own risks and side effects, especially the risk of getting serious infections. Some of the drugs used to prevent rejection can also cause other health problems.
Tumor ablation and embolization
Ablation refers to treatment that destroys the tumor without removing it. There are a number of ways to do this using:
- Heating with radio waves
- Alcohol (ethanol)
- Heating with microwaves
- Freezing (cryosurgery)
These treatments are most often used for patients with only a few small tumors that cannot be taken out with surgery. They are also sometimes used to treat liver cancer in patients waiting for a transplant. These methods are not likely to cure the cancer but can help people live longer.
Possible side effects after ablation treatment include belly pain, infection in the liver, and bleeding in the chest or abdomen. Serious complications are rare.
Embolization is another treatment for tumors that cannot be removed. A substance is put into the artery that carries blood to the tumor. This substance blocks the blood flow, which makes it harder for the tumor to grow.
Chemoembolization involves adding a chemo drug to embolization. Studies are now going on to see if this works better than embolization alone.
Radioembolization combines embolization with radiation treatment. It is done by putting small radioactive beads into the artery that feeds the liver. This allows small amounts of radiation to only get at the tumor sites. These methods are still fairly new.
Problems after embolization could include abdominal pain, fever, infection in the liver, gallbladder swelling, and blood clots in the liver. Serious complications are rare, but they can happen.
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