Liver Cancer

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Treating Liver Cancer TOPICS

Treatment of liver cancer by stage

Although the AJCC (TNM) staging system (see "How is liver cancer staged?") is often used to describe the spread of a liver cancer precisely, doctors use a more practical system to determine treatment options. Liver cancers are categorized as: localized resectable, localized unresectable, and advanced.

Localized resectable liver cancer (some T1 or T2, N0, M0 tumors)

If your cancer is at an early stage and the rest of your liver is healthy, surgery (partial hepatectomy) may cure you. Unfortunately, only a small number of people with liver cancer are in this category. An important factor affecting outcome is the size of the tumor(s) and whether nearby blood vessels are affected. Larger tumors or ones that invade blood vessels are more likely to come back in the liver or spread elsewhere after surgery. The function of the rest of the liver and your general health are also important. For some people with early-stage liver cancer, a liver transplant could be another option.

Clinical trials are now looking at whether patients who have a partial hepatectomy will be helped by getting other treatments in addition to surgery. Some studies have found that using chemoembolization or other treatments along with surgery may help some patients live longer. Still, not all studies have found this, and more research is needed to know the value (if any) of adding other treatments to surgery.

Localized unresectable liver cancer (some T1 to T4, N0, M0 tumors)

Localized, unresectable cancers include cancers that haven’t yet spread, but that can’t be removed safely by partial hepatectomy for some reason:

  • The tumor is too large to be removed safely
  • The tumor is in a part of the liver that makes it hard to remove (such as very close to a large blood vessel)
  • There are several tumors
  • The rest of the liver is unhealthy (because of cirrhosis or other reasons)

These patients may be treated with a liver transplant if it is possible. Although this is a very difficult operation, it has helped many people. Transplant may cure the cancer and any underlying liver disease.

Most people wait at least several months before a liver becomes available for transplant. In many cases a person may get other treatments, such as embolization or ablation, while waiting for a liver transplant.

If you are not eligible for a transplant, your doctor may recommend ablation, embolization, or both for the liver tumor(s). Other options may include targeted therapy with sorafenib, chemotherapy (either systemic or by hepatic artery infusion), and/or radiation therapy. In some cases, treatment may shrink the tumor(s) enough so that surgery (partial hepatectomy or transplant) may become possible.

Although it is unlikely that treatments other than a transplant will cure the cancer, they can reduce symptoms and may prolong life. Because these cancers can be hard to treat, clinical trials of newer treatments may offer a good option in many cases.

Advanced liver cancer (includes all N1 or M1 tumors)

Advanced cancer has spread outside the liver (either to the lymph nodes or to other organs). Because these cancers are widespread, they cannot be treated with surgery.

If your liver is functioning well enough (Child-Pugh class A or B), the targeted therapy sorafenib may help control the growth of the cancer for a time and may help you live longer.

As with localized unresectable liver cancer, clinical trials of targeted therapies, new approaches to chemotherapy (new drugs and ways to deliver chemotherapy), new forms of radiation therapy, and other new treatments may help you. These clinical trials are also important for improving the outcome for future patients.

Treatments such as radiation might also be used to help relieve pain and other symptoms. Please be sure to discuss any symptoms you have with your cancer team, so they can treat them effectively.

Recurrent liver cancer

Cancer that comes back after treatment is called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment of liver cancer that returns after initial therapy depends on many factors, including where it comes back, the type of initial treatment, and how well the liver is functioning. Patients with localized resectable disease that recurs in the liver might be eligible for further surgery or local treatments like ablation or embolization. If the cancer is widespread, targeted therapy (sorafenib) or chemotherapy may be options. Patients may also wish to ask their doctor whether a clinical trial may be right for them.

Treatment can also be given to relieve pain and other symptoms. Please be sure to discuss any symptoms you have with your cancer care team, so they may be treated effectively.

For more information on dealing with a recurrence, you may also want to look at our document When Your Cancer Comes Back: Cancer Recurrence.

Last Medical Review: 09/25/2013
Last Revised: 02/10/2014