- How is liver cancer treated?
- Liver cancer surgery
- Tumor ablation for liver cancer
- Embolization therapy for liver cancer
- Radiation therapy for liver cancer
- Targeted therapy for liver cancer
- Chemotherapy for liver cancer
- Clinical trials for liver cancer
- Complementary and alternative therapies for liver cancer
- Treatment of liver cancer by stage
- More treatment information about liver cancer
Liver cancer surgery
At this time, surgery, either with resection (removal of the tumor) or a liver transplant, offers the only reasonable chance to cure liver cancer. If all known cancer in the liver is successfully removed, you will have the best outlook for survival.
Surgery to remove part of the liver is called partial hepatectomy. This operation is only attempted if the person is healthy enough and all of the tumor can be removed while leaving enough healthy liver behind. Unfortunately, most liver cancers cannot be completely removed. Often the cancer has spread beyond the liver, has become very large, or is in too many different parts of the liver.
More than 4 out of 5 people with liver cancer in the United States also have cirrhosis. If you have severe cirrhosis, removing even a small amount of liver tissue at the edges of your cancer might not leave enough liver behind to perform essential functions. People with cirrhosis are eligible for surgery only if the cancer is small and they still have a reasonable amount of liver function left. Doctors often assess this function by assigning a Child-Pugh score (see the section “How is liver cancer staged?”), which is a measure of cirrhosis based on certain lab tests and symptoms. Patients who fall into class A are most likely to have enough liver function to have surgery. Patients in class B are less likely to be able to have surgery. Surgery is not typically an option for patients in class C.
Possible risks and side effects: Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually 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 function adequately.
A lot of blood passes through the liver at any given time, and bleeding after surgery is a major concern. On top of this, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to potential bleeding problems.
Other possible problems are similar to those seen with other major surgeries and can include infections, complications from anesthesia, blood clots, and pneumonia.
Another concern is that because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.
When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
According to the Organ Procurement and Transplantation Network, about 1,100 liver transplants were done in people with liver cancer in the United States in 2009, the last year for which numbers are available. The 5-year survival rate for these patients is around 60% to 70%. Not only is the risk of a second new liver cancer significantly reduced, but the new liver will function normally.
Unfortunately, the opportunities for liver transplants are limited. Only about 6,000 livers are available for transplant each year, and most of these are used for patients with diseases other than liver cancer. Increased awareness about the importance of organ donation is an essential public health goal that could make this treatment available to more patients with liver cancer and other serious liver diseases.
Most livers for transplants come from people who have just passed away. But in recent years, a small number of patients have received part of a liver from a living donor (usually a close relative) for transplant. The liver can regenerate some of its lost function over time if part of it is removed. Still, the surgery does carry some risks for the donor. About 200 to 250 living donor transplants are done in the United States each year. Only a small number of them are for patients with liver cancer.
People needing a transplant must wait until a liver is available, which can take too long for some people with liver cancer. In many cases a person may get other treatments, such as embolization or ablation (described in following sections), while waiting for a liver transplant. Or doctors may suggest a limited resection of the cancer or other treatments first and then a transplant if the cancer comes back.
Possible risks and side effects: Like partial hepatectomy, a liver transplant is a major operation with serious potential risks (bleeding, infection, blood clots, complications from anesthesia, etc.). But there are some additional risks after this surgery.
People who get a liver transplant have to be given drugs to help suppress their immune systems to prevent their bodies from rejecting the new organ. These drugs have their own risks and side effects, especially the risk of getting serious infections. By suppressing the immune system, these drugs might also allow any remaining cancer to grow even faster than before. Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, diabetes, and can weaken the bones and kidneys.
After a liver transplant, regular blood tests are important to check for signs of the body rejecting the new liver. Sometimes liver biopsies are also taken to see if rejection is occurring and if changes are needed in the anti-rejection medicines.
Last Medical Review: 06/21/2012
Last Revised: 01/18/2013