This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Making treatment decisions

After liver cancer is found and staged, your doctor will talk to you about treatment options. Choosing a treatment plan is a big decision. Take time and think about all of your choices.

When planning your treatment, it is important to take into account is the stage (extent) of the cancer. But you and your cancer care team will also want to think about your age, general state of health, and personal preferences.

If time permits, it may be a good idea to get a second opinion, especially from a doctor experienced in treating liver cancer. A second opinion can give you more information and help you feel more certain about the treatment plan you pick.

Surgery

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. If all of the cancer that 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 surgery an option.

Risks and side effects of surgery

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 people with small liver cancers. For now, transplant is 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 a limited resection 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 300 living donor transplants are done in the United States each year. Only a small percent 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. These treatments are usually 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 meant to cure the cancer but can help people live longer.

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 chemo 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 and are discussed in more detail in the section "What's new in liver cancer research?"

Radiation treatment

Radiation therapy is treatment that uses high-energy rays to kill cancer cells or shrink tumors. External beam radiation aims radiation from outside the body to the cancer. Liver cancer cells can be killed by radiation, but this treatment can't be used at very high doses because normal liver tissue is killed, too. This type of radiation may be used to shrink a liver tumor or to give relief from symptoms like pain, but it does not cure the liver cancer and usually does not help people live longer.

Three-dimensional conformal radiation therapy (3DCRT) is a newer type of external-beam radiation treatment. It uses computers to map the exact location of a tumor. This lowers the damage to normal tissue and allows higher doses to be used. When available, this approach is usually preferred over standard radiation treatment.

Possible side effects of radiation treatment

Side effects of radiation treatment might include sunburn-like skin problems at the place where the radiation enters the body, nausea, vomiting, and tiredness. Often these go away after treatment is finished. Radiation might also make chemo side effects worse.

Targeted therapy

As researchers have learned more about the changes in cells that cause cancer, they have been able develop newer drugs that are aimed at these changes. Targeted drugs do not work the same as standard chemo drugs (which are described in the next section). They tend to focus on killing the cancer cells and cause less damage to normal tissues. And they often have different, and less severe, side effects.

Like chemo, these drugs enter the bloodstream and travel throughout the body. This makes them useful against cancers that have spread to distant organs. Because chemo has not worked well in most patients with liver cancer, doctors have begun testing and using targeted therapies.

Chemotherapy

Chemotherapy (or "chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs get in the blood, they spread throughout the body. This makes them useful for cancer that has spread to distant organs.

Liver cancer does not respond to most chemo drugs. The drugs that have worked best are doxorubicin (Adriamycin^®) 5-fluorouracil, and cisplatin. But most studies have not shown that chemo helps liver cancer patients to live longer.

Hepatic artery infusion: Because standard chemo does not work very well for liver cancer, doctors have studied putting chemo drugs right into the hepatic artery. This is called hepatic artery infusion (HAI). The chemo goes to the whole liver through the hepatic artery, but the healthy liver breaks down most of the drug before it can reach the rest of the body. This gets more chemo to the tumor and may cause fewer or less severe side effects.

Although early studies have found that HAI works to shrink tumors, more research is still needed. This method may not be useful in all patients because it often means surgery is needed to put in a catheter. Many liver cancer patients may not be able to withstand this surgery.

Possible side effects of chemo

Chemo can have side effects like these:

• Mouth sores
• Loss of appetite
• Hair loss
• Nausea and vomiting
• A higher chance of infection (from a shortage of white blood cells)
• Easy bleeding or bruising (from a shortage of blood platelets)
• Tiredness and shortness of breath (from low red blood cell counts)

Most side effects go away once treatment is over. If you have side effects, be sure to tell your doctor or nurse. There are often ways to help.

Last Medical Review: 12/15/2009
Last Revised: 12/15/2009