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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
recommend one or more treatment options. Choosing a treatment plan is a
major 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.
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 confident about the
treatment plan that you pick. Some insurance companies want a second
opinion before they will agree to pay for certain treatments. Almost
all will pay for the second opinion.
Surgery
At this time surgery offers the only likely chance to cure
liver cancer. Surgery is done either to remove the tumor or 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 normally 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 disease damage that led to the
cancer, sometimes a new liver cancer can 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 the location of the
tumors or because not enough normal liver remains.
Not many livers are available 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.
Increased awareness about organ donation is a crucial public
health goal that could make this treatment available to more patients
with liver cancer and other serious liver diseases.
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 risk 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 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. Future
medical advances are expected to reduce the risk of rejection and the
harsh side effects.
Tumor ablation and embolization
Ablation refers to a local treatment that destroys the tumor
without removing it. There are a number of different 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 not meant to
cure the cancer but can allow people to live longer.
Embolization is another treatment for tumors that cannot be
removed. A material is put in the artery that carries blood to the
tumor. This blocks the blood flow and makes it harder for the tumor to
grow.
Chemoembolization involves combining embolization with
chemotherapy. Studies are now going on to see if this works better than
embolization alone.
Radioembolization combines embolization with radiation
therapy. It is done by injecting small radioactive beads or oils into
the artery that feeds the liver. This allows small amounts of radiation
to only get at the tumor sites. These techniques 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
(such as x-rays) to kill cancer cells and shrink tumors. External beam
radiation delivers 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. 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 often have
different, and less severe, side effects.
Like chemo these drugs enter the bloodstream and go 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 (often called "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.
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.
Liver cancer survival rates
Only a small number of liver cancers are found in the early
stages and can be removed with surgery. The 5-year survival rate for
patients with resectable early stage cancer is in the range of 30% to
60%. This percentage drops for more advanced cancers or with more
severe liver disease.
The 5-year survival rate refers to the percentage of patients
who live at least 5 years after their cancer is diagnosed. Five-year
rates are used to produce a standard way of discussing prognosis. Of
course, some people live much longer than 5 years.
The 5-year survival rate for people with cancer that has
spread widely throughout the liver or to distant sites is less than 5%,
and the average survival time is often measured in months.
The overall 5-year survival rate from liver cancer is less
than 10%. Part of the reason for this low survival rate is that most
patients with liver cancer also have other liver problems such as
cirrhosis, which itself can be fatal.
Each person is different
While numbers provide an overall picture, keep in mind that
every person's situation is unique and statistics can't predict exactly
what will happen in your case. Talk with your cancer care team if you
have questions about your personal chances of a cure, or how long you
might survive your cancer. They know your situation best.
Last Medical Review: 01/09/2009 Last Revised: 05/06/2009
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