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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.
Partial hepatectomy
Surgery to remove part of the liver is called partial hepatectomy.
This operation is only attempted if all of the tumor can be removed
while leaving enough healthy liver behind to function. Unfortunately,
complete removal of most liver cancers is not possible. Often the
cancer has spread beyond the liver, it has become quite large or is
present in too many different parts of the liver, or the person is not
healthy enough for surgery.
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 eligible for 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, and pneumonia.
Another concern is that because the remaining liver still
contains the underlying disease that led to the cancer, sometimes a new
liver cancer can develop afterward.
Liver transplant
When it is available, a liver transplant has become the best
option for some people with small liver cancers. At the present time,
liver transplants are reserved for those with small tumors (either 1
tumor smaller than 5 cm or 1 to 3 tumors no larger than 3 cm) 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, more than 6,000 liver transplants are done each year in the
United States. About 10% of these are done in people with liver cancer.
The 5-year survival for these patients is around 60%. 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. Not many livers are available for patients with cancer because
they are generally used for patients with more curable diseases.
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.
An option that has become more popular in recent years is
having a living donor give a part of their liver for transplant to a
close relative. This can be successful, but it carries risk for the
donor. About 300 living donor transplants are done in the United States
each year. Only a small percentage 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.
Some doctors suggest a limited resection 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 potential risks (bleeding,
infection, 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 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. By suppressing the
immune system, these drugs can 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 rejection. Sometimes liver
biopsies are also taken to see if rejection is occurring and if changes
are needed in the anti-rejection medicines. Future advances are
expected to reduce the risk of liver rejection and the severity of side
effects caused by these drugs.
Last Medical Review: 11/05/2009 Last Revised: 11/05/2009
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