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