Although the AJCC (TNM) staging system is often used to precisely describe the spread of a liver cancer, doctors use a more practical system to determine treatment options. Liver cancers are divided into 3 categories: localized resectable, localized unresectable, and advanced.

Localized resectable liver cancer (some T1 or T2, N0, M0 tumors)

If your cancer is at an early stage and the rest of your liver is healthy, surgery (partial hepatectomy) may cure you. Unfortunately, only a small number of people with liver cancer fall into this category. An important factor affecting outcome is the size of the tumor and whether it has grown into blood vessels. A large tumor (more than 2 inches across) or one that invades blood vessels is more likely to come back in the liver or spread elsewhere after surgery. The function of the rest of the liver and the person's general health are also important.

Clinical trials are now looking at whether patients getting surgery will be helped by getting other treatments in addition to surgery. One study showed that chemoembolization before surgery helped some patients live longer after surgery. Another study found that patients given interferon after surgery were more likely to be alive one year after surgery. Still, not all studies agree and more studies are needed to know the value (if any) of adding other treatments to surgery.

Localized unresectable liver cancer (some T1 to T4, N0, M0 tumors)

Localized, unresectable cancers include tumors that haven't spread but are too large to be removed safely. This also includes cancers that are in certain areas that make it hard to remove them, cancers with 2 or more tumors, or cancers in patients with unhealthy livers. Treating these patients with a partial hepatectomy is often not a good option. These patients may instead be treated with a liver transplant if it is possible. This is a major operation where the liver is removed and replaced with one from a donor. Although this is a very difficult operation, it has helped many people. Transplant can cure the cancer and any underlying liver disease. The 5-year survival rate for patients who had a liver transplant for liver cancer is about 60%.

If you are not a candidate for a transplant, your doctor may recommend ablation of the tumor(s) using one of the methods discussed earlier. Other options may include embolization (with or without chemotherapy or radiation), targeted therapy with sorafenib, chemotherapy (either systemic or via hepatic artery infusion), and/or conformal radiation therapy.

Although it is very unlikely that treatment other than transplantation will cure the cancer, it can reduce symptoms and may prolong life. Because these treatments are not known to be curative, a clinical trial is still a good choice.

Advanced liver cancer (includes all N1 or M1 tumors)

Advanced cancer has spread throughout the liver or outside of the liver (either to the lymph nodes or to other organs). Because these cancers are widespread, they are not treatable by surgery.

If your liver is functioning well enough (Child-Pugh class A or B), the targeted therapy sorafenib may help control the growth of the cancer for a time and may help you live longer.

As with localized resectable liver cancer, clinical trials of targeted therapies, new approaches to chemotherapy (new drugs and regional chemotherapy), new forms of radiation therapy (with radiosensitizers or targeting via antibodies), and other new treatments (immunotherapy and gene therapy) may help you. These clinical trials are also important for improving the outlook for future patients.

Treatments such as radiation or chemotherapy may be used to help relieve pain and other symptoms. Please be sure to discuss any symptoms you have with your cancer team, so they may treat them effectively.

Recurrent liver cancer

Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment of liver cancer that returns after initial therapy depends on many factors, including the site of the recurrence, the type of initial treatment, and how well the liver is functioning. Patients with localized resectable disease that recurs in the same spot may be eligible for further surgery or local treatments like ablation or embolization. If the cancer is widespread, targeted therapy (sorafenib) or chemotherapy may be options. Patients may also wish to ask their doctor whether a clinical trial may be right for them.

Treatment may also be offered to relieve pain and other symptoms. Please be sure to discuss any symptoms you have with your cancer care team, so they may be treated effectively.

Last Medical Review: 11/05/2009
Last Revised: 11/05/2009