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.

After liver cancer is found and staged, your doctor will recommend one or more treatment options. Choosing a treatment plan is a major decision, so it is important to take time and think about all of your choices.

Getting a Second Opinion

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.

Tumor Size and Cirrhosis

Treatment of liver cancer depends on the size of the tumor and whether there is cirrhosis. People without cirrhosis can do well if the tumor is removed or with treatments that destroy the tumor without surgery (such as injecting them with alcohol or heating them to high temperatures in a procedure called radiofrequency ablation). If there is cirrhosis, or a very large tumor, most experts recommend liver transplantation as the main treatment.

Surgery

At this time surgery offers the only likely chance to cure liver cancer. Surgery is done to either 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. 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.

Liver Transplant

A liver transplant is an option for people with small liver cancers, but this is not done very often. 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 that 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 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.

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.

Medical advances will probably reduce the risk of rejection and the harshness of side effects. At the same time, more people are learning about the importance of organ donation.

Tumor Ablation and Embolization

Ablation (ab-lay-shun) refers to a local treatment that destroy 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 (em-buh-luh-ZAY-shun) 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. This will get small amounts of radiation only 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 and Treatment?"

Radiation Therapy

Radiation therapy is treatment that uses high-energy rays (such as x-rays) to kill or shrink cancer cells. 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 also killed. This type of radiation may be used to shrink a liver tumor or to give relief from symptoms such as pain, but it does not cure the liver cancer and usually does not help people to live longer.

A newer type of radiation treatment uses computers to map the exact location of a tumor. This lowers the damage to normal tissue and allows higher doses to be used. This treatment is not available at all hospitals.

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 most drug that has worked the best is doxorubicin (Adriamycin®). But most studies have not shown that chemo helps liver cancer patients to live longer.

Chemo can have side effects such as the following:

• nausea and vomiting 
• loss of appetite 
• hair loss 
• mouth sores 
• a higher chance of infection (from a shortage of white blood cells) 
• bleeding or bruising after small cuts or injuries (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 by surgery. Less than 30% of patients having surgery are able to have their cancer completely removed.

Survival rates

The 5-year relative survival rate is the percentage of patients who are still alive at least 5 years after the cancer is found. Keep this is mind:

• Some people will live longer than 5 years. 
• Some people will die from other diseases. 
• Some people will be cancer free during those 5 years. 
• Some people will have the cancer come back during those 5 years.

The overall 5-year relative survival rate from liver cancer is less than 10%. One reason for this low survival rate is that most patients with liver cancer also have cirrhosis of the liver, which itself can be fatal.

Each Situation Is Different

While numbers provide an overall picture, keep in mind that every person’s situation is unique and the 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.