Treatment of Liver Cancer, by Stage
Although the AJCC (TNM) staging system (see Liver Cancer Stages) is often used to describe the spread of a liver cancer precisely, doctors use a more practical system to determine treatment options. Liver cancers are categorized as: potentially resectable or transplantable, unresectable, inoperable with only local disease, and advanced.
Potentially resectable or transplantable liver cancers (stage I and some stage II tumors)
Potentially resectable: If your cancer is early stage and the rest of your liver is healthy, surgery (partial hepatectomy) may cure you. Only a small number of people with liver cancer are in this category. An important factor affecting outcome is the size of the tumor(s) and if nearby blood vessels are affected. Larger tumors or those that invade blood vessels are more likely to come back in the liver or spread elsewhere after surgery. The function of the rest of the liver and your general health are also important. For some people with early-stage liver cancer, a liver transplant could be another option.
Clinical trials are now looking at whether patients who have a partial hepatectomy will be helped by getting other treatments in addition to surgery. Some studies have found that using chemoembolization or other treatments along with surgery may help some patients live longer. Still, not all studies have found this, and more research is needed to know the value (if any) of adding other treatments to surgery.
Potentially transplantable: If your cancer is at an early stage, but the rest of your liver isn’t healthy, you may be able to be treated with a liver transplant. Liver transplant may also be an option if the tumor is in a part of the liver that makes it hard to remove (such as very close to a large blood vessel). Candidates for liver transplant might have to wait a long time for a liver to become available. While they are waiting, they are often given other treatments, such as ablation or embolization, to keep the cancer in check.
Unresectable liver cancers (some T1 to T4, N0, M0 tumors)
Unresectable cancers include cancers that haven’t yet spread to lymph nodes or distant sites, but can’t be removed safely by partial hepatectomy. This might be because:
- The tumor is too large to be removed safely
- The tumor is in a part of the liver that makes it hard to remove (such as very close to a large blood vessel)
- There are several tumors or the cancer has spread throughout the liver
Treatment options include ablation, embolization, or both for the liver tumor(s). Other options may include targeted therapy, chemotherapy (either systemic or by hepatic artery infusion), and/or radiation therapy. In some cases, treatment may shrink the tumor(s) enough so that surgery (partial hepatectomy or transplant) may become possible.
These treatments won’t cure the cancer, but they can reduce symptoms and may even help you live longer. Because these cancers can be hard to treat, clinical trials of newer treatments may offer a good option in many cases.
Inoperable liver cancers with only local disease
These cancers are small enough and in the right place to be removed but the patient isn’t healthy enough for surgery. Treatment options include ablation, embolization, or both for the liver tumor(s). Other options may include targeted therapy, chemotherapy (either systemic or by hepatic artery infusion), and/or radiation therapy.
Advanced (metastatic) liver cancers (includes all N1 or M1 tumors)
Advanced liver cancer has spread either to the lymph nodes or to other organs. Because these cancers are widespread, they cannot be treated with surgery.
If your liver is functioning well enough (Child-Pugh class A or B), the targeted therapy drug sorafenib (Nexavar) may help control the growth of the cancer for a time and may help you live longer. If this drug is no longer working, the targeted drug regorafenib (Stivarga) might be helpful.
As with localized unresectable liver cancer, clinical trials of targeted therapies, new approaches to chemotherapy (new drugs and ways to deliver chemotherapy), new forms of radiation therapy, and other new treatments may help you. These clinical trials are also important for improving the outcome for future patients.
Treatments such as radiation might also be used to help relieve pain and other symptoms. Please be sure to discuss any symptoms you have with your cancer team, so they can treat them effectively.
Recurrent liver cancer
Cancer that comes back after treatment is called recurrent. 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 where it comes back, the type of initial treatment, and how well the liver is functioning. Patients with localized resectable disease that recurs in the liver might be eligible for further surgery or local treatments like ablation or embolization. If the cancer is widespread, targeted therapy or chemotherapy drugs may be options. Patients may also wish to ask their doctor whether a clinical trial may be right for them.
Treatment can also be given to relieve pain and other side effects. Please be sure to discuss any symptoms you have with your cancer care team, so they may be treated effectively.
Last Medical Review: March 31, 2016 Last Revised: April 27, 2017