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Although the AJCC (TNM) staging system (see Liver Cancer Stages) is often used to describe the spread of a liver cancer, doctors use a more practical system to determine treatment options. Liver cancers are often categorized as:
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. Important factors that may influence the outcome are 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. How well your liver is working 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. More research is needed to know the value (if any) of adding other treatments to surgery.
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. A 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 under control.
Unresectable cancers include cancers that haven’t yet spread to lymph nodes or distant parts of the body, but that can’t be removed safely by partial hepatectomy. This might be because:
Treatment options might include ablation, embolization, or both for the liver tumor(s). Other options may include targeted therapy, immunotherapy, chemotherapy (either systemic or by hepatic artery infusion), and/or radiation therapy. For some of these cancers, treatment may shrink the tumor(s) enough so that surgery (partial hepatectomy or transplant) may become possible.
These treatments are very unlikely to cure the cancer, but they can reduce symptoms and may even help a person live longer. Because these cancers can be hard to treat, clinical trials of newer treatments may offer a good option in many cases.
Advanced liver cancer has spread either to the lymph nodes or to other organs. Because these cancers are widespread, they cannot be removed with surgery.
For people whose liver is functioning well enough (Child-Pugh class A or B), initial treatment options might include:
If these drugs are no longer working, other targeted drugs, such as regorafenib (Stivarga), cabozantinib (Cabometyx), or ramucirumab (Cyramza) are possible options. Immunotherapy drugs such as pembrolizumab (Keytruda), or nivolumab (Opdivo) combined with ipilimumab (Yervoy), might also be helpful.
As with unresectable liver cancer that has not spread, clinical trials of newer targeted therapies, immunotherapy, new approaches to chemotherapy (new drugs and ways to deliver chemotherapy), new forms of radiation therapy, and other new treatments may be helpful. 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.
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.
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.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Abou-Alfa GK, Jarnigan W, Dika IE, D’Angelica M, Lowery M, Brown K, et al. Ch. 77 - Liver and Bile Duct Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020:1314–1341.
Fong Y, Dupey DE, Feng M, Abou-Alfa G. Ch. 57 - Cancer of the Liver. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019:844-864.
National Cancer Institute. Physician Data Query (PDQ). Adult Primary Liver Cancer Treatment. Accessed at https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq on March 13, 2019.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. V.3.2020. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf on June 10, 2020.
Last Revised: July 27, 2021