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The best option to cure liver cancer is with either surgical resection (removal of the tumor with surgery) or a liver transplant. If all cancer in the liver is completely removed, you will have the best outlook. Small liver cancers may also be cured with other types of treatment such as ablation or radiation.
Partial hepatectomy is surgery to remove part of the liver. Only people with good liver function who are healthy enough for surgery and who have a single tumor that has not grown into blood vessels can have this operation.
Imaging tests, such as CT or MRI with angiography are done first to see if the cancer can be removed completely. Still, sometimes during surgery the cancer is found to be too large or has spread too far to be removed, and the surgery that has been planned cannot be done.
Most patients with liver cancer in the United States also have cirrhosis. In someone with severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform important functions.
People with cirrhosis are typically eligible for surgery if there is only one tumor (that has not grown into blood vessels) and they will still have a reasonable amount (at least 30%) of liver function left once the tumor is removed. Doctors often assess this function by assigning a Child-Pugh score (see Liver Cancer Stages), which is a measure of cirrhosis based on certain lab tests and symptoms.
Patients in Child-Pugh class A are most likely to have enough liver function to have surgery. Patients in class B are less likely to be able to have surgery. Surgery is not typically an option for patients in class C.
Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have other liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, but also leave enough behind for the liver to function.
When it is available, a liver transplant may be the best option for some people with liver cancer. Liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver has too much disease for the patient to tolerate removing part of it. In general, a transplant is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not grown into nearby blood vessels. It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely). With a transplant, not only is the risk of a second new liver cancer greatly reduced, but the new liver will function normally.
According to the Organ Procurement and Transplantation Network, about 1,000 liver transplants were done in people with liver cancer in the United States in 2016, the last year for which numbers are available. Unfortunately, the opportunities for liver transplants are limited. Only about 8,400 livers are available for transplant each year, and most of these are used for patients with diseases other than liver cancer. Increasing 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.
Most livers used for transplants come from people who have just died. But some patients receive part of a liver from a living donor (usually a close relative) for transplant. The liver can regenerate some of its lost function over time if part of it is removed. Still, the surgery does carry some risks for the donor. About 370 living donor liver transplants are done in the United States each year. Only a small number 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. In many cases a person may get other treatments, such as embolization or ablation, while waiting for a liver transplant. Or doctors may suggest surgery or other treatments first and then a transplant if the cancer comes back.
Like partial hepatectomy, a liver transplant is a major operation with serious risks and should only be done by skilled and experienced surgeons. Possible risks include:
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.
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.
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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 February 28, 2019.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf on February 28, 2019.
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Last Revised: April 1, 2019