Liver cancer - Treating liver cancer

The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication.

Cancer treatment teams

Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Your treatment plan

Your recommended treatment plan will depend on the stage your liver cancer is at (see diagnosing liver cancer for more information about staging).

If your cancer is at stage A when diagnosed, a complete cure may be possible. The three main ways this can be achieved are:

removing the affected section of liver – known as a resection
having a liver transplant – an operation to remove the liver and replace it with a healthy one
using heat to kill cancerous cells – known as microwave or radiofrequency ablation (RFA)

If your cancer is at stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There is also a medication called sorafenib that can help prolong life.

If your cancer is at stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.

The main treatment options for liver cancer are discussed in more detail below.

Surgical resection

If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.

As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their liver's regenerative ability may be significantly impaired and resection may be unsafe.

Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver).

If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you will be asleep during the procedure and won't feel any pain as it is carried out.

Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover.

Risks

Liver resection is a complicated surgery and can have a considerable impact on your body. There is a significant risk of complications occurring during and after surgery.

Possible complications of liver resection include:

infection at the site of the surgery
bleeding after the surgery
blood clots that develop in your legs – the medical term for this is deep vein thrombosis (DVT)
bile leaking from the liver – further surgery may be required to stop the leak
jaundice (yellowing of the skin and whites of the eyes)
liver failure (where your liver is no longer able to function properly)

Liver resection can also sometimes cause fatal complications, such as a heart attack. It is estimated that around 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.

Liver transplant

A liver transplant involves removing a cancerous liver and replacing it with a healthy one from a donor.

This is a major operation and there is a risk of potentially life-threatening complications. It's estimated around 1 in every 30 people will die during the procedure and up to 1 in 10 people will die at some point in the year after surgery.

A liver transplant may be suitable for you if:

you only have a single tumour less than 5cm (50mm) in diameter
you have three or fewer small tumours, each less than 3cm (30mm)
you have responded exceptionally well to other treatments, with no evidence of tumour growth for six months

If you have multiple tumours or a tumour larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit.

If you are suitable for a liver transplant, you will normally need to be placed on a waiting list until a donor liver becomes available. The average waiting time for a liver transplant is 142 days for adults.

In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.

The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long.

Microwave or radiofrequency ablation

Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm (50mm) in diameter.

They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.

These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink.

Similar procedures using lasers or freezing can also achieve the same result.

There are three main ways microwave ablation or RFA can be carried out:

where the needles are passed through the skin (percutaneously)
where the needles are inserted through small incisions in your abdomen – "keyhole" surgery (laparoscopy)
where the needles are inserted through a single large incision made in your abdomen – "open" surgery

Continuous ultrasound or computerised tomography (CT) scans are used to make sure the needles are guided into the correct position.

Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic (where you are awake but the area being treated is numbed), depending on the technique used and the size of the area being treated.

How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between one and three hours in total. Most people need to stay overnight in hospital.

You may experience some minor discomfort and flu-like symptoms, such as chills and muscle pains, for a few days after the procedure.

The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.

Chemotherapy

Chemotherapy uses powerful cancer-killing medications to slow the spread of liver cancer.

A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. In these cases, the treatment can prolong life, but cannot cure the cancer.

TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.

It is not recommended for stage D liver cancer because it can make the symptoms of liver disease worse.

TACE procedure

During TACE a fine tube called a catheter is inserted into the main blood vessel in your groin (femoral artery) and passed along the artery to the main blood vessel that carries blood to the liver (hepatic artery).

Chemotherapy medication is injected directly into the liver through the catheter and either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down the speed they grow at.

TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home.

This procedure can be completed several times if necessary.

Side effects

Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness.

However, the procedure is not free of side effects and complications. The most common side effect is post-chemoembolisation syndrome, which can cause abdominal (tummy) pain and a high temperature (fever), as well as making you vomit or feel sick.

These symptoms may last for a few weeks after a TACE session.

Alcohol injections

If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment. A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.

In most cases, this is carried out under a local anaesthetic, meaning you will be awake, but the affected area is numbed so you won't feel any pain.

Sorafenib

Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth.

It is sometimes used as a treatment for advanced cases of liver cancer, although it is not routinely available on the NHS because the National Institute for Health and Care Excellence (NICE) has said the cost of the medication is high for the limited benefit it offers.

Whether or not you are eligible for sorafenib will be decided by your medical team, and will depend on the likelihood of whether you will significantly benefit from the medication.

For more information, see the NICE guidelines on sorafenib for the treatment of advanced hepatocellular carcinoma.

Advanced liver cancer

Treatment for advanced liver cancer focuses on relieving symptoms such as pain and discomfort, rather than attempting to slow down the progression of the cancer.

Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.