Liver cancer - Treatment 

Treating liver cancer 

Cancer treatment: what happens during chemotherapy?

Chemotherapy is a treatment for cancer. A consultant medical oncologist explains the chemotherapy process and patients talk about their own experiences of the treatment.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Multidisciplinary teams (MDTs)

If you are diagnosed with liver cancer, you will be assigned a team of specialist healthcare professionals who will be responsible for your care. This team may include:

  • a surgeon
  • a clinical oncologist (a specialist in the non-surgical treatment of cancer)
  • a pathologist (a specialist in diseased tissue)
  • a hepatologist (a specialist in treating liver conditions)
  • a radiologist (a doctor who specialises in analysing the results of imaging tests, such as X-rays and ultrasound scans)
  • a dietitian
  • a social worker
  • a psychologist
  • a specialist cancer nurse, who will usually be the first point of contact between you and the rest of the team

Clinical trials

As the current methods of curing liver cancer are limited, you may want, or be asked, to take part in a clinical trial. Clinical trials are studies that use new and experimental techniques to see how well they work in treating or curing cancer.

However, if you agree to take part in a clinical trial, be aware there is no guarantee the technique being studied will be any more effective than standard treatments for liver cancer.

See our information about clinical trials for liver cancer.

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

Cancer treatment teams

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

Deciding what 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 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, which 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 symptoms of pain and discomfort you may have.

Each treatment option is 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 estimating the severity of the cirrhosis.

If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you will be asleep during the procedure andnot feel any pain.

Most people are well enough to leave hospital six to 12 days after surgery. However, depending on how much of your liver was removed, it may take up to three or four months for you to fully recover.

Liver resection is a complicated surgery and can have a considerable impact on your body. There is a one in four chance of complications 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 
  • liver failure

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

One type of liver resection surgery, which involves the temporary removal of the liver (ex-vivo hepatic resection), is a possible treatment for liver cancer.

However, the National Institute for Health and Clinical Excellence (NICE) has recently released guidance about this procedure which raises concerns about how safe and effective this treatment is.

Your doctor should discuss the benefits and dangers of this surgery before any decision is made.

Liver transplant

If you only have a single tumour less than 5cm (50mm) in diameter, you may be suitable for a liver transplant. However, if you have multiple tumours, or a tumour larger than 5cm, the risk of the cancer returning is usually so high a liver transplant will be of no benefit.

Some people who have three or fewer small tumours, each less than 3cm (30mm) in diameter may be offered a transplant. Occasionally, if a person has a tumour that responds exceptionally well to treatment, with no evidence of tumour growth for a six-month period, they may also be offered a transplant.

There can be a long time until a suitable liver becomes available, so you may be put on a waiting list.

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. 

However, there are also disadvantages, such as higher complication rates. Research has also found results of live donor liver transplants tend not to be as good as transplants using a liver from someone who has died.

Read more about liver transplants.

Radiofrequency ablation

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 (two inches) in diameter. RFA can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.

RFA usually involves heating the tumours with an electric current produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink. Similar procedures using microwaves, lasers or freezing can also be performed to achieve the same result.

There are three main ways RFA can be carried out:

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

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

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 that needs to be treated.

How long it takes for perform RFA depends on the size and number of tumours that need to be 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 RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.

Chemotherapy

Chemotherapy involves using a combination of 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. This is a palliative treatment that can prolong your life but is not curative. TACE is not recommended for Stage D liver cancer because it can make the symptoms of liver disease worse.

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

TACE uses a combination of two techniques:

  • chemotherapy medications are injected directly into your liver
  • gel or small plastic beads are injected into the blood vessels supplying the tumours with blood; this should help slow down the speed at which the tumours grow

TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home. Your response to the treatment will be assessed a month or so after the procedure, usually by having a CT scan. If you remain well, further TACE treatment may be requested for you.

People who have TACE often receive three to four sessions, with a period of about one month in between each session.

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 ‘traditional chemotherapy’, such as hair loss and fatigue.

However, the procedure is not free of side effects and complications. The most common being post-chemoembolisation syndrome, which occurs in around one in three cases.

Post-chemoembolisation syndrome can cause the following symptoms:

  • abdominal (tummy) pain
  • high temperature (fever) of 38ºC (100.4ºF) or above
  • nausea (feeling sick)
  • vomiting
  • loss of appetite

These symptoms may last for one to two weeks after having a session of TACE.

Less common complications of TACE include:

  • worsening of liver function, which is usually temporary
  • swelling of the abdomen due to a build-up of fluid – this occurs in around 1 in 20 cases
  • liver abscess
  • damage to the biliary tract or gall bladder

Alcohol injections

If you only have a few small tumours, alcohol injections may be used as a treatment. This involves using a needle that 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 tablet sometimes used to treat liver cancer. Whether or not you are eligible for sorafenib will be decided by your medical team and will depend on whether it is likely to do you more good than harm.

In cases of advanced liver cancer, NICE does not recommend the use of sorafenib because the cost is high for the limited benefit it brings.

Common side effects include:

  • diarrhoea
  • nausea (feeling sick)
  • vomiting
  • hair loss
  • itchy skin
  • pain, such as headaches, abdominal (tummy) pain or bone pain

Advanced liver cancer

Treatment for advanced liver cancer focuses on relieving the symptoms of 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. These will be given to you if they are needed. 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.

Read more about end of life care.

 

Page last reviewed: 20/09/2012

Next review due: 20/09/2014

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