Liver cancer: treatment
Cancer of the liver is a serious cancer. A cancer or tumour of the liver can either start in the liver (called a primary tumour or cancer) or be caused by cancer cells from other parts of the body that have travelled through the bloodstream or lymphatic system and lodged in the liver and started a new tumour (called a secondary tumour or metastasis).
Treatment of either form of liver cancer depends on the type of tumour, the stage it has reached, the general health of the person and their liver, and if there is cancer present in any other part of the body.
Treating primary liver cancer
Primary liver cancer is a relatively rare form of cancer. People with hepatitis B or hepatitis C infection or cirrhosis of the liver are more likely to get primary liver cancer than other people.
The first objective of the doctor treating a primary liver tumour is to ‘stage’ it. This is when the doctor finds out the extent of the cancer: is it just in the liver or has it spread to other parts of the body?
Doctors often use the TNM (tumour, node, metastasis) staging system to stage tumours from I (1) to IV (4), depending on:
- the size of the tumour;
- the degree to which it has invaded nearby blood vessels, lymph nodes and other structures; and
- whether or not the cancer has spread to other areas of the body – ‘distant metastases’.
Higher numbers indicate cancers that are more advanced. For example, a small tumour with no invasion of blood vessels, no spread to the lymph nodes and no distant spread would be stage I; a tumour that has spread to other parts of the body is stage IV.
Treatment of primary liver tumours is usually by one or more of a combination of medical techniques, including the following.
- Surgery. This may consist of cutting out the cancerous part of the liver or full transplantation of another liver to replace the diseased one. Liver transplantation is a difficult procedure and not all people with liver cancer will be suitable for it.
- Cryosurgery or cryotherapy kills the cancer cells by freezing them.
- Chemotherapy uses drugs to kill cancer cells. The medications are usually injected into a vein or artery using a needle. The drugs are taken in the bloodstream to the liver, but can also kill cancer cells in other parts of the body. Sometimes the drugs are put directly into a blood vessel that supplies the liver tumour. Chemotherapy is often used after surgery to kill off any remaining cancer cells in the body.
- Chemembolisation. This medical technique involves blocking the main artery supplying the liver and then inserting the chemotherapy medications between the blockage and the liver. The blood supply then delivers the medications to the liver.
- Radiotherapy uses X-rays or radiolabelled substances to kill the cancer cells. Sometimes the radiation is put into the body with thin plastic tubes to direct it to the exact location of the tumour. The tumour cells can also be targeted by radiation taken directly to them by so-called radiolabelled substances. These radiolabelled substances seek out the liver cells specifically and so deliver the radiation directly to them.
- Ethanol (absolute alcohol) injection directly into the tumour is reportedly quite successful with small tumours.
- Radiofrequency ablation. An electric current of a certain frequency is used to heat and destroy cancer cells. This type of treatment may be used for small, unresectable tumours.
- Targeted treatment. A new medication – sorafenib (brand name Nexavar) has been developed for the treatment of advanced liver cancer. This medication works by interfering with the tumour’s ability to generate new blood vessels.
Treatment of secondary liver cancer
In the case of secondary liver cancer that has spread from other areas, such the colon, surgical removal is sometimes possible if there is only one area of metastasis. However, if there are multiple metastases (secondary tumours) in the liver, surgery may not be effective. In cases of multiple tumour sites in the liver, treatment may include chemotherapy, cryosurgery, radiofrequency ablation or alcohol injections.
Your doctor is the best person to advise you about management options for your particular tumour.
2. Alam N, Chen W, Baker D, Bishop JF. Liver cancer in NSW. Sydney: Cancer Institute NSW, February 2009.
3. MayoClinic.com. Liver cancer [updated 2008, Jan 9; accessed 2009, Apr 6]. Available from: http://www.mayoclinic.com/health/liver-cancer/DS00399/