The best treatment option for primary liver cancer patients depends on many factors including the type and stage of primary liver cancer as well as the patient's general heath and personal values.
Deciding which treatment course to take can be difficult and it is advisable to discuss options with the doctor as well as family and friends. It is important to make a well-informed decision regarding the treatment, and understanding the disease and the treatments available can help the patient weigh the pros and cons of each option to determine what would be best for them.
Treatment options for primary liver cancer
The aim of liver surgery (resection) is to remove the part of the liver that contains cancer. This may involve removing a portion of the liver (partial hepatectomy) or a liver transplant – where the whole liver is replaced by a donor liver.
Surgery is the best option for treating primary liver cancer, as the remaining part of the liver can repair itself (as long as it is undamaged) and grow back to its normal size within a few months.
However, surgery is only suitable for a small number of people with primary liver cancer and depends on the size, number and position of the tumours. People with early cirrhosis may be suitable for liver surgery as long as their liver is still working well, however those with more advanced cirrhosis are likely not healthy enough for surgery to be successful.
Chemotherapy drugs are used to kill, shrink or slow the growth of the tumours. The course will be given over several weeks or months and may be given systemically (throughout the whole body) into a vein (intravenously) via a drip, or orally via tablets. Alternatively, high levels of chemotherapy drugs can also be given directly into a tumour through Transarterial chemoembolisation (TACE).
Chemotherapy may be given following another treatment to remove any remaining cancer cells (adjuvant chemotherapy) or used as palliative treatment in order to slow down cancer growth and control symptoms including pain.
Tumour ablation destroys small tumours (<3cm) without removing them. The method of tumour ablation depends on the size, shape and location of the tumour and may involve using heat via radio waves or microwaves (thermal ablation), injecting pure alcohol into the tumour (alcohol injection) or freezing the cancer cells (cryotherapy).
Radiotherapy uses x-rays, gamma cells, electron beams or protons to kill cancer cells or prevent them from multiplying. Radiotherapy is usually given daily for several weeks, and is commonly used to treat bile duct cancer.
SIRT (also known as radioembolisation) uses high doses of radiotherapy in tiny radioactive beads to target liver tumours directly. It's often used when there are many small tumours throughout the liver that cannot be removed by surgery, most likely for hepatocellular carcinoma (HCC) and bile duct cancer.
Liver cancers can obstruct bile ducts, particularly if this is where the cancer initiated. The obstruction of bile ducts causes a build up of bile in the liver, leading to jaundice symptoms. An endoscopic stent is a thin tube that can be placed into the liver to drain the bile and ease symptoms.
Recommended treatment options for primary liver cancer
For HCC the most common treatments include surgery, tumour ablation (thermal ablation) or delivering chemotherapy directly into the tumour (TACE). The choice of treatment depends on the staging of HCC:
Stage 0 (very early) – Surgery
Stage A (early) – Surgery, tumour ablation, liver transplant or TACE
Stage B (intermediate) – TACE
Stage C (advanced) – Targeted therapies or palliative treatment
Stage D (end-stage) – Palliative treatment
Cholangiocarcinoma (bile duct cancer) is usually treated with surgery, chemotherapy, radiotherapy and stenting, whereas angiosarcoma is usually treated with surgery and TACE.
Clinical trials
Your healthcare professional may offer you the opportunity to take part in a clinical trial. Clinical trials test new or modified treatments to determine whether they are better than current methods, and have improved treatments and led to better outcomes for cancer patients. For patients with secondary liver cancer in particular, clinical trial participation could allow access to modified new therapies.
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