The liver cancer treatment options depends on many factors including but not limited to the type of liver cancer, stage of the disease, liver function, performance status of the patient, along with other factors.
Following are the treatment options for hepatocellular carcinoma of the liver, but the final decision is taken by the oncologist on an individual patient basis.
|Potentially resectable or transplantable||In patients with potentially resectable liver cancer and adequate liver function, Surgery (partial hepatectomy) is considered the preferred treatment approach. For patients who are the candidates for liver transplantation, treatments like ablation or embolization may be employed until as a bridge for transplantation.|
|Unresectable||In patients with some advanced stage cancer that are considered unresectable due to invasion into blood vessels or large tumor size, treatments like ablation and/or embolization are generally preferred, depending on the location and the extent of invasion. Targeted therapy or chemotherapy may also be employed.|
|Inoperable with only local disease||In some cases, the tumor is limited to a part of the liver (which can be removed with surgery) but patients cannot have surgery due to poor liver function or performance status. Thus, treatments like ablation or embolization are usually employed in such cases. Targeted therapy or chemotherapy may also be considered.|
|Advanced (metastatic)||For patients with advanced liver cancer that has spread to distant body parts, targeted therapy or chemotherapy are generally considered.|
Liver Cancer Treatment Options
- Surgery: Surgery provides significantly longer survival and is considered as the treatment of choice for most early-stage liver cancers. Sometimes, surgery is employed to relieve symptoms of advanced stage disease like bleeding and pain. The following types of surgery may be used for the treatment of Liver cancer:
Partial hepatectomy: In this surgery, only the liver tissue containing cancer and some of the nearby tissue is removed leaving the rest of the liver in place. This is generally preferred in case of early-stage disease where the tumor is limited to a part of the liver (not affecting major blood vessels) and when liver function is adequate.
Liver transplant: In this surgical procedure, the entire liver is removed and replaced by a liver donated by some other individual. This is generally 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 invaded nearby major blood vessels, with poor liver function. However, a patient who is a good candidate for transplantation may have to wait until availability of the donated liver, which may take too long. Thus, these patients generally receive other treatment(s) during this time to keep the liver cancer in check.
Ablation: Ablation is a technique in which tumors are destroyed without actual removal from the body. This technique is generally used for patients with small tumors (usually <3 cm) when surgery is not an option due to location of the tumor, poor performance status of the patient, etc.
Ablation can destroy cancer cells along with some of the nearby tissue, and hence, it is not used for the treatment of tumors invading blood vessel or important structures. High-energy radio waves are utilized in radiofrequency ablation (RFA), microwaves are used in microwave ablation (MWA) technique, while very cold gases are used in cryoablation to destroy tumors. Imaging techniques are utilized along with these ablation techniques to accurately locate the target tumors.
- Embolization: in this technique liver cancer is destroyed by blocking the blood supply to the cancer cells with the help of some inert tiny particles (particles are loaded with drugs in chemo-embolization and with a radioactive substance in radio-embolization) that are injected directly in the artery supplying blood to cancer cells. This technique is generally employed in patients who cannot undergo surgery and in those waiting for liver transplantation. Embolization can be employed for large tumors (>5 cm) and can also be used in conjunction with ablation.
- Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is not very effective in treating liver cancer and is not commonly employed for its treatment.
- Palliative Treatment: This may help in improving the overall quality of life by providing relief from the symptoms caused by the liver cancer. However, they do not directly treat liver cancer. They are generally given as supportive care for advanced stage cancer. These include but are not limited to using drugs to reduce pain and other symptoms such as vomiting, external-beam radiation therapy for bleeding or pain, etc.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes the patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of treating liver cancer:
- Prolongation of life
- Reduction of symptoms
- Improvement of overall quality of life
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