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Treatment

If you or a loved one is affected by liver cancer, it is important to know that there may be a team of doctors who will work with you to determine a treatment plan. Physician specialties might include:

• Hepatologist/Gastroenterologist that specializes in liver disease
• Interventional radiologist
• Medical oncologist
• Surgeon (transplant surgeon and/or surgical oncologist)

Treatment choices depend on the type and stage of the cancer, how well the liver is functioning and the overall health of the individual.

• If the cancer has not spread outside the liver, surgery to remove the tumor or a liver transplant may be considered.^2,9
• For more advanced cancers, there are several treatment procedures (see Locoregional Options) that directly damage the liver tumor(s).^2,9
• There is also a recently approved oral treatment (see Systemic Therapy) that slows the progression of the cancer.

Surgery

Surgery is the treatment of choice for primary liver cancer. Removing the part of the liver containing the tumor may result in a cure and long-term survival.²

• Surgical resection (removal): It may be possible to remove the tumor(s) and the surrounding tissues in the liver if the tumor is small and in one lobe.²
  • If the patient has cirrhosis, but still has well-preserved liver function, then resection remains an option.
  • However, many patients are not eligible for resection.²
    
• Liver transplant: In patients with small tumors and advanced cirrhosis the treatment of choice is liver transplantation.²

Locoregional Treatment Options^{2, 9}

If the cancer has not spread, but the patient is not well enough to have surgery, procedures that damage or kill the tumor in the liver can be used.

• Percutaneous ethanol injection (PEI) can be a useful treatment option in those patients who cannot undergo surgery. This technique is performed under ultrasound guidance. It consists of an injection of alcohol or other substances into the liver, which results in destruction of the tumor.
• Radiofrequency ablation (RFA) is the use of high frequency electrical currents to destroy tumor cells. A probe is inserted into or next to a tumor mass and heat from the probe kills the cancer cells in the tumor mass.
• Cryosurgery is the use of subzero temperatures to freeze the tumor. Liquid nitrogen is injected directly into the tumor under ultrasound guidance. The tumor is frozen and thawed twice. The procedure can be performed alone or in conjunction with a liver resection.
• Transarterial chemoembolization (TACE) is a procedure in which the blood supply to the tumor is blocked and anticancer drugs are administered directly into the tumor. It allows a higher concentration of drugs to be in contact with the tumor for a longer period of time.

Systemic Therapy

Systemic therapy refers to treatment that affects the whole body. In recent years, newer targeted therapies have been developed that target certain protein messengers (kinases) that play a part in the growth and spread of cancer cells and tumors. Research has shown that some kinase signaling pathways inside cancer cells cause them to keep dividing in an uncontrolled fashion causing cancer cells to become tumors. Other important kinase signaling pathways within the surrounding tumor create new blood vessels (neoangiogenesis) which bring the tumor oxygen and nutrients. Therefore these are also important targets to stop the progression and spread of cancer.^{21, 22}

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