Liver Cancer Treatment Options

The treatment of HCC often requires the expertise of multiple medical professionals. Your care may consist of a multidisciplinary team that includes an oncologist, gastroenterologist, hepatologist, interventional radiologist, radiation oncologist, surgical oncologist, and transplant surgeon.

Surgery and Radio Frequency Ablation (RFA)

• Liver transplant: In this surgery, a donor provides a new or partial liver to replace the diseased liver in another person. This complicated procedure is usually recommended for Very Early Stage patients. A liver transplant can be done when the disease is in the liver only. Sometimes other treatments will be administered before transplantation in order to shrink tumors while the patient waits for a donated liver. It is possible for tumors to recur in the liver or outside the liver.

• Resection: Liver resection, also known as a partial hepatectomy, involves the removal of damaged tissue or entire portions of the liver. The remaining part of the liver continues to function and regrowth is possible. Many patients are not candidates for resection. Similar to liver transplantation, other treatments may be administered before resection to shrink tumors.

Ablation

Ablation destroys cancer cells with minimally invasive, local, and variable techniques. This treatment destroys liver tumors without removing them. Ablation treatments are often used when surgery is not an option and are most beneficial in patients with smaller tumors. Different types of ablation therapy are used for liver cancer.

• Radio Frequency Ablation (RFA) uses image guidance to place a needle through the skin into a liver tumor. High-frequency electrical currents pass through an electrode in the needle, creating a small region of heat that destroys the liver cancer cells.

• Microwave therapy 

• Percutaneous ethanol injection

• Cryoablation

• Electroporation therapy

Embolization*

Embolization is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. The goal is to block the tumor’s supply and thereby stop its growth. Embolization therapy is used for patients who can’t have surgery to remove the tumor or ablation therapy whose tumor has not spread outside the liver.

The main types of embolization therapy are

• Transarterial Embolization without chemotherapy (TAE): A small incision is made in the inner thigh and a catheter is inserted through the incision up into the hepatic artery. A substance that blocks blood flow to the tumor is injected. 

• Transarterial Chemoembolization (TACE): This procedure is similar to TAE, but an anticancer drug is also given. The purpose of the procedure is to trap the anticancer drug near the tumor. TACE can be used to decrease the size of tumors to make surgical options possible. The procedure can be done by attaching the anticancer drug to small beads which are then injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. 

Radiation

• Selective Internal Radiation Therapy (SIRT): This treatment consists of microscopic glass beads filled with radioactive elements. Injected through the hepatic artery, the beads deliver radiation directly to the liver tumors. SIRT is also known as SIR-Spheres®, TheraSphere®, Yttrium 90, Y90, and brachytherapy.

Systemic, Targeted, and Immunotherapies*

Systemic Therapy controls cancer cells and prevents the production of new cancer cells. Systemic therapies may be administered by mouth (e.g., pills) or through the vein. Patients taking such therapies may experience side effects.

• Chemotherapy is the classic form of systemic therapy used to treat cancer. Sometimes, people use the words chemotherapy and systemic therapy interchangeably, which is incorrect. The role of chemotherapy in treating HCC is very limited. Chemotherapy is not an approved form of systemic therapy for HCC except in a few countries.

• Targeted Therapy is a form of systemic therapy that targets or attacks specific cancer cells. Targeted therapies cause less harm to normal cells than chemotherapy or radiation therapy does.

• Immunotherapy works by activating your immune cells against the cancer cells in your body. The FDA has approved some immunotherapies for HCC.

Note: It is not uncommon to combine a targeted therapy with an immunotherapy.

*Indicates a palliative treatment, which is designed to provide relief but not a cure. Sources: American Cancer Society, Cancer Research Institute, National Cancer Institute, and Food and Drug Administration © March 2022