Gastrointestinal (GI) Oncology Program

Liver Cancer

Stages and Treatments

If a patient has adult primary liver cancer, more tests will be done to find out if cancer cells have spread to other parts of the body. This process is called staging. A doctor needs to know the stage of the disease in order to plan treatment.

The following stages and treatments are used for adult primary liver cancer:

Localized resectable: Cancer is found in one place in the liver and can be totally removed in an operation. Treatment is usually surgery (resection). Liver transplantation may be done in certain patients. Clinical trials are testing adjuvant systemic or regional chemotherapy following surgery.

Localized unresectable: Cancer is found only in one part of the liver, but the cancer cannot be totally removed. Treatment may be one of the following:

Blocking the hepatic artery and then injecting chemotherapy drugs into the artery and liver (chemoembolization); surgery to freeze and kill the tumor (cryosurgery); injection of ethanol into the tumor; or use of highly focused radio waves designed to destroy the tumor
Liver transplantation
Regional chemotherapy, including injecting the chemotherapy directly into the tumor
Systemic chemotherapy
Surgery with or without chemotherapy, possibly followed by radiation therapy
Injection of alcohol directly into the tumor
Radiation therapy plus special drugs that make the tumor more susceptible to the radiation
Highly focused radio waves designed to destroy the tumor

Advanced: Cancer has spread through much of the liver or to other parts of the body. Treatment depends on what treatment a patient has already received, the part of the body where the cancer has spread, whether the liver has cirrhosis, and other factors. Patients may wish to consider taking part in a clinical trial.

Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the liver or in another part of the body. Treatment depends on what treatment a patient has already received, the part of the body where the cancer has come back, whether the liver has cirrhosis, and other factors. Patients may wish to consider taking part in a clinical trial.

About the Treatments and Side Effects

There are three primary treatment options for patients with adult primary liver cancer:

surgery
radiation therapy
chemotherapy

Hyperthermia (warming the body to kill cancer cells) and biological therapy (using the body's immune system to fight cancer) are being tested in clinical trials.

Surgery

Surgery may be used to take out the cancer or to replace the liver. Removing the tumor is the only way to cure the cancer.

A resection of the liver is the removal of the part of the liver where the cancer is found.
A liver transplant is the removal of the entire liver and replacement with a healthy liver donated from someone else. Very few patients with liver cancer are eligible for this procedure.
Cryosurgery is a type of surgery that kills cancer by freezing it.

Side effects of surgery: The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

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Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. It is sometimes used to treat liver cancer, although it has not had a measurable effect on survival rates. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy). Drugs may be given with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization).

Radiation may also be given by attaching radioactive substances to antibodies (radiolabeled antibodies) that search out certain cells in the liver. Antibodies are made by the body to fight germs and other harmful things; each antibody fights specific cells.

Side effects of radiation therapy: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

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Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.

In a special type of chemotherapy called regional chemotherapy, a small pump containing drugs is placed in the body. The pump puts drugs directly into the blood vessels that go to the tumor, so that high doses of the drugs reach the cancer. This method may help to shrink a tumor in the liver. However, in general, chemotherapy has not proved effective in curing liver cancer.

If a doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy that is given after surgery to remove the cancer is called adjuvant chemotherapy.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

Chemoembolization

Chemoembolization of the hepatic artery involves blocking the hepatic artery (the major artery that supplies blood to the liver) and then injecting chemotherapy drugs between the blockage and the liver, using the liver's arteries to deliver the chemotherapy throughout the liver.

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Hyperthermia

Hyperthermia therapy is the use of a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the tumor shrinks.

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Biological Therapy

Biological therapy uses the body's immune system to fight cancer. Materials made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

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This page was last updated on: March 3, 2008.

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